Pain-Related Fear, Pain Intensity and Function in Individuals With Chronic Musculoskeletal Pain: A Systematic Review and Meta-Analysis

Martinez-Calderon, Javier; Flores-Cortes, Mar; Morales-Asencio, Jose Miguel; Luque-Suarez, Alejandro

doi:10.1016/j.jpain.2019.04.009

Cited by 141Musculoskeletal pain and rehabilitationPediatric Pain Management TechniquesPain Mechanisms and Treatments

Pain-Related Fear, Pain Intensity and Function in Individuals With Chronic Musculoskeletal Pain: A Systematic Review and Meta-Analysis

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Martinez-Calderon, Javier, Flores-Cortes, Mar, Morales-Asencio, Jose Miguel, Luque-Suarez, Alejandro·2019·The Journal of Pain

DOI 10.1016/j.jpain.2019.04.009

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Abstract

Pain-related fear is considered a strong psychological predictor for both chronic pain and disability. The aims of this study were to systematically review and critically appraise the concurrent association and the predictive value of pain-related fear affecting both pain intensity and disability in individuals with chronic musculoskeletal pain (MSK). PubMed, AMED, CINAHL, PsycINFO, PubPsych, and the grey literature were searched from inception to January 2019. Observational studies reporting cross-sectional and longitudinal associations between pain-related fear and pain intensity and/or disability were included. The GRADE criteria judged whether the overall quality and strength of the evidence was high or low in terms of risk of bias, inconsistency, indirectness, imprecision and publication bias. Seventy observational studies (97% cross-sectional) were included with a total sample of 15,623 individuals (63.56% females) with chronic MSK. Pain-related fear is composed of fear of pain, pain-related anxiety, and fear-avoidance beliefs. Greater levels of fear of pain, pain-related anxiety, and fear-avoidance beliefs were significantly associated with greater pain intensity and disability. However, the quality and strength of the evidence was very low owing to the imprecision of results, risk of bias, indirectness, and publication bias were common across the included studies. Despite these limitations, these findings highlight the potential role that pain-related fear may play in chronic MSK and disability. The field would benefit from research using higher quality studies and longitudinal designs. PERSPECTIVE: This article presents promising results about the concurrent association between pain-related fear and both pain intensity and disability in individuals with chronic MSK. Nevertheless, the overall quality and strength of the evidence was very low in terms of risk of bias, indirectness, imprecision, and publication bias. Thus, the findings should be taken with caution, and further research is needed. PROSPERO: CRD42018082018.

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These models identify key psychological constructs (yellow flags) such as pain catastrophizing, kinesiophobia, pain anxiety, depression, pain avoidance and low pain self-efficacy which are associated with poor long-term MSK health outcomes.
“These models identify key psychological constructs (yellow flags) such as pain catastrophizing, kinesiophobia, pain anxiety, depression, pain avoidance and low pain self-efficacy which are associated with poor long-term MSK health outcomes (Leeuw et al., 2007;Lentz et al., 2016;Martinez-Calderon et al., 2019;Stearns et al., 2021;Van Wyngaarden et al., 2019).”
From Beyond yellow flags: The Big‐Five personality traits and psychologically informed musculoskeletal rehabilitation. (2023) · cites this paper as Martinez-Calderon et al., 2019

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Sex differences in outcomes of methadone maintenance treatment for opioid use disorder: a systematic reviewand meta-analysis
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Fear-Avoidance, Pain Acceptance and Adjustment to Chronic Pain: A Cross-Sectional Study on a Sample of 686 Patients with Chronic Spinal Pain
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Sex differences in the associations among psychological factors and pain report: a novel psychophysical study of patients with chronic low back pain
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Relationships Between Physical Symptoms, Emotional Distress, and Pain Appraisal in Fibromyalgia: The Moderator Effect of Alexithymia
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Assessing fear in patients with cervical pain: Development and validation of the Pictorial Fear of Activity Scale-Cervical (PFActS-C)
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Fear-Avoidance Beliefs and Temporal Summation of Evoked Thermal Pain Influence Self-Report of Disability in Patients With Chronic Low Back Pain
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Fear-Avoidance Beliefs Are Associated With Disability in Older American Adults With Low Back Pain
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Exploratory factor analysis of the Pain Anxiety Symptoms Scale in patients with chronic pain complaints
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Is there a relationship between pain and psychological concerns related to falling in community dwelling older adults? A systematic review
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Clinical Investigation of Pain-related Fear and Pain Catastrophizing for Patients With Low Back Pain
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The relationship between disability, quality of life and fear- avoidance beliefs in patients with chronic low back pain
Güçlü, D. G., Güçlü, O., Ozaner, A., Şenormancı, Ö., & Konkan, R. (2012) · Turkish Neurosurgery · doi:10.5137/1019-5149.jtn.6156-12.1 · Cited by 52 · see citing works
Predictors of the Pain Perception and Self-Efficacy for Pain Control in Patients with Fibromyalgia
