• Katja Boersma and Steven J Linton.
• Department of Occupational and Environmental Medicine, Orebro University Hospital, Orebro, Sweden. katja.boersma@orebroll.se
• Clin J Pain. 2006 Feb 1; 22 (2): 160-6.

ObjectivesUnderstanding the psychological processes that underlie the development of a chronic pain problem is important to improve prevention and treatment. The aim of this study was to test whether distinct profiles of variables within the fear-avoidance model could be identified and could be related to disability in a meaningful way.MethodsIn 81 persons with a musculoskeletal pain problem, cluster analysis was used to identify subgroups with similar patterns on fear and avoidance beliefs, catastrophizing, and depression. The clusters were examined cross-sectionally and prospectively on function, pain, health care usage, and sick leave.ResultsFive distinct profiles were found: pain-related fear, pain-related fear + depressed mood, medium pain-related fear, depressed mood, and low risk. These subgroups were clearly related to outcome. In contrast to the clusters "medium pain-related fear" and "low risk," the majority of those classified in the clusters "pain-related fear," "pain-related fear + depressed mood," and "depressed mood" reported long-term sick leave during follow-up. The subjects in the clusters with high scores on the depression measure reported the highest percentage of health care usage during follow-up (70% in the "pain-related fear + depressed mood" group and 42% in the "depressed mood" group reported >10 health care visits).ConclusionsDistinct profiles of psychological functioning could be extracted and meaningfully related to future disability. These profiles give support to the fear-avoidance model and underscore the need to address the psychological aspects of the pain experience early on.

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