A body of evidence has accrued supporting the Fear-Avoidance Model (FAM) of chronic pain which postulated the mediating role of pain-related fear in the relationships between pain catastrophizing and pain anxiety in affecting pain-related outcomes. Yet, relatively little data points to the extent to which the FAM be extended to understand chronic pain in Chinese population and its impact on quality of life (QoL).

This study explored the relationships between FAM components and their effects on QoL in a Chinese sample.

A total of 401 Chinese patients with chronic musculoskeletal pain completed measures of three core FAM components (pain catastrophizing, pain-related fear, and pain anxiety) and QoL. Cross-sectional structural equation modeling (SEM) assessed the goodness of fit of the FAM for two QoL outcomes, Physical (Model 1) and Mental (Model 2). In both models, pain catastrophizing was hypothesized to underpin pain-related fear, thereby influencing pain anxiety and subsequently QoL outcomes.

Results of SEM evidenced adequate data-model fit (CFI³0.90) for the two models tested (Model 1: CFI=0.93; Model 2: CFI=0.94). Specifically, pain catastrophizing significantly predicted pain-related fear (Model 1: stdb=0.90; Model 2: stdb=0.91), which in turn significantly predicted pain anxiety (Model 1: stdb=0.92; Model 2: stdb=0.929) and QoL outcomes in a negative direction (Model 1: stdb=−0.391; Model 2: stdb=−0.651) (all P<0.001) (Table 1, Fig. 1).

Our data substantiated the existing FAM literature and offered evidence for the cross-cultural validity of the FAM in the Chinese population with chronic pain.