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Low Back Pain Subgroups Using Fear-Avoidance Model Measures
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The relationships between measures of stature recovery, muscle activity and psychological factors in patients with chronic low back pain
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What is the Role of Fear and Escape/Avoidance in Chronic Pain? Models, Structural Analysis and Future Directions
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The Italian Version of the Fear-Avoidance Beliefs Questionnaire (FABQ-I)
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The Influence of Self‐Efficacy, Fear‐Avoidance Belief, and Coping Styles on Quality of Life for Chinese Patients with Chronic Nonspecific Low Back Pain: A Multisite Cross‐Sectional Study
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Experiential avoidance and anxiety sensitivity as dispositional variables and their relationship to the adjustment to chronic pain
Esteve, R., Ramírez‐Maestre, C., & López-Martínez, A. E. (2011) · European Journal of Pain · doi:10.1002/j.1532-2149.2011.00035.x · Cited by 43 · see citing works
Fear-avoidance beliefs about physical activity in adults with rheumatoid arthritis
Lööf, H., Demmelmaier, I., Henriksson, E. W., Lindblad, S., Nordgren, B., Opava, C. H., & Johansson, U. (2014) · Scandinavian Journal of Rheumatology · doi:10.3109/03009742.2014.932432 · Cited by 43 · see citing works
An Overview of the Management of Persistent Musculoskeletal Pain
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Cognitive assessment of musculoskeletal pain with a newly validated Greek version of the Fear‐Avoidance Beliefs Questionnaire (FABQ)
Georgoudis, G., Papathanasiou, G., Spiropoulos, P., & Katsoulakis, K. (2006) · European Journal of Pain · doi:10.1016/j.ejpain.2006.05.001 · Cited by 41 · see citing works
Patients with non-specific neck disorders commonly report upper limb disability
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PTSD and Chronic Pain: Cognitive-Behavioral Perspectives and Practical Implications
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Decrease of fear avoidance beliefs following person-centered progressive resistance exercise contributes to reduced pain disability in women with fibromyalgia: secondary exploratory analyses from a randomized controlled trial
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A Controlled Examination of Medical and Psychosocial Factors Associated With Low Back Pain in Combination With Widespread Musculoskeletal Pain
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Pain, social support and depressive symptoms in patients with rheumatoid arthritis: testing the stress-buffering hypothesis
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Musculoskeletal Disorders, Workforce Health and Productivity in the United States
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The development and preliminary validation of the Profile of Chronic Pain: Extended Assessment Battery
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Fear-avoidance beliefs increase perception of pain and disability in Mexicans with chronic low back pain
Nava‐Bringas, T. I., Macías‐Hernández, S. I., Vásquez‐Ríos, J. R., Coronado‐Zarco, R., Miranda‐Duarte, A., Cruz‐Medina, E., & Arellano‐Hernández, A. (2016) · Revista Brasileira de Reumatologia (English Edition) · doi:10.1016/j.rbre.2016.11.003 · Cited by 28 · see citing works
Reliability and Validity of the Pain Anxiety Symptom Scale in Persian Speaking Chronic Low Back Pain Patients
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Psychological Knowledge in Court
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The Reduction of Fear of Movement-related Pain: Does Motivational Context Matter?
Volders, S., Meulders, A., Peuter, S. D., & Vlaeyen, J. (2015) · The Clinical Journal of Pain · doi:10.1097/ajp.0000000000000187 · Cited by 25 · see citing works
Investigating dynamic pain sensitivity in the context of the fear‐avoidance model
Gay, C. W., Horn, M. E., Bishop, M. D., Robinson, M. E., & Bialosky, J. E. (2014) · European Journal of Pain · doi:10.1002/ejp.519 · Cited by 24 · see citing works
Economic Burden of Chronic Pain Across Europe
Barham, L. (2012) · Journal of Pain & Palliative Care Pharmacotherapy · doi:10.3109/15360288.2011.650364 · Cited by 24 · see citing works
Prevalence of obesity and overweight in African learners: a protocol for systematic review and meta-analysis
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The impact of chronic low back pain on physical performance, fear avoidance beliefs, and depressive symptoms: A comparative study on Turkish elderly population
Telci, E. A., Yağcı, N., Can, T., & Cavlak, U. (2013) · Pakistan Journal of Medical Sciences · doi:10.12669/pjms.292.3196 · Cited by 22 · see citing works
Pain anxiety and fear of (re) injury in patients with chronic back pain: Sex as a moderator
Kreddig, N., & Hasenbring, M. I. (2017) · Scandinavian Journal of Pain · doi:10.1016/j.sjpain.2017.03.009 · Cited by 21 · see citing works
Sleep and the generalization of fear learning
Davidson, P., Carlsson, I., Jönsson, P., & Johansson, M. (2015) · Journal of Sleep Research · doi:10.1111/jsr.12339 · Cited by 20 · see citing works
The Pain Anxiety Symptoms Scale Fails to Discriminate Pain or Anxiety in a Chronic Disabling Occupational Musculoskeletal Disorder Population
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Borgne, M. L., Boudoukha, A. H., Petit, A., & Roquelaure, Y. (2017) · Scandinavian Journal of Pain · doi:10.1016/j.sjpain.2017.08.008 · Cited by 20 · see citing works
How well do observed functional limitations explain the variance in Roland Morris scores in patients with chronic non-specific low back pain undergoing physiotherapy?
