Iranian Red Crescent Medical Journal

Published by: Kowsar

The Effects of an Educational Program on Beliefs and Relaxation Behaviors of Patients with Chronic Low Back Pain Referred to Pain Clinics: An Experimental Study

Gholam Ali Heidari 1 and Sedigheh Sadat Tavafian 1 , *
Authors Information
1 Health Education and Health Promotion Department, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
Article information
  • Iranian Red Crescent Medical Journal: December 31, 2018, 20 (S1); e61173
  • Published Online: September 18, 2018
  • Article Type: Research Article
  • Received: August 31, 2017
  • Revised: November 21, 2017
  • Accepted: February 5, 2018
  • DOI: 10.5812/ircmj.61173

To Cite: Heidari G A, Tavafian S S. The Effects of an Educational Program on Beliefs and Relaxation Behaviors of Patients with Chronic Low Back Pain Referred to Pain Clinics: An Experimental Study, Iran Red Crescent Med J. 2018 ; 20(S1):e61173. doi: 10.5812/ircmj.61173.

Copyright © 2018, Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited
1. Background
2. Methods
3. Results
4. Discussion
  • 1. Hung CI, Liu CY, Fu TS. Depression: An important factor associated with disability among patients with chronic low back pain. Int J Psychiatry Med. 2015;49(3):187-98. doi: 10.1177/0091217415573937. [PubMed: 25930736].
  • 2. Eklund A, Bergstrom G, Bodin L, Axen I. Psychological and behavioral differences between low back pain populations: a comparative analysis of chiropractic, primary and secondary care patients. BMC Musculoskelet Disord. 2015;16:306. doi: 10.1186/s12891-015-0753-5. [PubMed: 26483193]. [PubMed Central: PMC4617861].
  • 3. Karimi A, Saeidi M. A review of relationship between fear avoidance beliefs and postural stability in non specific chronic low back pain. J Spine. 2013;2(4). doi: 10.4172/2165-7939.1000139.
  • 4. Pincus T, Burton AK, Vogel S, Field AP. A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain. Spine (Phila Pa 1976). 2002;27(5):E109-20. [PubMed: 11880847].
  • 5. Dedeli O, Kaptan G. Spirituality and religion in pain and pain management. Health Psychol Res. 2013;1(3):29. doi: 10.4081/hpr.2013.1448.
  • 6. Robertson D, Kumbhare D, Nolet P, Srbely J, Newton G. Associations between low back pain and depression and somatization in a Canadian emerging adult population. J Can Chiropr Assoc. 2017;61(2):96-105. [PubMed: 28928493]. [PubMed Central: PMC5596967].
  • 7. Newcomer KL, Shelerud RA, Vickers Douglas KS, Larson DR, Crawford BJ. Anxiety levels, fear-avoidance beliefs, and disability levels at baseline and at 1 year among subjects with acute and chronic low back pain. PM R. 2010;2(6):514-20. doi: 10.1016/j.pmrj.2010.03.034. [PubMed: 20630438].
  • 8. Curtin KB, Norris D. The relationship between chronic musculoskeletal pain, anxiety and mindfulness: Adjustments to the fear-avoidance model of chronic pain. Scand J Pain. 2017;17:156-66. doi: 10.1016/j.sjpain.2017.08.006. [PubMed: 28968567].
  • 9. Topcu SY, Findik UY. Effect of relaxation exercises on controlling postoperative pain. Pain Manag Nurs. 2012;13(1):11-7. doi: 10.1016/j.pmn.2010.07.006. [PubMed: 22341136].
  • 10. Akmese ZB, Oran NT. Effects of progressive muscle relaxation exercises accompanied by music on low back pain and quality of life during pregnancy. J Midwifery Womens Health. 2014;59(5):503-9. doi: 10.1111/jmwh.12176. [PubMed: 24965313].
  • 11. Radat F, Koleck M. [Pain and depression: Cognitive and behavioural mediators of a frequent association]. Encephale. 2011;37(3):172-9. French. doi: 10.1016/j.encep.2010.08.013. [PubMed: 21703432].
  • 12. Domenech J, Banos R, Penalver L, Garcia-Palacios A, Herrero R, Ezzedine A, et al. Design considerations of a randomized clinical trial on a cognitive behavioural intervention using communication and information technologies for managing chronic low back pain. BMC Musculoskelet Disord. 2013;14:142. doi: 10.1186/1471-2474-14-142. [PubMed: 23607895]. [PubMed Central: PMC3655937].
