Determinants of pain behaviour in patients with chronic low back pain

Experience of pain is manifested by a subject's behaviour, i.e. by verbalization, movements, facial expressions etc. Experience of pain is a latent construct, and the question of whether the pain is "real" becomes secondary when the behavioural aspect is emphasised: "When the patient communicates pain, then there is a pain problem". The task of the clinician and the researcher is to find out what is behind a person's response to pain. The pain behaviour is determined by many factors. These include psychological suffering due to emotional distress; learning processes regulating pain behaviour; anticipated pain and fear of pain as a cause of passivity and avoidance behaviour in chronic low back pain patients; the influence of cognitive factors, particularly the relationship between negative expectations, cognitive distortion and activity; and finally, the role of psychological distress in chronic pain. These factors are discussed in this paper. Some empirical studies are briefly reviewed to illustrate the topic. Implication of these conceptualizations for treatment of and outcome research in chronic low back pain will be briefly discussed.