Caporaso, F., Pulkovski, N., Sprott, H., & Mannion, A. F. (2012) · European Spine Journal · doi:10.1007/s00586-012-2255-6 · Cited by 19 · see citing works
Fear of Injury Predicts Self-Reported and Behavioral Impairment in Patients With Chronic Low Back Pain
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Patient-Preference Disability Assessment for Disabling Chronic Low Back Pain
Sanchez, K., Papelard, A., Nguyen, C., Jousse, M., Rannou, F., Revel, M., & Poiraudeau, S. (2009) · Spine · doi:10.1097/brs.0b013e31819c093b · Cited by 17 · see citing works
Understanding fear of pain in chronic pain: Interoceptive fear conditioning as a novel approach
Peuterl, S., Diestl, I., Vansteenwegenl, D., Berghl, O., & Vlaeyenl, J. W. S. (2011) · European Journal of Pain · doi:10.1016/j.ejpain.2011.03.002 · Cited by 15 · see citing works
A prospective study predicting the outcome of chronic low back pain and physical therapy: the role of fear-avoidance beliefs and extraspinal pain
Feitosa, A. S. A., Lopes, J. B., Bonfá, E., & Halpern, A. S. R. (2016) · Revista Brasileira de Reumatologia (English Edition) · doi:10.1016/j.rbre.2016.03.002 · Cited by 14 · see citing works
Pain rather than self-reported sedentary time explains variation in perceived health and activity limitation in persons with rheumatoid arthritis: a cross sectional study in Sweden
Demmelmaier, I., Åsenlöf, P., Bergman, P., Nordgren, B., & Opava, C. H. (2017) · Rheumatology International · doi:10.1007/s00296-016-3641-x · Cited by 14 · see citing works
Comparison of work-related fear-avoidance beliefs across different anatomical locations with musculoskeletal pain
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Structural Equation Model of Disability in Low Back Pain
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Is there a role of depressive symptoms in the fear-avoidance model? A structural equation approach
Seekatz, B., Meng, K., Bengel, J., & Faller, H. (2015) · Psychology Health & Medicine · doi:10.1080/13548506.2015.1111392 · Cited by 13 · see citing works
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Structural Evaluation of the Contemporary Psychological Models of Chronic Pain: Does Fear of Pain Work for All?
Dehghani, M., Sharpe, L., & Nicholas, M. K. (2010) · Cognitive Behaviour Therapy · doi:10.1080/16506070903390134 · Cited by 10 · see citing works
Chronic pain as a human rights issue: setting an agenda for preventative action
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Comparison of pain, disorder, back performance, and psychological factors in patients with low back pain and radicular pain
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The association between pain diagram area, fear-avoidance beliefs, and pain catastrophising
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Translation of the Fear Avoidance Beliefs Questionnaire Into Hausa Language
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Low back pain
Knezevic, N. N., Candido, K. D., Vlaeyen, J. W. S., Van Zundert, J., & Cohen, S. P. (2021) · The Lancet · doi:10.1016/s0140-6736(21)00733-9 · Cited by 1,345 · see citing works
Co-occurrence of chronic pain and anxiety/depression symptoms in U.S. adults: prevalence, functional impacts, and opportunities
Rosa, J. S. D. L., Brady, B. R., Ibrahim, M. M., Herder, K. E., Wallace, J., Padilla, A. R., & Vanderah, T. W. (2023) · Pain · doi:10.1097/j.pain.0000000000003056 · Cited by 258 · see citing works
Application of standardized regression coefficient in meta-analysis
Nieminen, P. (2022) · BioMedInformatics · doi:10.3390/biomedinformatics2030028 · Cited by 230 · see citing works
Behavioral Conceptualization and Treatment of Chronic Pain
Vlaeyen, J. W. S., & Crombez, G. (2019) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-050718-095744 · Cited by 146 · see citing works
In pursuit of ‘safe’ water: the burden of personal injury from water fetching in 21 low-income and middle-income countries
Venkataramanan, V., Geere, J., Thomae, B., Stoler, J. B., Hunter, P. R., & Young, S. L. (2020) · BMJ Global Health · doi:10.1136/bmjgh-2020-003328 · Cited by 105 · see citing works
Which Psychological Factors Are Involved in the Onset and/or Persistence of Musculoskeletal Pain? An Umbrella Review of Systematic Reviews and Meta-Analyses of Prospective Cohort Studies
Martínez-Calderón, J., Flores-Cortés, M., Morales‐Asencio, J. M., & Luque-Suárez, A. (2020) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000000838 · Cited by 98 · see citing works
Self-citation
Associations between pain intensity, psychosocial factors, and pain-related disability in 4285 patients with chronic pain
Landmark, L., Sunde, H. F., Fors, E. A., Kennair, L. E. O., Sayadian, A., Backelin, C., & Rème, S. E. (2024) · Scientific Reports · doi:10.1038/s41598-024-64059-8 · Cited by 80 · see citing works
Biopsychosocial Factors for Chronicity in Individuals with Non-Specific Low Back Pain: An Umbrella Review
Otero-Ketterer, E., Peñacoba, C., Pinheiro, C. F., Valera‐Calero, J. A., & Ortega‐Santiago, R. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191610145 · Cited by 78 · see citing works
Effects of manual therapy on fear avoidance, kinesiophobia and pain catastrophizing in individuals with chronic musculoskeletal pain: Systematic review and meta-analysis
Kamonseki, D. H., Christenson, P., Rezvanifar, S. C., & Calixtre, L. B. (2020) · Musculoskeletal Science and Practice · doi:10.1016/j.msksp.2020.102311 · Cited by 48 · see citing works
The strength of association between psychological factors and clinical outcome in tendinopathy: A systematic review
Stubbs, C., Auliffe, S. M., Mallows, A. J., O’Sullivan, K., Haines, T. P., & Malliaras, P. (2020) · PLoS ONE · doi:10.1371/journal.pone.0242568 · Cited by 40 · see citing works
