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The fear-avoidance model of chronic pain: validation and age analysis using structural equation modeling
Andrew J Cook1, Peter A Brawer, Kevin E Vowles
1Department of Anesthesiology, Division of Pain Management, University of Virginia Health System, Charlottesville, VA 22908, USA The Miriam Hospital, Brown Medical School, Providence, RI, USA.
Pain
|February 24, 2006
Summary
The fear-avoidance (FA) model of chronic pain is validated across age groups. Older adults show lower pain-related fear, with a stronger mediating role for fear in this group.
Area of Science:
- Psychology
- Pain Management
- Gerontology
Background:
- The cognitive-behavioral, fear-avoidance (FA) model of chronic pain has empirical support but requires validation of its multivariate relationships and applicability across age groups.
- Previous research has not uniformly validated the predictive relationships within the FA model or tested its applicability across different age demographics of chronic pain patients.
Purpose of the Study:
- To validate the predictive relationships of the multivariate FA model using structural equation modeling.
- To evaluate the factor structure of the Tampa Scale of Kinesiophobia (TSK) and the fit of the FA model across young, middle-aged, and older adult chronic pain patients.
- To examine age-related differences in pain-related fear and the FA model's parameters.
Main Methods:
- A heterogeneous sample of 469 chronic pain patients provided self-report ratings.
- Data included measures of catastrophizing, pain-related fear, depression, perceived disability, and pain severity.
- Confirmatory factor analysis and structural equation modeling were used to test the TSK factor structure and the FA model, with multigroup analyses conducted across age groups (young, middle-aged, older).
Main Results:
- A 2-factor, 13-item structure of the TSK demonstrated the best fit and was invariant across age groups.
- Older participants reported lower TSK fear scores (FA and Harm factors) compared to middle-aged participants.
- A modified FA model showed a close fit to the data, with significant differences in structural weights for older versus middle-aged participants, indicating a stronger mediating role for pain-related fear in older adults.
Conclusions:
- The findings support the fear-avoidance model of chronic pain.
- Important age-related differences exist in the FA model's structure and in levels of pain-related fear.
- Longitudinal testing of the multivariate FA model is recommended to further elucidate these age-specific dynamics.
