Fear-avoidance, an important model in the understanding of chronic pain, has not yet been studied in patients with burns. The purpose of this study was to investigate if recovered burn patients have fear-avoidance beliefs and to explore the association with psychological and somatic symptoms. Eighty-four recovered burn patients completed self-report questionnaires. The results showed that there were fear-avoidance beliefs, but not to a large extent. Beta coefficients from multiple regression analyses indicated a strong association between fear-avoidance and problems with work, heat sensitivity and arousal symptoms. The model was capable of explaining 73 per cent of the variance in fear-avoidance beliefs.
American Psychiatric Association . (1994). Diagnostic and statistical manual of mental disorders, 4th edn.Washington, DC: APA .
2.
Asmundson, G. J. G. , Norton, P. J. , & Norton, G. R. (1999). Beyond pain: The role of fear and avoidance in chronicity . Clinical Psychology Review, 19, 97-119 .
3.
Blades, B. , Mellis, N. , & Munster, A. M. (1982). A burn specific health scale . Journal of Trauma, 22, 872-875 .
4.
Browne, G. , Byrne, C. , Brown, B. , Pennock, M. , Streiner, D. , Roberts R. , Eyles, P. , Truscott, D. , & Dabbs, R. (1985). Psychological adjustment of burn survivors . Burns, 12, 28-35 .
5.
Buer, N. , & Linton, S. J. (2002). Fear-avoidance beliefs and catastrophizing: Occurrence and risk factor in back pain and ADL in the general population . Pain, 99, 485-491 .
Crombez, G. , Vlaeyen, J. W. S. , Heuts, P. H. T. G. , & Lysens, R. (1999). Fear of pain is more disabling than pain itself: Evidence on the role of pain-related fear in chronic back pain disability . Pain, 80, 329-340 .
8.
Difede, J. A. , Jaffe, A. B. , Musngi, G. , Perry, S. , & Yurt, R. (1997). Determinants of pain expression in hospitalized burn patients . Pain, 72, 245-251 .
9.
Hayes, S. C. , Wilson, K. G. , Gifford, E. V. , Follette, V. M. , & Strosahl, K. (1996). Experimental avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment . Journal of Consulting and Clinical Psychology, 64, 1152-1168 .
10.
Herrmann, C. (1997). International experiences with the hospital anxiety and depression scale—a review of validation data and clinical results . Journal of Psychosomatic Research, 42, 17-41 .
11.
Horowitz, M. , Wilner, N. , & Alvarez, W. (1979). Impact of event scale: A measure of subjective stress . Psychosomatic Medicine, 41, 209-218 .
12.
Johnston, M. , Pollard, B. , & Hennessey, P. (2000). Construct validation of the hospital anxiety and depression scale with clinical populations . Journal of Psychosomatic Research, 48, 579-584 .
13.
Joseph, S. (2000). Psychometric evaluation of Horowitz’s impact of event scale: A review . Journal of Traumatic Stress, 13, 101-113 .
14.
Kildal, M. , Andersson, G. , Fugl-Meyer, A. R. , Lannerstam, K. , & Gerdin, B. (2001). Development of a brief version of the burn specific health scale (BSHS-B) . Journal of Trauma, 51, 740-746 .
15.
Klenerman, L. , Slade, P. D. , Stanley, I. M. , Pennie, B. , Reilly, J. P. , Atchison, L. E. , Troup, J. D. , & Rose, M. J. (1995). The prediction of chronicity in patients with an acute attack of low back pain in a general practice setting . Spine, 20, 478-484 .
16.
Knudson-Cooper, M. (1981). Adjustment to visible stigma: The case of the severely burned . Social Science and Medicine, 15B, 31-44 .
17.
Kori, S. H. , Miller, R. P. , & Todd, D. D. (1990). Kinesiophobia: A new view of chronic pain behavior . Pain Management, Jan/Feb, 35-43 .
18.
Lethem, J. , Slade, P. D. , Troup, J. D. G. , & Bentley, G. (1983). Outline of a fear-avoidance model of exaggerated pain perception—I . Behaviour Research and Therapy, 21, 401-408 .
19.
Linton, S. J. , Buer, N. , Vlaeyen, J. , & Hellsing, A.-L. (2000). Are fear-avoidance beliefs related to the inception of an episode of back pain? A prospective study . Psychology and Health, 14, 1051-1059 .