The “future” pain clinician: Competencies needed to provide psychologically informed care
Linton, S. J., O’Sullivan, P., Zetterberg, H., & Vlaeyen, J. W. S. (2024) · Scandinavian Journal of Pain · doi:10.1515/sjpain-2024-0017 · Cited by 36 · see citing works
IL-33/ST2 signaling in pain and itch: Cellular and molecular mechanisms and therapeutic potentials
Li, P., Yu, Q., Nie, H., Yin, C., & Liu, B. (2023) · Biomedicine & Pharmacotherapy · doi:10.1016/j.biopha.2023.115143 · Cited by 31 · see citing works
Widespread Pressure Delivered by a Weighted Blanket Reduces Chronic Pain: A Randomized Controlled Trial
Baumgartner, J. N., Quintana, D., Leija, L., Schuster, N. M., Bruno, K. A., Castellanos, J. P., & Case, L. K. (2021) · Journal of Pain · doi:10.1016/j.jpain.2021.07.009 · Cited by 29 · see citing works
Self-efficacy as a mediator of the relationship between pain and disability in chronic pain patients: a narrative review
Kripa, S., & Sharma, P. (2022) · Bulletin of Faculty of Physical Therapy · doi:10.1186/s43161-022-00101-y · Cited by 28 · see citing works
Identifying Motor Control Strategies and Their Role in Low Back Pain: A Cross-Disciplinary Approach Bridging Neurosciences With Movement Biomechanics
Schmid, S., Bangerter, C., Schweinhardt, P., & Meier, M. L. (2021) · Frontiers in Pain Research · doi:10.3389/fpain.2021.715219 · Cited by 29 · see citing works
The relationship between chronic pain and psychosocial aspects in patients with haemophilic arthropathy. A cross‐sectional study
Ucero‐Lozano, R., Pina, J. A. L., Ortiz‐Pérez, A., & Cuesta‐Barriuso, R. (2021) · Haemophilia · doi:10.1111/hae.14469 · Cited by 27 · see citing works
A Systematic Review of the Adherence to Home-Practice Meditation Exercises in Patients with Chronic Pain
Barceló-Soler, A., Morillo-Sarto, H., Fernández-Martínez, S., Monreal-Bartolomé, A., Chambel, M. J., Gardiner, P., López-del-Hoyo, Y., García-Campayo, J., & Pérez-Aranda, A. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20054438 · Cited by 26 · see citing works
“Previous studies have concluded that these interventions’ effects on reducing pain interference are achieved through enhancing pain acceptance and psychological flexibility [19], as well as reducing fear of pain, pain-related anxiety, and fear-avoidance beliefs [20].”
Background
Systematic reviews and meta-analyses in regional anesthesia and pain medicine (Part II): guidelines for performing the systematic review
D'Souza, R. S., Barrington, M. J., Sen, A., Mascha, E. J., & Kelley, G. A. (2023) · Regional Anesthesia & Pain Medicine · doi:10.1136/rapm-2023-104802 · Cited by 30 · see citing works
High-impact chronic pain: evaluation of risk factors and predictors
Şentürk, İ. A., Şentürk, E., Üstün, I., Gökçedağ, A., Yıldırım, N. P., & Kale, N. (2022) · The Korean journal of pain · doi:10.3344/kjp.22357 · Cited by 23 · see citing works
Systematic Reviews and Meta-analyses in Regional Anesthesia and Pain Medicine (Part II): Guidelines for Performing the Systematic Review
D'Souza, R. S., Barrington, M. J., Sen, A., Mascha, E. J., & Kelley, G. A. (2023) · Anesthesia & Analgesia · doi:10.1213/ane.0000000000006607 · Cited by 25 · see citing works
Intervention Therapies to Reduce Pain-Related Fear in Fibromyalgia Syndrome: A Systematic Review of Randomized Clinical Trials
Martinez-Calderon, J., Flores-Cortes, M., Morales-Asencio, J. M., & Luque-Suarez, A. (2021) · Pain Medicine · doi:10.1093/pm/pnaa331 · Cited by 21 · see citing works
Self-citation
The Correlation between Malocclusion and Body Posture and Cervical Vertebral, Podal System, and Gait Parameters in Children: A Systematic Review
Różańska-Perlińska, D., Potocka-Mitan, M., Rydzik, Ł., Lipińska, P., Perliński, J., Javdaneh, N., & Jaszczur-Nowicki, J. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13123463 · Cited by 20 · see citing works
The influence of kinesiophobia and pain catastrophizing on pain-induced corticomotor modulation in healthy participants: A cross sectional study
Duport, A., Pelletier, R., Martel, M., & Léonard, G. (2022) · Neurophysiologie Clinique · doi:10.1016/j.neucli.2022.08.001 · Cited by 20 · see citing works
Theoretical Schemas to Guide Back Pain Consortium (BACPAC) Chronic Low Back Pain Clinical Research
Chau, A., Steib, S., Whitaker, E. M., Kohns, D. J., Quinter, A., Craig, A. S. W., Chiodo, A., Chandran, S., Laidlaw, A. T., Schott, Z., et al. (2022) · Pain Medicine · doi:10.1093/pm/pnac196 · Cited by 20 · see citing works
The Perceived Opportunity to Avoid Pain Paradoxically Increases Pain-Related Fear Through Increased Threat Appraisals.
van Vliet, C. V., Meulders, A., Vancleef, L., & Vlaeyen, J. (2020) · Annals of Behavioral Medicine · doi:10.1093/abm/kaaa045 · Cited by 18 · see citing works
A Cross-Sectional Study of the Impact of Pain Severity on Absenteeism and Presenteeism Among Japanese Full-Time Workers
Tanaka, C., Wakaizumi, K., Takaoka, S., Matsudaira, K., Mimura, M., Fujisawa, D., & Kosugi, S. (2022) · Pain and Therapy · doi:10.1007/s40122-022-00408-7 · Cited by 19 · see citing works
A Systematic Review of Pain Catastrophizing and Chronic Musculoskeletal Pain
Shimada, S., Doorenbos, A. Z., Goldstein, E., & Wi, D. (2025) · Pain Management Nursing · doi:10.1016/j.pmn.2025.07.014 · Cited by 18 · see citing works
“My Pain Is Unbearable…I Cannot Recognize Myself!” Emotions, Cognitions, and Behaviors of People Living With Musculoskeletal Disorders: An Umbrella Review
Martínez-Calderón, J., Matias-Soto, J., & Luque-Suárez, A. (2022) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2022.10707 · Cited by 20 · see citing works
Does interpretation bias moderate the relationship between pain and fear of cancer recurrence?