  • 13. Valenzuela-Pascual F, Molina F, Corbi F, Blanco-Blanco J, Gil RM, Soler-Gonzalez J. The influence of a biopsychosocial educational internet-based intervention on pain, dysfunction, quality of life, and pain cognition in chronic low back pain patients in primary care: a mixed methods approach. BMC Med Inform Decis Mak. 2015;15:97. doi: 10.1186/s12911-015-0220-0. [PubMed: 26597937]. [PubMed Central: PMC4657202].
  • 14. Rainville J, Smeets RJ, Bendix T, Tveito TH, Poiraudeau S, Indahl AJ. Fear-avoidance beliefs and pain avoidance in low back pain--translating research into clinical practice. Spine J. 2011;11(9):895-903. doi: 10.1016/j.spinee.2011.08.006. [PubMed: 21907633].
  • 15. Fujii T, Matsudaira K, Oka H. Factors associated with fear-avoidance beliefs about low back pain. J Orthopaed Sci. 2013;18(6):909-15. doi: 10.1007/s00776-013-0448-4.
  • 16. Glanz K, Rimer BK, Viswanath K. Health behavior and health education: theory, research, and practice. 4th ed. San Fransisco, USA: John Wiley & Sons; 2008.
  • 17. Ajzen I. The theory of planned behaviour: reactions and reflections. Psychol Health. 2011;26(9):1113-27. doi: 10.1080/08870446.2011.613995. [PubMed: 21929476].
  • 18. Consort. Consort transparent reporting of trials. Consort,; 2017, [cited Nov 11]. Available from:
  • 19. Heidari GA, Tvafian SS. Predicting relaxation behaviors in patients with chronic low back pain: A theory based study from Yazd, Iran. Int J Musculoskeletal Pain Prevent. 2017;2(2):265-9.
  • 20. Montazeri A, Vahdaninia M, Ebrahimi M, Jarvandi S. The hospital anxiety and depression scale (HADS): translation and validation study of the Iranian version. Health Qual Life Outcomes. 2003;1:14. doi: 10.1186/1477-7525-1-14. [PubMed: 12816545]. [PubMed Central: PMC161819].
  • 21. Jonbozorgi M, Golchin N, Alipour A, Agah Heris M. [The effectiveness of group cognitive-behavior therapy on decreasing severity of pain and psychological distress among women with chronic back pain]. Iran J Psychiatr Clin Psychol. 2013;19(2):102-8. Persian.
  • 22. Rahimian Boogar I, Tabatabaeian M. [Effect of cognitive-behavioral group therapy on depression of the patients with chronic low back pain: A 4-months follow up]. Koomesh. 2012;13(2):209-17. Persian.
  • 23. Sajjadian I, Neshat Dost HT, Molavi H, Bagherian Sararoudi R. Cognitive and emotional factors effective on chronic low back pain in women: Explanation the role of fear-avoidance believes, pain catastrophizing and anxiety. J Res Behav Sci. 2011;9(5):79-90.
  • 24. Henschke N, Ostelo RW, van Tulder MW, Vlaeyen JW, Morley S, Assendelft WJ, et al. Behavioural treatment for chronic low-back pain. Cochrane Database Syst Rev. 2010;7(7).
  • 25. Monticone M, Cedraschi C, Ambrosini E, Rocca B, Fiorentini R, Restelli M, et al. Cognitive-behavioural treatment for subacute and chronic neck pain. Cochrane Database Syst Rev. 2015;(5). CD010664. doi: 10.1002/14651858.CD010664.pub2. [PubMed: 26006174].
  • 26. Hong JH, Kim HD, Shin HH, Huh B. Assessment of depression, anxiety, sleep disturbance, and quality of life in patients with chronic low back pain in Korea. Korean J Anesthesiol. 2014;66(6):444-50. doi: 10.4097/kjae.2014.66.6.444. [PubMed: 25006368]. [PubMed Central: PMC4085265].
  • 27. Tavafian SS, Gregory D, Montazeri A. The experience of low back pain in Iranian women: A focus group study. Health Care Women Int. 2008;29(4):339-48. doi: 10.1080/07399330701876356. [PubMed: 18389431].
  • 28. Tavafian SS, Jamshidi AR, Mohammad K. Treatment of low back pain: Extended follow up of an original trial comparing a multidisciplinary group-based rehabilitation program with oral drug treatment alone up to 36 months. Int J Musculoskeletal Pain Prevent. 2016;1(3):93-100.

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