Behavioural activation and inhibition systems in relation to pain intensity and duration in a large chronic musculoskeletal pain sample

Abstract

BACKGROUND: Pain related complaints form one of the most common, and most costly, presentations of patients in healthcare in New Zealand and worldwide. Theories of pain such as the biopsychosocial and fear-avoidance models aim to provide a multidimensional framework from which pain can be approached, considering various aspects of how pain affects people. The most effective pain management approaches seem to be multimodal and patient-specific. The Reinforcement Sensitivity Theory proposes two neurophysiological systems that regulate impulsivity and anxiety in human behaviour: the behavioural activation system and the behavioural inhibition system. It has recently been suggested that sub-grouping individuals affected by pain based on their levels of activation and inhibition could facilitate the allocation of more effective management strategies.

DESIGN Cross-sectional survey design.

AIM: To establish which of the following best predicts average intensity and duration of musculoskeletal pain: fear avoidance beliefs, kinesiophobia, and levels of behavioural activation or inhibition system.

METHODS: Surveys were made available online to adults in New Zealand with pain complaints, and to patients at the Unitec Osteopathic Clinic, Clinic 41. Data were gathered over a three month period and analysed using Spearman’s rho correlations, linear regressions and a between groups analysis assessing for differences between high and low intensity pain and levels of behavioural activation or inhibition.

RESULTS: Correlational analyses showed significant positive relationships between pain intensity and fear-avoidance beliefs, kinesiophobia, and disability, as well as between pain duration and fear-avoidance, kinesiophobia and perceived disability. Regression analyses showed fear-avoidance beliefs, kinesiophobia and disability accounted for 31% of pain intensity variance. Disability alone accounted for 5% of the pain duration variance. Neither iv behavioural activation nor inhibition systems significantly related to or predicted pain intensity or duration.

CONCLUSION: This study provides further support for the inter-relationships between fear avoidance beliefs, kinesiophobia, disability and pain duration and intensity. The results do not show explicit support for the behavioural activation or inhibition systems relating to pain intensity or duration. It is suggested that this may be due to the measurement instrument, which could be explored in further studies..