Pradhan, P., Sharpe, L., Butow, P. N., Coutts‐Bain, D., & Heathcote, L. C. (2022) · Health Psychology · doi:10.1037/hea0001217 · Cited by 19 · see citing works
Applying the behavioural change wheel to guide the implementation of a biopsychosocial approach to musculoskeletal pain care
Ng, W., Beales, D. J., Gucciardi, D. F., & Slater, H. (2023) · Frontiers in Pain Research · doi:10.3389/fpain.2023.1169178 · Cited by 18 · see citing works
Prevalence of low back pain in professional drivers: a meta-analysis
Chen, C.-S., Xiao, B., He, X., Wu, J., Li, W., & Yan, M. (2024) · Public Health · doi:10.1016/j.puhe.2024.03.007 · Cited by 16 · see citing works
Utilizing machine learning to predict post-treatment outcomes in chronic non-specific neck pain patients undergoing cervical extension traction
Moustafa, I. M., Ozsahin, D. U., Mustapha, M. T., Ahbouch, A., Oakley, P. A., & Harrison, D. E. (2024) · Scientific Reports · doi:10.1038/s41598-024-62812-7 · Cited by 16 · see citing works
Beyond yellow flags: The Big‐Five personality traits and psychologically informed musculoskeletal rehabilitation.
Williams, M. K., Waite, L., Van Wyngaarden, J. J., Meyer, A. R., & Koppenhaver, S. L. (2023) · Musculoskeletal Care · doi:10.1002/msc.1797 · Cited by 15 · see citing works
The Role of Positive Psychological Factors in the Association between Pain Intensity and Pain Interference in Individuals with Chronic Musculoskeletal Pain: A Cross-Sectional Study
Martínez-Calderón, J., Flores-Cortés, M., Clavero-Cano, S., Morales‐Asencio, J. M., Jensen, M. P., Rondón-Ramos, A., Díaz-Cerrillo, J. L., Ariza-Hurtado, G. R., & Luque-Suárez, A. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9103252 · Cited by 15 · see citing works
Self-citation
Detrimental impact of temporomandibular disorders (mis)beliefs and possible strategies to overcome
Cintra, D. N., de Oliveira, S. A. S., Lorenzo, I. A., Costa, D. M. F., Bonjardim, L. R., & Costa, Y. M. (2022) · Journal of Oral Rehabilitation · doi:10.1111/joor.13330 · Cited by 15 · see citing works
Dynamic processes of mindfulness-based alterations in pain perception
Lu, C., Moliadze, V., & Nees, F. (2023) · Frontiers in Neuroscience · doi:10.3389/fnins.2023.1253559 · Cited by 14 · see citing works
The effects of the mirror therapy on shoulder function in patients with breast cancer following surgery: a randomized controlled trial
Yuan, R., Wei, X., Ye, Y., Wang, M., Jiang, J., Li, K., Zhu, W., Zheng, W., & Wu, C. (2023) · Journal of Cancer Survivorship · doi:10.1007/s11764-023-01398-x · Cited by 14 · see citing works
Health-Related Outcomes 3-15 Years Following Ankle Sprain Injury in Youth Sport: What Does the Future Hold?
Owoeye, O. B. A., Whittaker, J. L., Toomey, C., Räisänen, A. M., Jaremko, J. L., Carlesso, L. C., Manske, S. L., & Emery, C. A. (2021) · Foot & Ankle International · doi:10.1177/10711007211033543 · Cited by 15 · see citing works
Self-reported physical function is strongly related to pain behavior and pain interference and weakly related to physical capacity in people with chronic low back pain
Karayannis, N. V., Smuck, M. W., Law, C. S. W., Mackey, S., Gross, J. J., Darnall, B. D., & Hush, J. M. (2023) · Musculoskeletal Science and Practice · doi:10.1016/j.msksp.2023.102721 · Cited by 13 · see citing works
An exploration of knowledge‐organizing technologies to advance transdisciplinary back pain research
Lotz, J. C., Ropella, G. E. P., Anderson, P., Yang, Q., Hedderich, M. A., Bailey, J. F., & Hunt, C. A. (2023) · JOR Spine · doi:10.1002/jsp2.1300 · Cited by 13 · see citing works
International Delphi study of clinical and exercise professionals’ opinion of physical activity prescreening and contraindications for participating in postpartum physical activity
Davenport, M. H., Christopher, S. M., Deering, R. E., Prevett, C., Dufour, S. P., Forte, M., Beamish, N., Adamo, K. B., Bø, K., Brockwell, E., et al. (2025) · British Journal of Sports Medicine · doi:10.1136/bjsports-2024-109104 · Cited by 13 · see citing works
Does past/current pain change pain experience? Comparing self-reports and pupillary responses
Yoo, H., Cho, Y., & Cho, S. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1094903 · Cited by 14 · see citing works
The effect of weighted blankets on sleep and related disorders: a brief review
Yu, J., Yang, Z., Sun, S., Sun, K., Chen, W., Zhang, L., Xu, J., Xu, Q., Liu, Z., Ke, J., et al. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1333015 · Cited by 12 · see citing works
Impact of the digital health application ViViRA on spinal mobility, physical function, quality of life and pain perception in spondyloarthritides patients: a randomized controlled trial
Blaskowitz, P. P. V. A., Liphardt, A., Bouzas, C., Coppers, B., Petit, P., Vuillerme, N., Bundle, V., Rudolf, S., Knitza, J., Raimondo, M. G., et al. (2024) · Arthritis Research & Therapy · doi:10.1186/s13075-024-03443-1 · Cited by 12 · see citing works
The relationships between pain‐associated psychological distress, pain intensity, patient expectations, and physical function in individuals with musculoskeletal pain: A retrospective cohort study
Leech, J. B., Lulofs-MacPherson, K., Klopper, M., Shumway, J., Salvatori, R. T., Rhon, D. I., & Young, J. L. (2023) · PM&R · doi:10.1002/pmrj.12983 · Cited by 11 · see citing works
Behavioral Health, Telemedicine, and Opportunities for Improving Access
Rogers, D. G., Santamaria, K., Seng, E. K., & Grinberg, A. S. (2022) · Current Pain and Headache Reports · doi:10.1007/s11916-022-01096-w · Cited by 10 · see citing works
