title: The role of fear-avoidance and helplessness in explaining functional disability in chronic pain: a prospective study.
abstract: OBJECTIVE
  Based on the fear-avoidance and helplessness models, the relative contribution of fear of pain, avoidance behavior, worrying, and helplessness were examined in relation to fluctuations in functional disability in chronic-pain patients.
  
  
  METHODS
  A cohort of 181 chronic-pain patients first completed various questionnaires and kept a 7-day pain journal during a standard 3-month waiting-list period prior to their scheduled treatment at an Interdisciplinary Pain Centre and did so again immediately preceding the intervention.
  
  
  RESULTS
  At baseline, fear of pain, avoidance behavior, and helplessness all predicted functional disability after 3 months. Stepwise regression analyses showed avoidance behavior to be the strongest predictor of change in functional disability followed by helplessness, thus both ahead of fear of pain.
  
  
  CONCLUSIONS
  The current findings support the roles of both fear-avoidance factors and helplessness in the functional disability in chronic-pain patients awaiting treatment but revealed a central role for avoidance behavior.
authors.affiliation: Department of Medical Psychology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. h.samwel@mps.umcn.nl
authors.forename: Han J A
authors.initials: HJ
authors.lastname: Samwel
authors.forename: Floris W
authors.initials: FW
authors.lastname: Kraaimaat
authors.forename: Ben J P
authors.initials: BJ
authors.lastname: Crul
authors.forename: Andrea W M
authors.initials: AW
authors.lastname: Evers
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000209:etiology / Q000523:psychology*; D001362:Avoidance Learning; D002908:Chronic Disease; D015331:Cohort Studies; D004185:Disability Evaluation; D005239:Fear / Q000523:psychology*; D005260:Female; D006380:Helplessness, Learned; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000150:complications / Q000523:psychology*; D012044:Regression Analysis; D018709:Statistics, Nonparametric