Psychological Interventions for Reducing Fear Avoidance Beliefs Among People With Chronic Back Pain

Impact and Implications There is some promising evidence to support that cognitive behavior therapy (CBT) is effective in treating fear avoidance beliefs (FAB) among people with chronic back pain (CBP). Future research should focus on stratifying the pain neuroscience education and identifying which aspects of CBT are most effective for changing beliefs. Future research efforts should be directed toward developing and testing tailored interventions to address individualized patient pain problems. Potential collaborations looking at individual patient data meta-analysis or network meta-analysis may help isolate aspects of CBT that are most worthwhile pursuing for changing fear avoidance outcomes. Objective: Chronic back pain (CBP) is responsible for considerable suffering across the world and is frequently associated with decreased functional capacity, quality of life, and substantial health care costs. Fear avoidance beliefs (FAB) comprise cognitions and fears about the potential for physical activities to produce pain and harm and are common among people with CBP. Collectively, research shows that FAB are frequently associated with low levels of physical activity, poorer work outcomes, and disability. Therefore, the purpose of this systematic review is to systematically locate and synthesize the current evidence regarding the effectiveness of psychological interventions on fear avoidance beliefs and fear avoidance behavior in patients with CBP. Design: A systematic literature search was conducted based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and included the databases Web of Science, PubMed, Cochrane, CINAHL, Medline, and PsycINFO. Results: A total of 5,052 records were identified resulting in 2,448 documents after duplicates were removed. We screened 147 studies full text. Twenty-two studies were included in the qualitative synthesis. FAB were assessed by the Fear Avoidance Beliefs Questionnaire, the Tampa Scale of Kinesiophobia and the Avoidance Exercise Questionnaire. Interventions included cognitive behavior therapy (CBT), psychoeducation (PE), and other psychological approaches like motivational interviewing. Twelve of 22 studies demonstrated significant improvements in FAB for people with CBP who underwent a PE or CBT intervention or a different psychological approach. Conclusion: CBT and PE interventions are mainly used to address FAB among people with CBP. However, there is still inconsistent evidence as to which psychological interventions are most effective to treat FAB among people with CBP.