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

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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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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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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 › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
Health Sciences › Medicine › Physiology (medical) › 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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