Left to themselves: Time to target chronic pain in childhood rare diseases
Sieberg, C. B., Lebel, A., Silliman, E., Holmes, S. A., Borsook, D., & Elman, I. (2021) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2021.03.008 · Cited by 11 · see citing works
Pain-related fear phenotypes are associated with function of the upper limbs in individuals with shoulder pain
Kamonseki, D. H., Pott, H., Haik, M. N., Almeida, L. A., & Camargo, P. R. (2021) · Musculoskeletal Science and Practice · doi:10.1016/j.msksp.2021.102416 · Cited by 10 · see citing works
How to tackle non-specific low back pain among adult patients? A systematic review with a meta-analysis to compare four interventions
Jiang, Y., Xu, Y., Kong, X., Zhao, E., Ma, C., Lv, Y., Xu, H., Sun, H., & Gao, X. (2024) · Journal of Orthopaedic Surgery and Research · doi:10.1186/s13018-023-04392-2 · Cited by 9 · see citing works
The mechanisms of effect of a physiotherapist-delivered integrated psychological and exercise intervention for acute whiplash-associated disorders: secondary mediation analysis of a randomized controlled trial
Elphinston, R. A., Sterling, M. M., Kenardy, J. A., Smeets, R., & Armfield, N. R. (2020) · PAIN Reports · doi:10.1097/pr9.0000000000000835 · Cited by 9 · see citing works
The Effects of Mind–Body Exercises on Chronic Spinal Pain Outcomes: A Synthesis Based on 72 Meta-Analyses
Martínez-Calderón, J., Almeida, M. D. L. C., & Matias-Soto, J. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191912062 · Cited by 10 · see citing works
Examining Psychological Factors as Contributors to Pain, Disability, and Physical Function in Geriatric Chronic Low Back Pain: A Prospective Analysis of the Delaware Spine Studies Cohort
Knox, P. J., Simon, C. B., Pohlig, R. T., Pugliese, J. M., Coyle, P. C., Sions, J. M., & Hicks, G. E. (2023) · Journal of Pain · doi:10.1016/j.jpain.2023.12.005 · Cited by 9 · see citing works
Don’t Throw the ‘Bio’ out of the Bio-Psycho-Social Model: Editorial for Spine Rehabilitation in 2022 and Beyond
Harrison, D. E., Oakley, P. A., & Moustafa, I. M. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12175602 · Cited by 9 · see citing works
Effects of pain neuroscience education on psycho-emotional and cognitive variables in individuals with chronic musculoskeletal pain: a systematic review of randomised clinical trials
Salazar‐Méndez, J., Ribeiro, I. L., Garrido-Castillo, M., & Gacitúa, J. (2023) · European Journal of Physiotherapy · doi:10.1080/21679169.2022.2162962 · Cited by 8 · see citing works
Is it Possible to Reduce Pain-Related Fear in Individuals with Knee Osteoarthritis? a Systematic Review of Randomised Clinical Trials
Martínez-Calderón, J., Flores-Cortés, M., Morales‐Asencio, J. M., Galán, C. P., Ríos, M. D. C. G., Torrontegui‐Duarte, M., & Luque-Suárez, A. (2022) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2022.2038743 · Cited by 8 · see citing works
Self-citation
Fear Avoidance Beliefs in Upper-Extremity Musculoskeletal Pain Conditions: Secondary Analysis of a Prospective Clinical Study on Digital Care Programs
Janela, D., Costa, F. M. T. A., Molinos, M., Moulder, R. G., Jr., Laíns, J., Scheer, J. K., Bento, V., Yanamadala, V., Cohen, S. P., & Correia, F. D. (2022) · Pain Medicine · doi:10.1093/pm/pnac149 · Cited by 8 · see citing works
Cooled radiofrequency for the treatment of sacroiliac joint pain – impact on pain and psychometrics: a retrospective cohort study
Kleinmann, B., Wolter, T., & Weyerbrock, A. (2020) · Scandinavian Journal of Pain · doi:10.1515/sjpain-2020-0011 · Cited by 7 · see citing works
Identifying pain perceptual biases related to fear of pain and threat in a pain‐free sample
Yang, Z., & Bateer (2020) · European Journal of Pain · doi:10.1002/ejp.1553 · Cited by 8 · see citing works
Rehabilitation Interventions for Fear-Avoidance Beliefs and Behaviors in Sudden Onset Musculoskeletal Conditions: A Scoping Review
Lu, J., Kobelsky, E., Fung, J., Sogomonian, T., Edger-Lacoursière, Z., & Nedelec, B. (2025) · Journal of Burn Care & Research · doi:10.1093/jbcr/iraf009 · Cited by 7 · see citing works
The Influence of Exercise Intensity on Psychosocial Outcomes in Musculoskeletal Disorders: A Systematic Review
Klaps, S., Haesevoets, S., Verbunt, J., Köke, A., Janssens, L., Timmermans, A., & Verbrugghe, J. (2022) · Sports health · doi:10.1177/19417381221075354 · Cited by 8 · see citing works
Discordance between joint pain and imagery severity in the ankle joint and contributors of lower limb activity limitations in adults with haemophilia: A cross‐sectional study
Chantrain, V., Guillaume, S., Foubert, A., Meeus, M., Lobet, S., Lambert, C., Lecouvet, F. E., Hermans, C. R. J. R., & Roussel, N. A. (2023) · Haemophilia · doi:10.1111/hae.14749 · Cited by 7 · see citing works
Individual Patterns and Temporal Trajectories of Changes in Fear and Pain during Exposure In Vivo: A Multiple Single-Case Experimental Design in Patients with Chronic Pain
Bontinck, J., den Hollander, M., Kaas, A., de Jong, J. D., & Timmers, I. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11051360 · Cited by 7 · see citing works
Acceptance and Fear-Avoidance Mediate Outcomes of Interdisciplinary Pain Rehabilitation Programs at 12-Month Follow-Up: A Clinical Registry-Based Longitudinal Cohort Study from the Swedish Quality Registry for Pain Rehabilitation (SQRP)
Gerdle, B. U. C., Dragioti, E., Fischer, M. R., & Ringqvist, Å. (2024) · Journal of Pain Research · doi:10.2147/jpr.s438260 · Cited by 7 · see citing works
Influence of Family-Learned Fear-of-Pain on Patients.
