Kinesiophobia in chronic musculoskeletal pain
The authors of this systematic review found strong evidence of an association between a greater degree of kinesiophobia and higher pain intensity; the association with higher pain severity and lower quality of life was supported by moderate-strength evidence.
The same level of evidence also supported the predictive ability of kinesiophobia for the progression of disability. On the contrary, there was no evidence of a predictive role of kinesiophobia on changes in pain intensity.
Chronic musculoskeletal pain (CMP) is fairly frequent and has a multifactorial origin, with a significant role being played by biopsychosocial factors. One of these is kinesiophobia, which has been found to increase the likelihood of progressing from acute to CMP. The role of kinesiophobia in CMP has been explored extensively. However, a synthesis of the available literature is still missing.
Sixty-three observational studies involving 10,726 patients were included. All studies met the risk of bias criteria, although to a variable degree. Evidence quality ranged from strong to moderate in cross-sectional studies and from moderate to limited in longitudinal studies.
This review suggests clinicians should identify the presence of kinesiophobia before recommending any intervention.
This allows for addressing biopsychosocial factors to modify the fear-avoidance pattern, which can be achieved through the selection of functional goals, education to manage safe behaviors and graded exposure to feared activities.
Expert opinion by José Pedro Correia
This review alerts us for the importance of fear-avoidance patterns in people with chronic musculoskeletal pain and how we should aim at breaking that pattern before progressing to other interventions.
Given the long-term impact and predictive ability of kinesiophobia on the outcomes of people with chronic with musculoskeletal pain, reducing it may be the biggest factor of success.
> From: Luque-Suarez et al., Br J Sports Med 53 (2019) 554-559 (Epub ahead of print). All rights reserved to The Author(s). Click here for the online summary.