Big Five Personality Traits and Disabling Chronic Low Back Pain: Association with Fear-Avoidance, Anxious and Depressive Moods
Open accessAbstract
Purpose: Physical dysfunction in chronic low back pain patients is influenced by psychological variables rather than by pain severity. Assessing personality traits may help clinicians address the complexity of patients’ experiences and design treatments that target these vulnerabilities. This study aimed to identify the distinguishing personality traits of a cohort of patients with disabling chronic low back pain and to determine associations between those traits and fear-avoidance beliefs, depressive, and anxious moods. Patients and Methods: This cross-sectional study included 102 chronic low back pain patients (57% male), who failed standard management and were referred to a multidisciplinary rehabilitation program. All patients completed the five domains of the NEO Personality Inventory (NEO PI)–Revised (Neuroticism, Extraversion, Openness to experience, Agreeableness and Conscientiousness), the Tampa Scale for Kinesiophobia (TSK), and the Hospital Anxiety and Depression Scale (HADS). One-sample t -test was used to compare sample personality means with average population norms. Association between the five personality domains with TSK and HADS was assessed using Pearson’s correlation, adjusted for patient demographics and pain-related variables. Linear regression was used to estimate associations adjusted for covariates. Results: Both men and women had significantly lower scores in the Openness to experience domain and significantly higher scores in the Conscientiousness domain than the general population norms. After adjusting for covariates, Neuroticism was associated with higher fear-avoidance, depression and anxiety scores. Conversely, Extraversion and Openness to experience negatively correlated with depression scores. Extraversion also inversely correlated with fear-avoidance. Conscientiousness negatively correlated with depression and anxiety after adjustment. Conclusion: Patients with disabling chronic low back pain show personality characteristics that deviate significantly from the normal population norms but do not reach maladaptive forms of personality disorders. Clinicians would benefit from assessing patients’ personality traits to address protective and risk factors for psychological distress, particularly in difficult-to-treat, highly disabled low back pain patients. Keywords: NEO PI, anxiety, depression, kinesiophobia, chronic low back pain, personality
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Extraversion shows some relationship with fewer MSK complaints.
“Extraversion shows some relationship with fewer MSK complaints, but one study in military trainees found that high extraversion and neuroticism predicted increased self-report of MSK complaints (Ibrahim et al., 2020;Malchaire et al., 2001;Oron & Reichenberg, 2003).”
From Beyond yellow flags: The Big‐Five personality traits and psychologically informed musculoskeletal rehabilitation. (2023) · cites this paper as Ibrahim et al., 2020
The Results (Table 3; page unavailable) show that, among patients with disabling chronic low back pain, extraversion was associated with lower depression scores and, after adjustment, lower fear-avoidance. The paper does not establish that more extraverted people reported fewer musculoskeletal complaints; those are different outcomes. (LLM, conf=0.83)
Experimental — accuracy not yet measuredThe most consistent finding in this body of work is that neuroticism is associated with MSK health complaints, non-adherence to exercise programing, and other markers of poor psychosocial function in a rehab setting.
“The most consistent finding in this body of work is that neuroticism is associated with MSK health complaints, non-adherence to exercise programing, and other markers of poor psychosocial function in a rehab setting (Ibrahim et al., 2020;Mercurio et al., 2020;Talaei-Khoei et al., 2018;Vogel et al., 2019;Wright et al., 2014).”
From Beyond yellow flags: The Big‐Five personality traits and psychologically informed musculoskeletal rehabilitation. (2023) · cites this paper as Ibrahim et al., 2020
The Results report that neuroticism was associated with greater fear-avoidance, depression, and anxiety among 102 patients entering a chronic low-back-pain rehabilitation program. The paper does not establish an association between neuroticism and exercise-program non-adherence or musculoskeletal health complaints more broadly; the Discussion notes that this patient group did not have elevated neuroticism. (LLM, conf=0.88)
Experimental — accuracy not yet measuredOne study in military trainees found that high extraversion and neuroticism predicted increased self-report of MSK complaints.
“Extraversion shows some relationship with fewer MSK complaints, but one study in military trainees found that high extraversion and neuroticism predicted increased self-report of MSK complaints (Ibrahim et al., 2020;Malchaire et al., 2001;Oron & Reichenberg, 2003).”
From Beyond yellow flags: The Big‐Five personality traits and psychologically informed musculoskeletal rehabilitation. (2023) · cites this paper as Ibrahim et al., 2020
The Patients and Methods section describes a study of 102 patients with disabling chronic low back pain, not military trainees. The Results link neuroticism and extraversion to fear-avoidance and mood, but do not address whether either trait predicts trainees’ self-reported musculoskeletal complaints. Searches for military trainees and those complaints found no supporting passage in our copy. (LLM, conf=0.76)
Experimental — accuracy not yet measured
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Meduri, A., Merlo, E. M., Sparacino, G., Luca, L. D., Mancini, M., Oliverio, G. W., Palino, P., Silvestro, O., Martino, G., & Aragona, P. (2026) · Frontiers in Medicine · doi:10.3389/fmed.2026.1776417 · Cited by 1 · see citing works
“…personality traits and symptom burden have been reported across other chronic medical conditions, where traits such as neuroticism influence patient-reported outcomes and psychological adjustment, suggesting that the mechanisms observed in Dry Eye Disease may extend beyond ocular pathology (96).”
