Fear Avoidance Model: Difference between revisions

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== Fear-Avoidance Model  ==
== Fear-Avoidance Model  ==
[[File:Back pain image.jpg|right]]
Pain lasting longer than 3 months, despite healing, is known as [https://www.physio-pedia.com/Chronic_Pain#:~:text=Chronic%20pain%20is%20on%20the%20rise%20with%20an,leading%20source%20of%20human%20suffering%20and%20disability.%20 Chronic Pain]<ref name=":0">Vlaeyen, JWS., Crombez, G., Linton, SJ. [https://journals.lww.com/pain/Fulltext/2016/08000/The_fear_avoidance_model_of_pain.5.aspx The fear-avoidance model of pain.] Pain [Internet]. 2016. [cited 2023 May 22] 157:1588–1589</ref>, and is most commonly explained by the Fear Avoidance Model<ref name=":1">Rogers, AH., Farris, SG. [https://pubmed.ncbi.nlm.nih.gov/35727200/ A meta-analysis of the associations of elements of the fear-avoidance model of chronic pain with negative affect, depression, anxiety, pain-related disability and pain intensity]. Eur J Pain [Internet]. 2022 June 12 [cited 2023 May 22]. 26:1611–1635</ref>. 


Another psychological issue associated with chronic [[Pain Behaviours|pain]] is catastrophizing, which is outlined through the Fear Avoidance Model.  
[[Pain Behaviours|'''Pain''']] is an individual, interpretation of sensory information associated with perceived tissue threat<ref>Hoegh, M., Pain Science in Practice: [https://www.jospt.org/doi/10.2519/jospt.2022.10995 What Is Pain Neuroscience? Part 1]. J Orthop Sports Phys Ther [Internet]. 2022 Apr [cited 2023 May 22]. 52(4):163-165</ref><ref name=":2">Marieb EN., Human anatomy & physiology. 6th ed. San Francisco: Pearon Benjamin Cummings; 2004. 1187 p</ref>.  '''Fear''' is the emotional reaction to a specific, identifiable and immediate threat, such as a dangerous injury <ref name="Rachman 1998">Misslin, R., [https://www.sciencedirect.com/science/article/abs/pii/S0987705303000091 The defence system of fear: behaviour and neurocircuitry.] Clin Neurophysiol [Internet]. 2003 Jan 27 [cited 2023 May 22]; 33:55–66</ref>. Fear may protect the individual from impeding danger as it instigates the defensive behaviour that is associated with '''the fight or flight''' response <ref name="Cannon 1929">Cannon, W. B., 1929. Bodily changes in pain, hunger, fear and rage: an account of recent researches into the functions of emotional excitement. Appleton-Century-Crofts, New York</ref>.  


'''Fear''' is the emotional reaction&nbsp;to a specific, identifiable and immediate threat, such as a dangerous injury <ref name="Rachman 1998">Rachman, S., 1998. Anxiety. Psychological Press: Hove</ref>. &nbsp;Fear&nbsp;may protect the individual from impeding danger as it instigates the defensive behaviour that is associated with '''the fight or flight''' response <ref name="Cannon 1929">Cannon, W. B., 1929. Bodily changes in pain, hunger, fear and rage: an account of recent researches into the functions of emotional excitement. Appleton-Century-Crofts, New York</ref>.  
The Fear-Avoidance Model was designed to identify and explain why chronic low back pain problems, and associated disability, develop in members of the population suffering from an onset of low back pain <ref name="Leeuw et al,. 2007">Leeuw, M., Goossens, E.J.B., Linton, S., Crombez, G., Boersma, K., Vlaeyen, J., 2007. The Fear-Avoidance Model of Musculoskeletal Pain: Current State of Scientific Evidence. Journal of Behavioural Medicine, 30(1): 77-94</ref>. But is has since been applied to other chronic pain conditions<ref name=":3">Asmundson, GJG., Parkerson, HA., Petter, M., Noel, M., [https://www.futuremedicine.com/doi/10.2217/pmt.12.15 What is the role of fear and escape/avoidance in chronic pain? Models, structural analysis and future directions.] Pain Management [Internet]. 2012 May 18 [cited 2023 May 22]; 2(3):</ref>. This model indicates that a person suffering from pain will undergo one of two different pathways (Fig.1).<br>


The Fear-Avoidance Model was designed to identify and explain why chronic low back pain problems, and associated disability, develop in members of the population suffering from an onset of low back pain <ref name="Leeuw et al,. 2007">Leeuw, M., Goossens, E.J.B., Linton, S., Crombez, G., Boersma, K., Vlaeyen, J., 2007. The Fear-Avoidance Model of Musculoskeletal Pain: Current State of Scientific Evidence. Journal of Behavioural Medicine, 30(1): 77-94</ref>. This model indicates that a person suffering from pain will undergo one of two different pathways (Fig.1).<br>
[[Image:Pain fear.jpg|center|Fig.1 Fear Avoidance Model]]


[[Image:Pain fear.jpg|center|Fig.1 Fear Avoidance Model]]&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;


