Avoidance and confrontation of painful, back-straining movements in chronic back pain patients.

Avoidance of painful activities has been proposed to be an important risk factor for the initiation and maintenance of chronic low back suffering, whereas exposure to these activities has been suggested to be beneficial for recovery. In a cross-sectional study, the differences between chronic patients with avoidant and confrontational styles were investigated using self-report measures and a behavioral test. Participants were first classified as avoiders or confronters. In comparison with confronters, avoiders reported greater frequency and duration of pain, higher fear of pain and injury, more disability in daily living, and more attention to back sensations. Finally, avoiders reported more fear of (re)injury during the behavioral test and had a worse performance than confronters. The results suggest a close link between the fear of pain/(re)injury on one hand and avoidance behavior and physical deconditioning on the other hand.