Schwendenmann, Y., Palacios, P., Descarreaux, M., & Marchand, A.-A. (2026) · European Journal of Pain · doi:10.1002/ejp.70374 · Cited by 1 · see citing works
García, M. Z., Santamaría, G., Seco-Casares, M., Miguel, A. M., Caeiro, E. M. L., Sierra, J. F. G., & Fernández‐Lázaro, D. (2024) · Safety · doi:10.3390/safety10010012 · Cited by 1 · see citing works
Teixidó-Abiol, L., de Arriba‐Arnau, A., Montesinos, J. S., Gil-Gallardo, G. H., Sánchez, M. J., & Sanctis, V. D. (2022) · International journal of psychological research · doi:10.21500/20112084.5631 · Cited by 1 · see citing works
“…personality disorder and coincides with previous results describing difficulties in acquiring coping strategies for pain (Ibrahim et al., 2020), manifesting with harm avoidance and low self-directedness (Gustin et al., 2015; Ibrahim et al., 2020; Kato et al., 2017; Naylor et al., 2017).”
Influentialعوامل الخطر والوقایة المؤثرة على النتائج الصحیة والنفسیة لمرضی الألم العضلی اللیفی
الشناوي, ن. إ. (2023) · دراسات نفسية · doi:10.21608/psj.2023.174919.1055
Intervención psicofisiológica basada en la Teoría Polivagal para manejo del dolor lumbar crónico
Sandoval, I. A. M., Alva, G. L., Velázquez, A. M. P., Figuerola-Escoto, R. P., Silva, P. Z., & Medina, D. A. R. (2023) · Acta de Investigación Psicológica · doi:10.22201/fpsi.20074719e.2023.1.471
Chapleau, R. R. (2023) · medRxiv · doi:10.1101/2023.05.16.23289997
“In a recent study, while neuroticism was not significantly associated with debilitating lower back pain, high neuroticism was associated with use of coping strategies to control and adjust pain [33].”
Backgroundالشناوي, ن. إ. (2023) · مجلة الدراسات النفسیة المعاصرة جامعة بنى سویف · doi:10.21608/bshjo.2023.195537.1043
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“A correlation has been shown between high neuroticism and musculoskeletal complaints, most notably back pain [41–43] and tension headaches [44].”
Personality traits: an important factor affecting fear of movement in dialysis patients
Zhang, Y., Zhang, R., Miao, X., Li, M., Zhang, L., Li, L., Liu, Y., Shao, Q., Ding, L., Su, T., et al. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1574232
Shavit, R., Kushnir, T., Nudelman, Y., & Springer, S. (2025) · PLoS ONE · doi:10.1371/journal.pone.0323580
“Perceptions of reassurance messages may be influenced by traits associated with neuroticism, such as emotional instability, anxiety, catastrophizing, and self-consciousness [30,31].”
Farmer, A., Kumar, S., Truong, H., & Brinsley, J. (2025) · Musculoskeletal Science and Practice · doi:10.1016/j.msksp.2025.103424
Navid, S., Gutierrez, S., Saenz, J. L., & Milani, S. A. (2025) · Aging & Mental Health · doi:10.1080/13607863.2025.2597963
“Other traits, such as neuroticism, are associated with depressive symptoms among those with pain (Ibrahim et al., 2020), but data on these other traits are not collected in the MHAS.”
Kiel, S., Raus, C., Sierocinski, E., Knauthe, P., & Chenot, J. (2020) · Figshare · doi:10.6084/m9.figshare.13467215
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Hayashi, K., Miki, K., Fukushima, Y., Iwai, M., Shiro, Y., Tetsunaga, T., Takasusuki, T., Hosoi, M., Yukioka, M., & Okada, S. (2026) · PLoS ONE · doi:10.1371/journal.pone.0354827
Ahmed, G. K., Khalifa, H., Abdelrahman, A. A., El-Awamy, A., Adeeb, C. A., & Haridy, N. A. (2026) · Middle East Current Psychiatry · doi:10.1186/s43045-026-00675-6
“…as the dominant personality correlate of depression is notable — neuroticism was strongly correlated with depression on univariable analysis but did not survive adjustment — and is compatible with reports that low conscientiousness marks reduced self-regulatory capacity in chronic pain [57].”
Perfectionism and Chronic Pain: A Scoping Review.
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- Authors
- Ibrahim, M. E., Weber, K., Courvoisier, D. S., & Genevay, S.
- Affiliations
- Suez Canal University (EG)
- University Hospital of Geneva (CH)
- University of Geneva (CH)
- Corresponding author
- Ibrahim, Maha Emad
- Venue
- Journal of Pain Research
- Publisher
- Informa UK Limited
- Published
- 2020-04
- Volume
- Volume 13
- Pages
- 745-754
- ISSN
- 1178-7090 (ISSN-L)
- PMC
- PMC7167306
- OpenAlex
- W3016011721
- Cited by
- 48
- References
- 52
- Citations by year
- 2026: 7 · 2025: 6 · 2024: 6 · 2023: 12 · 2022: 12 · 2021: 3 · 2020: 2
- FWCI
- 4.35
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal of Pain Research (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Archive ouverte UNIGE (University of Geneva) (publishedVersion, other-oa)
- Dove Medical Press (Taylor and Francis Group) (submittedVersion, cc-by-nc)
- Archive ouverte UNIGE (University of Geneva) (submittedVersion, cc-by-nc)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Social Sciences › Psychology › Clinical Psychology › Personality Traits and Psychology
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Keywords
- chronic low back pain, Big Five personality traits, neuroticism, extraversion, openness to experience, conscientiousness, agreeableness, fear-avoidance beliefs, kinesiophobia, depression, anxiety, psychological distress, multidisciplinary rehabilitation
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