Fear-Avoidance Beliefs and Chronic Pain.

Fear-avoidance (FA) beliefs are significantly associated with the experience of pain, especially when the pain becomes chronic in nature. The anticipated threat of intense pain will often result in the constant vigilance and monitoring of pain sensations, which, in turn, can cause even low-intensity sensations of pain to become unbearable for the person. Just the anticipation of increased pain or reinjury can further stimulate avoidance behaviors. A vicious cycle may develop, in which fears of increased pain or reinjury contribute to the avoidance of many activities, leading to inactivity and, ultimately, to greater disability. Anyone who assesses and treats pain-related disability should also be prepared to assess and treat pain-related FA.

Improvement in postoperative and nonoperative spinal patients on a self-report measure of disability: the Spinal Function Sort (SFS).

The present study was designed to evaluate the clinical utility of the Spinal Function Sort (SFS), in a group of postoperative and nonoperative low back pain patients who completed a functional restoration program. The SFS was administered to 38 spinal pain patients (16 nonoperative and 21 postoperative), before and after completing a functional restoration program. Results revealed that the SFS detected a significant improvement in Ratings of Perceived Capacity scores, and that the postoperative patients appeared to improve more than nonoperative patients. These findings demonstrate the clinical utility of the SFS as an effective assessment tool of functional capacity in both postoperative and nonoperative spinal disorder patients. It provides a time-efficient method for evaluating a patient's functional status.

Secondary loss and pain-associated disability: theoretical overview and treatment implications.

In the area of occupational pain disability, a major barrier to effective rehabilitation of patients may be the extensive personal losses that can arise as secondary features of chronic pain disability. In this review, we discuss the concept of secondary loss and how it can have a profound impact on patients with occupational pain disability. Such secondary loss issues are extremely important to consider in any rehabilitation program in order to ensure the most comprehensive and compassionate treatment of these patients. We discuss the types of intervention that may be employed within the context of interdisciplinary rehabilitation programs.

A prospective short-term study of chronic low back pain patients utilizing novel objective functional measurement.

The present study utilized recently developed diagnostic tests that permit recognition of functional deficits in spine mobility, trunk strength, endurance, coordination, and dynamic lifting capacity. Changes in these tests were compared to changes in psychological functioning (e.g., self-report of pain) as well as to outcome criteria such as return-to-work and resolution of litigation. The study utilized these tests repeatedly during a new treatment approach to feed back objective information of the patient's functional capacity, not amenable to simple visual inspection, to both the patient and the surgeon. The program itself integrated a low back physical rehabilitation program with a multimodal pain management program and was guided by repeated functional capacity measurements. A total of 66 patients were evaluated. Results demonstrated significant improvement in physical function in these patients, which was also accompanied by changes in self-report of pain complaints. Moreover, an 82% return-to-work rate was achieved in this sample which was initially 92% unemployed. These results indicate that the physician dealing with chronic low back dysfunction can employ objective measures of functional capacity as an alternative to the sole reliance on pain patient self-report or structured tests, such as radiographic imaging, which merely document a universal, progressive degenerative process.