. The dominant role that psychosocial factors play in the development of chronic disability from low back pain has been well established in the literature. As a result, the investigation of biopsychosocial models for treatment of low back pain has been advocated by researchers. The Fear-Avoidance Model of Exaggerated Pain Perception (FAMEPP) is a biopsychosocial model that proposes an individual's pain related fear and avoidance is the most important factor in determining whether chronic disability results from an episode of low back pain. In the FAMEPP, individuals with high pain related fear and avoidance are hypothesized to use an avoidance response to low back pain and have deleterious physical and psychological consequences. Individuals with low pain related fear and avoidance are hypothesized to use a confrontation response to low back pain and gradually return to their normal social and physical functioning. Support for the validity of the FAMEPP is found in longitudinal studies that have demonstrated that pain related fear and avoidance significantly predicts future disability after a low back injury. Treatment based on the FAMEPP involves facilitating confrontation in individuals that normally would not use a confrontation response (i.e. those with high pain related fear and avoidance). Two specific behavioral interventions have been used to facilitate confrontation for patients with low back pain. Graded exposure facilitates confrontation by systematically exposing the individual to situations that they are fearful of and gradually increasing their exposure to such situations. Graded exercise facilitates confrontation by systematically increasing the patients' tolerance to activity (graded exercise). Investigations in the literature support the use of these behavioral interventions, but their effectiveness has not been investigated in patients before they have chronic low back pain. Behavioral interventions that effectively reduce future disability before the onset of chronic symptoms could potentially reduce societal and economic costs associated with low back pain. The purpose of this small grant (RO3) research proposal is to determine the efficacy of a graded exposure rehabilitation intervention for reducing future disability from sub-acute low back pain for patients with elevated fear-avoidance beliefs.

Agency
National Institute of Health (NIH)
Institute
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Type
Small Research Grants (R03)
Project #
5R03AR051128-02
Application #
7087979
Study Section
Special Emphasis Panel (ZAR1-EHB-E (M1))
Program Officer
Panagis, James S
Project Start
2005-07-01
Project End
2008-06-30
Budget Start
2006-07-01
Budget End
2007-06-30
Support Year
2
Fiscal Year
2006
Total Cost
$71,040
Indirect Cost
Name
University of Florida
Department
Other Health Professions
Type
Schools of Public Health
DUNS #
969663814
City
Gainesville
State
FL
Country
United States
Zip Code
32611
Robinson, Michael E; George, Steven Z (2012) Screening for problematic low back pain: STarT. Pain 153:2159-60
Beneciuk, Jason M; Robinson, Michael E; George, Steven Z (2012) Low back pain subgroups using fear-avoidance model measures: results of a cluster analysis. Clin J Pain 28:658-66
Valencia, Carolina; Robinson, Michael E; George, Steven Z (2011) Socioeconomic status influences the relationship between fear-avoidance beliefs work and disability. Pain Med 12:328-36
George, Steven Z; Robinson, Michael E (2010) Preference, expectation, and satisfaction in a clinical trial of behavioral interventions for acute and sub-acute low back pain. J Pain 11:1074-82
George, Steven Z; Wittmer, Virgil T; Fillingim, Roger B et al. (2010) Comparison of graded exercise and graded exposure clinical outcomes for patients with chronic low back pain. J Orthop Sports Phys Ther 40:694-704
Hill, Jonathan C; Foster, Nadine E; Main, Chris J et al. (2009) In response to: ""A randomized trial of behavioral physical therapy interventions for acute and sub-acute low back pain, by George SZ et al. [Pain 2008;140:145-57]. Pain 142:164; author response 164-5
George, Steven Z; Valencia, Carolina; Zeppieri Jr, Giorgio et al. (2009) Development of a self-report measure of fearful activities for patients with low back pain: the fear of daily activities questionnaire. Phys Ther 89:969-79
George, Steven Z; Fritz, Julie M; Childs, John D (2008) Investigation of elevated fear-avoidance beliefs for patients with low back pain: a secondary analysis involving patients enrolled in physical therapy clinical trials. J Orthop Sports Phys Ther 38:50-8
Hirsh, Adam T; George, Steven Z; Bialosky, Joel E et al. (2008) Fear of pain, pain catastrophizing, and acute pain perception: relative prediction and timing of assessment. J Pain 9:806-12
George, Steven Z; Zeppieri Jr, Giorgio; Cere, Anthony L et al. (2008) A randomized trial of behavioral physical therapy interventions for acute and sub-acute low back pain (NCT00373867). Pain 140:145-57

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