title: Fear-avoidance beliefs and parental responses to pain in adolescents with chronic pain.
abstract: BACKGROUND
  The fear-avoidance model of chronic pain posits that fear of pain is associated with fear and avoidance of activity, which can lead to deconditioning and persistence of pain and disability. Despite being well supported in adults, little is known about the role of fear-avoidance beliefs regarding physical activity in children. Research has shown that parental protectiveness contributes to activity limitations in children; however, no studies have examined relationships between protectiveness, and fear and avoidance.
  
  
  OBJECTIVE
  To conduct a cross-sectional study to provide additional information regarding the reliability and validity of the Fear-Avoidance Beliefs Questionnaire physical activity subscale among adolescents with chronic pain; examine fear-avoidance beliefs and depressive symptoms as concurrent predictors of physical activity limitations; and test competing models using fear-avoidance beliefs as mediators and moderators of the association between parental protectiveness and activity limitations.
  
  
  METHODS
  Adolescents (n=42) 11 to 17 years of age with chronic pain completed questionnaires assessing pain intensity, fear-avoidance beliefs, depressive symptoms and physical activity limitations. Their parents completed questionnaires regarding protectiveness and adolescent activity limitations.
  
  
  RESULTS
  The Fear-Avoidance Beliefs Questionnaire physical activity subscale was useful for assessing fear-avoidance beliefs in the present population. In support of hypotheses, greater fear-avoidance beliefs were associated with greater activity limitations, above pain intensity and depressive symptoms. Support was found for fear-avoidance beliefs as mediators of the association between parental protectiveness and activity limitations. Tests of moderation were not significant.
  
  
  CONCLUSIONS
  Fear-avoidance beliefs may be an important target for interventions focused on decreasing activity limitations in youth with chronic pain. Future research should investigate these associations longitudinally.
authors.affiliation: Oregon Health and Science University, Portland, OR, USA. longann@ohsu.edu
authors.forename: Anna C
authors.initials: AC
authors.lastname: Wilson
authors.forename: Amy S
authors.initials: AS
authors.lastname: Lewandowski
authors.forename: Tonya M
authors.initials: TM
authors.lastname: Palermo
mesh_terms: D000293:Adolescent; D001294:Attitude to Health; D001362:Avoidance Learning; D002648:Child; D002908:Chronic Disease; D003469:Culture; D003863:Depression / Q000209:etiology; D004185:Disability Evaluation; D005191:Family Characteristics; D005239:Fear / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008960:Models, Psychological; D009043:Motor Activity; D010146:Pain / Q000150:complications / Q000523:psychology*; D010147:Pain Measurement; D010290:Parents / Q000523:psychology*; D012044:Regression Analysis; D011795:Surveys and Questionnaires