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A Comparison of Fear-Avoidance Beliefs in Patients With Lumbar Spine Pain and Cervical Spine Pain

George, Steven Z., MS, PT*; Fritz, Julie M., PhD, PT, ATC*; Erhard, Richard E., DC, PT

Health Services Research
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SDC

Study Design.  A prospective consecutive cohort study of patients with cervical spine pain and patients with lumbar spine pain referred to an academic medical center.

Objectives. To investigate the presence of fear-avoidance beliefs in a sample of patients with cervical spine pain and to compare the association of pain intensity, disability, and fear-avoidance beliefs in patients with cervical spine pain with that in patients with lumbar spine pain.

Summary of Background Data.  Fear-avoidance beliefs are a specific psychosocial variable involved in the development of disability from low back pain. Psychosocial variables are believed to play a role in cervical disability, but specific variables have not been investigated.

Methods. Consecutive patients referred to a multidisciplinary center completed self-reports of disability, pain intensity, and fear-avoidance beliefs during an initial evaluation session. Gender, type of symptom onset, acuity, and payer source were also recorded. Associations between disability, pain intensity, and fear-avoidance beliefs were investigated in patients with cervical spine pain and patients with lumbar spine pain.

Results. In all, 163 patients completed the self-reports and were included in this study. Weaker relations between fear-avoidance beliefs and disability were found in patients with cervical pain than in those with lumbar pain. Significant differences in fear-avoidance beliefs were found for gender, type of symptom onset, and payer source (workers’ compensation, auto insurance, and traditional insurance).

Conclusion. The associations among fear-avoidance beliefs, pain intensity, and disability differed between patients with cervical spine pain and patients with lumbar spine pain. Fear-avoidance beliefs were significantly different in subgroups of patients.

From the *School of Health and Rehabilitation Sciences, University of Pittsburgh, and

†Physical Therapy and Chiropractic Services Comprehensive Spine Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.

Acknowledgment date: June 29, 2000.

First revision date: September 1, 2000.

Second revision date: November 6, 2000.

Acceptance date: January 29, 2001.

Device status category: 1.

Conflict of interest category: 12.

Address correspondence to

Steven Z. George

6035 Forbes Tower

Pittsburgh, PA 15260

E-mail: georgesz@msx.upmc.edu

© 2001 Lippincott Williams & Wilkins, Inc.