The model of fear of movement/(re)injury runs clockwise from catastrophizing: evidence from a sample of outpatients with chronic non-specific low back pain

Objective: To provide evidence that catastrophizing is the primer of the cognitive-behavioural model of fear of movement/(re)injury (FAM). Design: A cross-sectional analysis of 180 outpatients with chronic non-specific low back pain who completed the Pain Catastrophizing Scale (PCS), the Tampa Scale of Kinesiophobia (TSK), the Roland-Morris Disability Questionnaire (RMDQ), the Hospital Anxiety and Depression Scale - Depression (HADS-D), and a pain intensity numerical rating scale (NRS). The intercorrelations of the outcome measures were estimated using Pearson's correlation coefficient (r), and regression analyses were used to examine their predictive values by following the left side of the FAM clockwise from the PCS (p = 0.05). A postdictive analysis dichotomizing the sample into high- and low-level catastrophizers evaluated the effects of addressing catastrophizing on disability and pain. Results: The intercorrelations of the PCS with the TSK, RMDQ, HADS-D and NRS were respectively r = 0.59, r = 0.54, r = 0.18, and r = 0.44. PCS was a significant predictor of TSK; PCS and TSK significantly predicted RMDQ and HADS-D; and PCS, TSK, RMDQ and HADS-D significantly predicted NRS. The postdictive analysis showed that addressing catastrophizing reduces disability and pain experience by 14% in high-level catastrophizers and 86% in low-level catastrophizers. Conclusion: Our findings provide evidence that catastrophizing is the primer of the FAM.