20.
Love, B. , Byrne, C. , Roberts, J. , Browne, G. , & Brown, B. (1987). Adult psychosocial adjustment following childhood injury: The effect of disfigurement . Journal of Burn Care and Rehabilitation, 8, 280-285 .
21.
Malenfant, A. , Forget, R. , Papillon, J. , Amsel, R. , Frigon, J.-Y. , & Chonière, M. (1996). Prevalence and characteristics of chronic sensory problems in burn patients . Pain, 67, 493-500 .
22.
Malt, U. , & Ugland, O. A. (1989). A long term psychosocial follow-up study of burned adults . Acta Psychiatrica Scandinavia, 335(Supp. 80), 94-102 .
23.
Melzack, R. (1990). The tragedy of needless pain . Scientific American, 262, 27-33 .
24.
Munster, A. M. (1999). Measurement of quality of life: Then and now . Burns, 25, 25-28 .
25.
Patterson, D. R. , Everett, J. J. , Bombardier, C. H. , Questad, K. A. , Lee, V. K. , & Marvin, J. A. (1993). Psychological effects of severe burn injuries . Psychological Bulletin, 113, 362-378 .
26.
Penley, J. A. , Tomaka, J. , & Wiebe, J. S. (2002). The association of coping to physical and psychological health outcomes: A meta-analytic review . Journal of Behavioral Medicine, 25, 551-603 .
27.
Pruzinsky, T. , Rice, L. D. , Himmel, H. N. , Morgan, R. F. , & Edlich, R. F. (1992). Psychometric assessment of psychological factors influencing adult burn rehabilitation . Journal of Burn Care and Rehabilitation, 13, 79-88 .
28.
Saffle, J. R. (1998). Predicting outcomes of burns . New England Journal of Medicine, 338, 340-346 .
29.
Taal, L.A. , & Faber, A.W. (1998). Posttraumatic stress and maladjustment among adult burn survivors 1 to 2 years postburn. Part II: The interview data . Burns, 24, 399-405 .
30.
Tarrier, N. (1995). Psychological morbidity in adult burns patients: Prevalence and treatment . Journal of Mental Health, 1, 51-62 .
31.
Tedstone, J. E. , & Tarrier, N. (1997). An investigation of the prevalence of psychological morbidity in burn injured patients . Burns, 23, 550-554 .
32.
Van Loey, N. E. , & van Son, M. J. (2003). Psychopathology and psychological problems in patients with burn scars: Epidemiology and management . American Journal of Clinical Dermatology, 4, 245-272 .
33.
Vlaeyen, J. W. S. , de Jong, J. , Geilen, M. , Heuts, P. H. T. G. , & van Breukelen, G. (2001). Graded exposure in vivo in the treatment of pain-related fear: A replicated single-case experimental design in four patients with chronic low back pain . Behaviour Research and Therapy, 39, 151-166 .
34.
Vlaeyen, J.W. S. , & Linton, S. J. (2000). Fear-avoidance and its consequences in chronic musculoskeletal pain: A state of the art . Pain, 85, 317-332 .
35.
Wadell, G. , Newton, M. , Henderson, I. , Somerville, D. , & Main, C. (1993). A fear-avoidance beliefs questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability . Pain, 52, 157-168 .
36.
Weiss, D. S. , & Marmar, C. R. (1997). The impact of event scale—revised. In J. P. Wilson & T. M. Keane (Eds.), Assessing psychological trauma and PTSD (pp. 399-411). New York: Guilford Press .
37.
Willebrand, M. , Kildal, M. , Ekselius, L. , Gerdin, B. , & Andersson, G. (2001). Development of the coping with burns questionnaire . Personality and Individual Differences, 30, 1059-1072 .
38.
Willebrand, M. , Norlund, F. , Kildal, M. , Gerdin, B. , Ekselius, L. , & Andersson, G. (2002). Cognitive distortions in recovered burn patients: The emotional stroop task and autobiographical memory test . Burns, 28, 465-471 .
39.
Williams, E. , & Griffiths, T. (1991). Psychological consequences of burn injury . Burns, 17, 478-480 .
40.
Zigmond, A. S. , & Snaith, R. P. (1983). The hospital anxiety and depression scale . Acta Psychiatrica Scandinavia, 67, 361-370 .