Fang, Y.-X., Shi, L., Qin, F., Li, T., Zhang, X., & Li, M. (2023) · Pain Management Nursing · doi:10.1016/j.pmn.2023.04.003 · Cited by 6 · see citing works
The multidisciplinary team in the management of chronic pain and pain-related fear: an evidence-based approach in a clinical case
Venturin, D., Battimelli, A., di Cara, G., & Poser, A. (2024) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2024.2336099 · Cited by 6 · see citing works
Trial and Error (-Related Negativity):An Odyssey of Integrating Different Experimental Paradigms
Traxler, J., Philips, R. V., von Leupoldt, A., & Vlaeyen, J. W. S. (2020) · Journal of Trial and Error · doi:10.36850/e2 · Cited by 5 · see citing works
What are the functional and clinical characteristics shared by fibromyalgia and low back pain? A scoping review
Couëpel, B., Tremblay, M., Bernier, M., Abboud, J., & Descarreaux, M. (2024) · BMC Rheumatology · doi:10.1186/s41927-024-00430-6 · Cited by 6 · see citing works
Effect of weighted blankets on sleep quality among adults with insomnia: a pilot randomized controlled trial
Yu, J., Du, J., Yang, Z., Chen, W., Sun, S., Gan, M., Cai, Y., Zhang, L., Sun, K., Xu, Q., et al. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-06218-9 · Cited by 5 · see citing works
Action observation as a treatment option for fear avoidance behavior in chronic spinal pain
Neelapala, Y. V. R., & Shankaranarayana, A. M. (2019) · Medical Hypotheses · doi:10.1016/j.mehy.2019.109535 · Cited by 5 · see citing works
Fear-avoidance beliefs increase the perception of pain and disability in Saudi Arabian patients with chronic low back pain
Alotaibi, M. A., Alhowimel, A., Alodaibi, F. A., Alimam, D., Alghadier, M., & Elnaggar, R. (2025) · Medicine · doi:10.1097/md.0000000000043510 · Cited by 3 · see citing works
Are depression, anxiety, and fear-avoidance predictors of outcomes after digital care for chronic musculoskeletal pain?
Janela, D., Tong, X., Areias, A. C., Pires, D., Costa, F. M. T. A., & Fonseca, H. (2025) · PAIN Reports · doi:10.1097/pr9.0000000000001319 · Cited by 4 · see citing works
Physical therapist guided active intervention of chronic temporomandibular disorder presenting as ear pain: A case report
Anandkumar, S., & Manivasagam, M. (2021) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2021.1938307 · Cited by 4 · see citing works
Development of the Chronic Pain Cognition Scale: A Culture-Sensitive Pain Measurement in Chinese
Wu, C., Chou, W., Long, Y.-H., Yang, H.-H., Lin, T., Yang, C.-C., Sun, W., Chen, C., & Lin, C. (2023) · Journal of Pain Research · doi:10.2147/jpr.s422197 · Cited by 4 · see citing works
Psychological and immunological associations with movement-evoked low back pain among older adults
Kahan, R., Woznowski‐Vu, A., Huebner, J. L., Pieper, C. F., Goode, A. P., George, S. Z., Wideman, T. H., Kraus, V. B., Colon-Emeric, C. S., & Simon, C. B. (2025) · PAIN Reports · doi:10.1097/pr9.0000000000001262 · Cited by 4 · see citing works
Chronic Pain in Autism
Garriga‐Cazorla, H., Roman‐Juan, J., Martí, L., Solé, E., Martínez‐Leal, R., & Miró, J. (2025) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000001296 · Cited by 4 · see citing works
Effect Sizes Reported in Highly Cited Emotion Research Compared With Larger Studies and Meta-Analyses Addressing the Same Questions
Cristea, I. A., Georgescu, R., & Ioannidis, J. P. A. (2021) · Clinical Psychological Science · doi:10.1177/21677026211049366 · Cited by 4 · see citing works
Pain by mistake: investigating a link between error-related negativity and pain avoidance behavior
Traxler, J., von Leupoldt, A., & Vlaeyen, J. W. S. (2021) · Pain · doi:10.1097/j.pain.0000000000002358 · Cited by 3 · see citing works
Explaining trunk strength variation and improvement following resistance training in people with chronic low back pain: clinical and performance-based outcomes analysis
Althobaiti, S., Jiménez-Grande, D., Deane, J. A., & Falla, D. (2025) · Scientific Reports · doi:10.1038/s41598-025-93280-2 · Cited by 3 · see citing works
Somatosensory and prefrontal cortex activity relates to emotional outcomes and hair cortisol concentration in chronic postsurgical pain
Moreland, M., Curry, C., Wang, A., Vansickel, M., Wu, Z., & Sieberg, C. B. (2025) · Scientific Reports · doi:10.1038/s41598-025-00685-0 · Cited by 3 · see citing works
