Association Between Chronic Back Pain and Protective Behaviors is Subjective and Context Dependent

Chronic lower back (CLB) pain limits patients' day-to-day activities, increases their missed days of work, and causes emotional distress. Developing adequate and individual-tailored treatment for CLB patients requires a better understanding of pain and protective behaviors, and how these behaviors are modulated or altered by context and subjectivity. In this work, we conducted experiments to investigate 1) the relationship between pain and protective behaviors in patients with CLB pain, 2) whether individual differences and context are relevant factors in the relationship, and 3) the impact of this relationship and its factors on the performance of current automated models for pain and protective behavior perception. Our results show 1) significant association (p - value < 0.05) between pain and protective behaviors in patients with CLB pain and 2) subjectivity and context are influential factors in this association. Further, our results show that considering this association along with its factors significantly (p-value < 0.05) improves the performance of automated pain and protective behaviors perception. These findings highlight the role of this association on pain and protective behaviors perception and raise several questions about the robustness of existing automated models that do not take this association into account.