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Pain Intensity and Fear Avoidance Explain Disability Related to Chronic Low Back Pain in a Saudi Arabian Population

Alamam, Dalyah M. MSc∗,†; Moloney, Niamh PhD‡,§; Leaver, Andrew PhD; Alsobayel, Hana I. PhD; Mackey, Martin G. PhD

doi: 10.1097/BRS.0000000000003002

Study Design. A cross-sectional study.

Objective. The aim of this study was to describe multi-dimensional profiles for people with chronic low back pain (CLBP) and to examine the associations between CLBP-related disability and individual, psychosocial and physical factors in a Saudi population.

Summary of Background Data. CLBP-related disability is a multidimensional phenomenon. There is growing interest in exploring factors associated with CLBP-related disability in Saudi Arabia but research is limited in comparison to other countries.

Methods. Participants completed questionnaires covering demographics, pain intensity, back beliefs, fear avoidance, psychological distress, and physical activity. Oswestry Disability Index (ODI) was used to measure disability. Participants also performed a standardized sequence of physical performance tests and a Pain Behavior Scale was used to evaluate pain behaviors during performance of these tests. The relationships between disability and all variables were explored using univariate and multivariate regression analyses.

Results. One hundred and fifteen participants were included, 63% of whom were female. Participants demonstrated moderate disability (mean [SD]: 26.6 [13.5]). The mean (SD) back beliefs score was 28.6 (7.3). Mean depression, anxiety, and stress (DASS 21) scores indicated mild distress; however, 26% to 39% scored in the moderate to severe range for at least one subscale. In univariate analyses, pain intensity and fear avoidance beliefs (physical activity and work) were moderately associated with disability (r = 0.56, 0.49, 0.52, respectively, P < 0.001), with all other factors demonstrating weak association. Multivariate regression revealed that pain intensity, fear avoidance beliefs, psychological distress, and participants’ age were all found to be associated with disability, accounting for 52.9% (adjusted R2 = 0.529) of variability.

Conclusion. This study provides a unique insight into the clinical profile of people with CLBP in a Saudi Arabian population. Pain and psychosocial factors were significantly associated with disability. This study supports the contention that CLBP-related disability is a multifactorial biopsychosocial condition across different cultures.

Level of Evidence: 3

This study examined individual, psychosocial, and physical factors in a Saudi population with chronic low back pain (CLBP) and their association with CLBP-related disability. Participants demonstrated moderate disability, high body mass index, and low physical activity. Moderate-severe distress was evident in 26% to 39%. Pain intensity, fear avoidance beliefs, psychological distress, and age emerged as important factors associated with disability.

Faculty of Health Sciences, The University of Sydney, Australia

Department of Rehabilitation Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia

Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, Australia

§THRIVE Physiotherapy, Guernsey, Channel Islands, UK.

Address correspondence and reprint requests to Dalyah M. Alamam, MSc, Faculty of Health Sciences, The University of Sydney, Australia; E-mail:

Received 2 July, 2018

Revised 26 November, 2018

Accepted 10 January, 2019

The manuscript submitted does not contain information about medical device(s)/drug(s).

King Saud University scholarship grant funds were received in support of this work.

No relevant financial activities outside the submitted work.

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