A new direction for the fear avoidance model?

Pain, 2009

The primary purpose of this study was to analyze the sequential relationships proposed by the fearavoidance model of pain [Vlaeyen JWS et al. The role of fear of movement/(re)injury in pain disability. J Occup Rehab 1995;5:235-52]. Specifically, this study evaluated whether early change in catastrophizing predicted late change in fear of movement, and whether these factors influenced post-treatment returnto-work. Secondary analyses tested relationships between (1) early change in catastrophizing, late change in depression, and disability; and (2) early change in catastrophizing, late change in pain severity, and disability. Analyses were conducted on a sample of 121 individuals (82 men and 32 women) with a work-related musculoskeletal injury, and high baseline catastrophizing and fear of movement scores. Participants were enrolled in a 10-week community-based disability management intervention, and they completed measures of catastrophizing, fear of movement, depression and pain severity at pre-, mid-and post-treatment. Return-to-work was assessed 4 weeks following termination of the intervention. Contrary to predictions, results from correlational analyses revealed non-significant relationships among indices of early change in catastrophizing and late changes in fear of movement, depression and pain severity. Multiple logistic regression analyses revealed that early change in catastrophizing, late changes in fear of movement and late change in pain severity were significant predictors of return-to-work, while late changes in depression were not. These findings highlight the importance of reductions in psychosocial risk factors in augmenting return-to-work outcomes. Implications for the fear-avoidance model and future research are discussed.

Pain, 2000

In an attempt to explain how and why some individuals with musculoskeletal pain develop a chronic pain syndrome, Lethem et al. (Lethem J, Slade PD, Troup JDG, Bentley G. Outline of fear-avoidance model of exaggerated pain perceptions. Behav Res Ther 1983; 21: 401-408).ntroduced a so-called 'fear-avoidance' model. The central concept of their model is fear of pain. 'Confrontation' and 'avoidance' are postulated as the two extreme responses to this fear, of which the former leads to the reduction of fear over time. The latter, however, leads to the maintenance or exacerbation of fear, possibly generating a phobic state. In the last decade, an increasing number of investigations have corroborated and refined the fear-avoidance model. The aim of this paper is to review the existing evidence for the mediating role of pain-related fear, and its immediate and long-term consequences in the initiation and maintenance of chronic pain disability. We first highlight possible precursors of pain-related fear including the role negative appraisal of internal and external stimuli, negative affectivity and anxiety sensitivity may play. Subsequently, a number of fear-related processes will be discussed including escape and avoidance behaviors resulting in poor behavioral performance, hypervigilance to internal and external illness information, muscular reactivity, and physical disuse in terms of deconditioning and guarded movement. We also review the available assessment methods for the quantification of pain-related fear and avoidance. Finally, we discuss the implications of the recent findings for the prevention and treatment of chronic musculoskeletal pain. Although there are still a number of unresolved issues which merit future research attention, pain-related fear and avoidance appear to be an essential feature of the development of a chronic problem for a substantial number of patients with musculoskeletal pain.

The Journal of Pain, 2019

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2012

Behaviour Research and Therapy, 1983

The personal history of pain and personal coping strategies for pain are two of the contributory factors in the Fear-Avoidance Model of exaggerated pain perception proposed by Lethem, Slade, Troup and Bentley (1983, this issue, pp. 401408). In order to test this aspect of the hypothesis, a questionnaire was designed and has been completed by 165 students (93 female, 72 male) at the University of Liverpool. They were asked about the severity of externally-produced pain (e.g. fracture), of internally-produced pain (e.g. headache) and of back pain; about the strategies they adopted for coping with internallyproduced pain (e.g. did they ignore the pain and carry on-an active strategy-or did they go and rest-a passive strategy); and about the effects of back pain on each of IO activities or postures (from 'no effect' to 'had to stop completely') in order to obtain an index of back-pain avoidance. Out of 165.91 reported previous back pain (Back Pain group) and their average rating for the severity of externally-produced pain was significantly higher than for the No Back Pain group; but there were no differences between these two groups for their coping strategies for internally-produced pain. However, of the Back Pain group with two or more previous attacks, 35 gave a history indicating decreasingly severe attacks and 28, increasingly severe: the coping strategies of the latter group for internally-produced pain were significantly more passive. The ratings for severity of back pain correlated significantly with the indices for back-pain avoidance and with the ratings for severity of internally-produced pain. These findings are in line with the prediction that personal pain history and personal coping strategies are relevant to the Fear-Avoidance Model of exaggerated pain perception and may therefore influence the adoption of an avoidance or a confrontation response by the patient with chronic back pain.

Behaviour Research and Therapy, 1983

The present paper describes a theoretical mode1 for exaggerated pain perception which has been generated from a multidisciplinary team approach to the problem of chronic low-back pain. The model is an attempt to explain how and why some individuals develop a more substantial psychological overlay to their pain problem than do others. Central to the model is the concept of 'fear of pain' which, it is suggested, leads to differing responses in different individuals, The two extreme responses are those of 'confrontation' and 'avoidance', although most individuals probably exhibit a mixture of the two. The former, it is argued, leads the individual to resume an increasing range of physical and social activities as the organic basis for the pain resolves and, as a consequence, ensures minimal psychological overlay. By contrast, an avoidance strategy is thought to produce a number of physical and psychological consequences which promote the development of the invalid status and the phenomenon of exaggerated pain perception. The model suggests that the type of strategy adopted (i.e. confrontation or avoidance) is in~uenc~ by a number of psychosocial factors.

Journal of Experimental Psychopathology, 2015

https://www.ijhsr.org/IJHSR_Vol.11_Issue.6_June2021/IJHSR-Abstract.034.html, 2021

Chronic pain has an impact not only on the physical function but also affects the quality of life of an individual. Psychosocial factors play an important role in mediating chronic pain. Fear-avoidance belief is considered as the important psychosocial factor in predicting patient's avoidance for work and physical activity as well as disability and has strong association with chronic pain. The aim of the study is to review the studies on the relationship between chronic pain and fear-avoidance beliefs. Articles from the PubMed, Research gate, Google Scholar and APTA databases were searched for this narrative review with related keywords like chronic pain, chronic musculoskeletal pain, fear avoidance beliefs, psychosocial factors and quality of life. Total fifteen articles were found. Out of which, five were excluded and ten were studied further. The sum of evidences proves that the fearavoidance belief is an important predictor of pain. Through this we conclude that the anticipation of chronic pain can further provoke fear-avoidance behaviour and can give rise to a vicious cycle, in which fear can contribute to avoidance of physical activity and work leading to disability.

Journal of Neurotrauma, 2020

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European Journal of Pain, 2010

Two studies are reported that tested the fear-avoidance (FA) model using path analytic techniques. In study 1, 429 employees with back pain at baseline and back pain at 18 months follow-up completed questionnaires assessing sociodemographic information, pain severity, negative affect, pain-related fear, and disability. Results indicated that pain severity at baseline predicted pain-related fear and disability at follow-up, and that pain-related fear is rather a consequence than an antecedent of pain severity. Results further revealed that the disposition to experience negative affect has a low impact upon pain severity and disability, and is best viewed as a precursor of pain-related fear. Study 2 included 238 employees without back pain at baseline, but who developed back pain at 1 year follow-up. A similar model as in study 1 was tested. Overall, results are in line with those of study 1. Results are discussed in terms of theoretical relevance and clinical implications.