Pain Behavior and the Development of Pain-related Disability: The Importance of Guarding

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To examine prospectively the association between the 4 categories of objectively assessed pain behavior and various disability outcomes. In the present study, relationships among the 4 categories of pain behavior and various disability-related outcomes were examined.


One hundred forty-eight workers were identified within 6 weeks of a first episode of low-back pain in the workplace. During a physical examination, observations were made of guarding, words, sounds, and facial expressions of pain. Three months later, participants were evaluated with respect to return to work and standardized self-report measures of pain-related disability. Administrative records were examined to determine the number of days lost and costs associated with their rehabilitation.


Only guarding showed consistent prospective associations with all disability outcomes. When examined in the context of other variables that have been associated with disability in the same population, guarding showed consistent independent associations.


Guarding behavior may play a role in the transition from acute to chronic pain. The findings underscore the multidimensional nature of pain behavior and suggest that there is value in examining overt pain behaviors in prospective studies of the development of chronic occupational pain disability.

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