Do Fear of Movement and Negative Cognitions After Trauma Lead to Activity Avoidance, Depression, and Chronic Posttraumatic Pain Development? Testing the Fear-Avoidance Model Using a Large Prospective Cohort
Lane S, Bollen KA, Mintz A, Kurz M, Hendry P, Pearson C, Velilla MA, Lewandowski C, Datner E, Domeier R, and McLean S. Do fear of movement and negative cognitions after trauma lead to activity avoidance, depression, and chronic posttraumatic pain development? Testing the fear-avoidance model using a large prospective cohort. Biol Psychiatry 2018; 83(9):S244.
Background: The most common model of chronic pain (CP) development posits that fear of movement and negative cognitions in the acute aftermath of injury lead to activity avoidance and depression, which in turn cause CP. However, this Fear-Avoidance Model (FAM) has rarely been tested empirically.
Methods: Participants enrolled after presenting to the emergency department (ED) following a motor vehicle collision (MVC). ED evaluation included assessment of pain (0-10 NRS), pain catastrophizing (PCS), and fear of movement (TSK, FABQ). Six-week assessment included depressive symptoms (CESD) and six-month assessment evaluated CP outcomes. Structural equation models (SEM) was used to determine whether FAM provided a good fit to the data and to evaluate hypothesized FAM relationships.
Results: Acute severe pain was common (mean 7.4 (SD = 2.2)) among participants (n=927, 62% female). Acute pain, pain catastrophizing, pain interference, and depressive symptoms were all included in the FAM SEM, but only acute pain (b= .308, <.001) and pain interference with normal work (b= .413, p<.004) contributed significantly to the prediction of CP. Negative cognitions (pain catastrophizing) in the aftermath of an MVC and depressive symptoms six weeks after an MVC did not predict chronic pain severity.
Conclusions: The FAM provided a poor fit to the data, and many relationships proposed in the FAM were not supported. Further studies are needed to better understand relationships between acute pain, negative cognitions, depressive symptoms, and the development of CP after common traumatic events such as MVC.