Avoidance of affective pain stimuli predicts chronicity in patients with acute low back pain

The aim of this prospective study of acute and sub-acute low back pain (LBP) patients was to assess whether attentional biases predicted chronic pain status 3 and 6months later. The attentional biases of 100 LBP patients were assessed within 3months of developing pain and 6months later. Participants also completed measures associated with outcome at 3 assessment points: baseline, 3 and 6months later. Current pain status was assessed at follow-ups. Patients were classified as those that met standard criteria for chronic pain or those who didn’t (i.e., the comparison group). At baseline, participants demonstrated a bias toward sensory pain words. However, biases toward sensory pain words did not distinguish those who subsequently developed chronic pain and those who did not at either follow-up. The same bias was observed 6months later,  but it failed to distinguish between the chronic pain and comparison groups. However, subjects who developed chronic pain at both 3 (n=22) and 6 (n=21) months showed biases away from affective pain words at baseline but not 6months later, when compared to other participants. The results remained significant in multivariate analyses. The findings are consistent with patterns observed in the previous research, and indicate that avoidance of emotionally laden pain-related stimuli (i.e., affective pain words) is associated with negative outcomes for LBP patients in the acute and sub-acute phase.

This research suggests that attentional biases in relation to pain-related stimuli are significant in the development of chronic pain, but are more complex than was first thought.

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