Is chronic neck pain related to scapular dyskinesia? A systematic review
Javdaneh, N., Barati, A., Shojaedin, S. S., & Mirzaei, R. M. (2025) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-025-08916-1 · Cited by 3 · see citing works
Exposure-based Interventions for Chronic Pain and Bodily Symptoms: A Special Interest Meeting Report
Schemer, L., Glogan, E., Sjouwerman, R., Ahm, R., Ashar, Y. K., Boddez, Y., Boersma, K., Cañeiro, J. P., Cima, R. F. F., den Hollander, M., et al. (2026) · Behaviour Research and Therapy · doi:10.1016/j.brat.2026.104998 · Cited by 3 · see citing works
Setting the stage for pain relief: how treatment setting impacts interdisciplinary multimodal pain treatment for patients with chronic back pain
Maser, D., Müßgens, D., Kleine‐Borgmann, J., Kincses, B., Schmidt, K., Elsenbruch, S., Müller, D., & Bingel, U. (2024) · Pain · doi:10.1097/j.pain.0000000000003318 · Cited by 3 · see citing works
Correlation between chronic pain, disability, and psychological factors (depression and anxiety) after surgery for acute orthopedic trauma
Yang, G., Li, D., & Cao, Y. (2025) · World Journal of Psychiatry · doi:10.5498/wjp.v15.i11.108185 · Cited by 3 · see citing works
Psychological Treatment Considerations in Medical Comorbidity
Farris, S. G., Kibbey, M. M., Fedorenko, E. J., Babu, A. A., Gomez, G. J., & Smith, J. E. (2021) · Comprehensive Clinical Psychology · doi:10.1016/b978-0-12-818697-8.00195-3 · Cited by 3 · see citing works
PREVALENCE OF CHRONIC NON-SPECIFIC MUSCULOSKELETAL PAIN IN HOUSEHOLD FEMALES, AND ITS IMPACT ON THEIR QUALITY OF LIFE
Basharat, A., Qamar, M. M., Nasir, H. S., & Faraz, K. (2022) · Pakistan Journal of Rehabilitation · doi:10.36283/pjr.zu.11.1/007 · Cited by 3 · see citing works
Cognitive behavioral therapy for chronic pain and opioid use disorder
Gazzola, M. G., Beitel, M., Cutter, C. J., & Barry, D. T. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-820237-1.00022-3 · Cited by 3 · see citing works
Alt Ekstremitenin Kronik Ortopedik Problemlerinde Ağrı, Hareket Korkusu ve Kaygı Düzeyi Arasındaki İlişkinin Araştırılması
Numanoğlu, E. A., Arık, A., Gökşen, A., Canlı, K., Yıldız, N. T., Coşkun, G., Erden, Z., & Can, F. (2023) · Hacettepe Üniversitesi Sağlık Bilimleri Fakültesi Dergisi · doi:10.21020/husbfd.1178079 · Cited by 2 · see citing works
The Effect of Foot Reflexology on Pain, Anxiety and Mobility in Patients with Knee Arthroplasty
Güven, D. Y., & Bulut, H. (2025) · Journal of Nursology · doi:10.17049/jnursology.1575904 · Cited by 2 · see citing works
Experience of endometriosis pain: a qualitative study
Williams, A. C. D. C., Azadi, A., & McGrigor, H. (2025) · Pain · doi:10.1097/j.pain.0000000000003763 · Cited by 2 · see citing works
Association between pain intensity, range of motion, disability, and mental health-related quality of life variables in frozen shoulder: A cross-sectional study
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Acceptability of a physiotherapeutic pain school treatment in trauma-affected populations in the Middle Eastern & Northern African region
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Authors: Martinez-Calderon, J., Flores-Cortes, M., Morales-Asencio, J. M., & Luque-Suarez, A.
ORCID: Morales-Asencio, Jose Miguel
Venue: The Journal of Pain
Publisher: Elsevier BV
Published: 2019-12
Volume: 20
Issue: 12
Pages: 1394-1415
ISSN: 1526-5900 (ISSN-L)
DOI: 10.1016/j.jpain.2019.04.009
OpenAlex: W2944252725
Cited by: 141
References: 161
Citations by year: 2026: 14 · 2025: 31 · 2024: 21 · 2023: 25 · 2022: 18 · 2021: 15 · 2020: 15 · 2019: 2
FWCI: 1.61
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 1380 d)
Locations: Journal of Pain (publishedVersion)
PubMed (publishedVersion)
Funders: Universidad de Málaga
Topics: Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
Keywords: fear of pain, chronic musculoskeletal pain, pain intensity, disability, pain-related anxiety, fear-avoidance beliefs
MeSH terms: Fear, Humans, Male, Chronic Pain, Musculoskeletal Pain, Observational Studies as Topic

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Pain-Related Fear, Pain Intensity and Function in Individuals With Chronic Musculoskeletal Pain: A Systematic Review and Meta-Analysis

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