Fear-Avoidance Beliefs and Chronic Pain

Abstract

Fear-avoidance (FA) beliefs are significantly associated with the experience of pain, especially when the pain becomes chronic in nature. The anticipated threat of intense pain will often result in the constant vigilance and monitoring of pain sensations, which, in turn, can cause even low-intensity sensations of pain to become unbearable for the person. Just the anticipation of increased pain or reinjury can further stimulate avoidance behaviors. A vicious cycle may develop, in which fears of increased pain or reinjury contribute to the avoidance of many activities, leading to inactivity and, ultimately, to greater disability. Anyone who assesses and treats pain-related disability should also be prepared to assess and treat pain-related FA.

High Disease Activity May Increase Fear-Avoidance Beliefs in Rheumatoid Arthritis

“…Therefore, higher FA beliefs in non-remission RA patients may preclude return to work, related with reduced physical activity and chronic pain syndrome. 1,28 Unlike the literature, our results did not show any association between disease chronicity and increased FA beliefs. 3 In our study, there was no difference in mFABQ scores according to the disease duration of RA patients.…”

“…Finally, mFABQ total score was sum of these two scores. All scores dichotomized as low (mFABQ physical activity score [0-6], mFABQ work score [0][1][2][3][4][5][6][7][8][9][10][11][12] and mFABQ total score [0-18]) or high (mFABQ physical activity score [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24], mFABQ work score and mFABQ total score ) according to medians of a previous study. 19 All patients were literate and none of the patients had pathological finding in the examinations that may influence the questionnaire.…”

“…1 These beliefs are thought to be related with the development of chronic pain syndrome in some individuals with musculoskeletal pain. 2 As fear and anxiety were found to be natural responses to impending pain, a FA model of exaggerated pain perceptions was postulated which depends on cognitive-behavioral accounts.…”

Rehabilitation management of low back pain – it’s time to pull it all together!

“…If a patient is categorized into a medium- to high-risk category, psychological interventions as part of the rehabilitation plan are likely to be beneficial. Consequently, for patients at risk, the clinician could also investigate for the presence of other specific maladaptive cognitions, such as fear avoidance, pain catastrophizing, poor coping, and low self-efficacy, as they are known to be potentially modifiable through rehabilitation and psychologically informed PT interventions 81. Clinical studies have shown that when these elements are targeted through a psychologically informed treatment approach, positive outcomes in pain and function are often observable 82,83.…”

A preliminary biopsychosocial analysis of online information on causes of neck pain

“…The features of psychological distress, self-efficacy and fear avoidance were additionally found to mediate the disability resulting from neck pain (Mäntyselkä et al, 2010). Fear avoidance behaviour implies that individuals with pain would themselves limit the movements or physical activities that are perceived to provoke pain or worsen the tissue injury (Gatchel, Neblett, Kishino, & Ray, 2016). The beliefs held by people with chronic pain about their ability to perform physical activities despite the existence of pain can be described as their self-efficacy (Ahmed et al, 2018).…”