Fear-avoidance beliefs increase the perception of pain and disability in Saudi Arabian patients with chronic low back pain

Fear-avoidance beliefs are recognized globally as psychological factors contributing to chronic low back pain (CLBP), influencing pain perception and disability. While this relationship has been explored across various populations, there is limited evidence in Asian countries, including Saudi Arabia. Understanding regional variations is essential for developing culturally sensitive interventions. This study analyzes the relationship between fear-avoidance beliefs with pain and disability in Saudi Arabian patients with CLBP and analyze potential differences between subgroups according to the time of evolution. A cross-sectional study was conducted among 178 patients aged 18 to 65 years diagnosed with CLBP. Sociodemographic data, pain intensity, disability (Roland Morris Questionnaire), and fear-avoidance beliefs questionnaire were collected. Participants had a mean age of 42.3 ± 11.6 years; 50% were male, for the disability model, the significant predictors were interference, fear-avoidance beliefs questionnaire-physical activity, and occupation. The significant predictors for the pain intensity model were interference, age, and duration. The R2 for the disability model was 0.33, indicating that the included variables can explain 33% of the variance in disability, while the R2 for the pain intensity model was 0.50, indicating that the included variables can explain 50% of the variance in pain intensity. Fear-avoidance beliefs and pain interference significantly contribute to disability and pain in Saudi CLBP patients. Although age was a contributing factor, the wide age range may limit generalizability. These findings, however, emphasize the need for pain interference and fear-avoidance interventions in patients with CLBP to reduce disability and improve outcomes.