The modification of avoidance learning pain behaviors

Fordyce, Wilbert E.; Shelton, John L.; Dundore, Diana E.

doi:10.1007/bf00845370

Cited by 116 publications

(37 citation statements)

References 5 publications

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“…Subsequently, the most common approach would be to devise individually tailored practice tasks based on a graded hierarchy of fear-eliciting situations. Such a graded exposure is quite similar to the graded activity programs in that it gradually increases activity levels despite pain (Fordyce et al, 1982(Fordyce et al, , 1986Lindstro Èm et al, 1992), but is quite dissimilar in that it pays special attention to the idiosyncratic aspects of the pain-related fear stimuli. For example, if the patient fears the repetitive spinal compression produced by riding a bicycle on a bumpy road, then the graded exposure should include an activity that mimics that speci®c activity, and not just a stationary bicycle.…”

Section: Clinical Management Of Pain-related Fearmentioning

confidence: 90%

“…Already in 1976, Fordyce devoted nearly ten pages to avoidance learning to explain various pain behaviors in chronic pain patients. Fordyce et al (1982) also described how individuals learn that the avoidance of pain-provoking or pain-increasing situations reduces the likelihood of new pain episodes. The authors also proposed behavioral treatment approaches designed to modify these learned behaviors.…”

Section: Early Views On the Role Of Fear On Painmentioning

confidence: 99%

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Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art

Vlaeyen

Linton

2000

Pain

3,968

171

2,797

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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 a fear-avoidance model of exaggerated pain perceptions. Behav Res Ther 1983;21:401±408) introduced 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 re®ned the fear-avoidance model. The aim of this paper is to review the existing evidence for the mediating role of painrelated fear, and its immediate and long-term consequences in the initiation and maintenance of chronic pain disability. We ®rst 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 quanti®cation of pain-related fear and avoidance. Finally, we discuss the implications of the recent ®ndings 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. q

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Section: Clinical Management Of Pain-related Fearmentioning

confidence: 90%

Section: Early Views On the Role Of Fear On Painmentioning

confidence: 99%

Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art

Vlaeyen

Linton

2000

Pain

3,968

171

2,797

View full text Add to dashboard Cite

show abstract

“…34 Importantly, as with chronic pain, depressive symptoms have been associated with greater likelihood of relapse in opioid dependent treatment patients. 35 Fordyce et al 36 proposed an operant conditioning model of chronic pain in which, following an injury, avoidance behavior is negatively reinforced through the reduction of physical pain. This model postulates that avoidance of physical activity leads directly to a withdrawal of positive reinforcers (e.g., employment) and thereby increases depressive symptoms as well.…”

Section: Introductionmentioning

confidence: 99%

Chronic Pain and DepressionAmong Primary Care Patients Treated with Buprenorphine

et al. 2015

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“…Prompted by earlier writings on avoidance behaviors and their role in chronic pain (e.g., Fordyce et al, 1982;Philips, 1987), McCracken and colleagues argued that fear of pain plays an important role in maintaining chronic pain. Accordingly, McCracken et al (1992, 1993 developed the Pain Anxiety Symptoms Scale (PASS), which has there subscales measuring dimensions of fear of pain (i.e., fearful appraisals, cognitive symptoms of anxiety, and physiological.symptoms of anxiety) and a subscale measuring pain-related escape and avoidance (e.g., activity restriction).…”

Section: Introductionmentioning

confidence: 99%

Role of anxiety sensitivity in pain-related fear and avoidance

1996

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Anxiety sensitivity (AS) is the fear of anxiety-related bodily sensations, arising from beliefs that the sensations have harmful consequences. There has been a good deal of research on the role of AS in anxiety disorders, and only recently have investigators begun to assess its role in other conditions. In a preliminary report, Asmundson and Norton (1995) found that chronic back-pain patients with high AS (n = 14), compared to those with lower AS (n = 56), reported greater pain-related fear, and tended to have greater avoidance. The present study further investigated the role of AS in pain-related fear and escape/avoidance. Patients with chronic musculoskeletal pain (N = 259) completed measures of AS, pain severity, and pain-related fear and escape/avoidance. Structural equation modeling supported the prediction that AS directly exacerbates fear of pain, even after controlling for the effects of pain severity on fear of pain. Support also was found for the prediction that AS indirectly promotes pain-related escape/avoidance via its influence on fear of pain. This indirect effect was significant even when controlling for the direct influence of pain severity on pain-related escape/avoidance. These results suggest that AS plays an important role in pain-related fear and escape/avoidance in people with chronic pain.

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The modification of avoidance learning pain behaviors

Cited by 116 publications

References 5 publications

Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art

Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art

Chronic Pain and DepressionAmong Primary Care Patients Treated with Buprenorphine

Role of anxiety sensitivity in pain-related fear and avoidance

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