&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp;&nbsp; Fig.1 Fear Avoidance Model&nbsp;<ref name="Fear avoidance 2014">www.psychomaticmedicine.org (2014) Fear Avoidance Model (photograph). Available at: http://www.psychosomaticmedicine.org/cgi/content-nw/full/67/5/783/F117 (Accessed 11th January 2014)</ref>  
Fig.1 Fear Avoidance Model<ref name="Fear avoidance 2014">www.psychomaticmedicine.org (2014) Fear Avoidance Model (photograph). Available at: http://www.psychosomaticmedicine.org/cgi/content-nw/full/67/5/783/F117 (Accessed 11th January 2014)</ref>
[[File:Sam-burriss-zHSX9o2 B7Y-unsplash.jpg|left|449x449px]]


This&nbsp;shows that when pain/injury occurs, people will take the path of continuing their independence without negative thoughts of the pain they are suffering from, therefore leading them to accept that they have this pain that ultimately accumulates to a faster recovery. In contrast to this, a cycle can be initiated if the pain is misinterpreted in a catastrophising manner. It has been recognised that these thoughts can lead on to pain-related fear and associated safety seeking behaviours, such as avoidance. However, this could cause the pain to become worse and enter a chronic phase due to the disuse and disability. &nbsp;This in turn can lower the threshold at which the person will experience pain.
=== Path of Recovery ===
The first pathway is that of recovery. When pain/injury occurs, people who are not threatened by pain prioritise a return to normal function and pursue recovery-oriented goals, this taking the path of continuing their independence without negative thoughts of the pain they are suffering from, therefore leading them to accept that they have this pain that ultimately accumulates to a faster recovery<ref name=":4">Slepian, PM., Ankawi, B., France, CR., [https://www.sciencegate.app/document/10.1093/abm/kaz051 Longitudinal Analysis Supports a Fear-Avoidance Model That Incorporates Pain Resilience Alongside Pain Catastrophizing.] Ann. behav. med [Internet]. 2020 [cited 2023 May 22]; 54:335–345</ref>. It has been shown that people who follow this path demonstrate dispositional traits such as pain resilience and optimism.<ref name=":4" />
 
=== Path of Chronic Pain ===
In contrast to the above pathway, a cycle can be initiated if the pain is misinterpreted in a catastrophising manner. Here, individuals exaggerate the threat of pain<ref>Wideman, TH., Adams, H., Sullivan, MJL., [https://pubmed.ncbi.nlm.nih.gov/19477072/ A prospective sequential analysis of the fear-avoidance model of pain.] Pain [Internet]. 2009 Apr 22 [cited 2023 May 22]; 145:45–51</ref>. It has been recognised that these thoughts can lead to pain-related fear, pain hypervigilance, and associated safety seeking behaviours, such as avoidance<ref name=":1" />. However, this emotional distress amplifies the subjective intensity of the pain experience causing the person to enter a chronic phase due to the associated disuse and disability<ref name=":1" />. This in turn can lower the threshold at which the person will experience pain<ref name=":2" />.
 
The correlation between fear and chronic pain-related disability is stable across demographic groups<ref name=":1" />. It has been suggested that gradual exposure to the perceived threatening stimulus can help to re-organise the response to that of non-threatening; however, it is acknowledged that this is fragile and can be context specific<ref name=":0" />. Further to this, it is suggested that further research into the model should investigate the role of pre-existing health beliefs<ref name=":3" />.


== References ==
== References ==

Latest revision as of 13:06, 22 May 2023

Original Editor - Admin Top Contributors - Kim Jackson, Admin, George Prudden, Shaimaa Eldib, Claire Knott and Rebecca Willis

Fear-Avoidance Model[edit | edit source]

Back pain image.jpg

Pain lasting longer than 3 months, despite healing, is known as Chronic Pain[1], and is most commonly explained by the Fear Avoidance Model[2].

Pain is an individual, interpretation of sensory information associated with perceived tissue threat[3][4]. Fear is the emotional reaction to a specific, identifiable and immediate threat, such as a dangerous injury [5]. Fear may protect the individual from impeding danger as it instigates the defensive behaviour that is associated with the fight or flight response [6].

The Fear-Avoidance Model was designed to identify and explain why chronic low back pain problems, and associated disability, develop in members of the population suffering from an onset of low back pain [7]. But is has since been applied to other chronic pain conditions[8]. This model indicates that a person suffering from pain will undergo one of two different pathways (Fig.1).

Fig.1 Fear Avoidance Model


Fig.1 Fear Avoidance Model[9]

Sam-burriss-zHSX9o2 B7Y-unsplash.jpg

Path of Recovery[edit | edit source]

The first pathway is that of recovery. When pain/injury occurs, people who are not threatened by pain prioritise a return to normal function and pursue recovery-oriented goals, this taking the path of continuing their independence without negative thoughts of the pain they are suffering from, therefore leading them to accept that they have this pain that ultimately accumulates to a faster recovery[10]. It has been shown that people who follow this path demonstrate dispositional traits such as pain resilience and optimism.[10]

Path of Chronic Pain[edit | edit source]

In contrast to the above pathway, a cycle can be initiated if the pain is misinterpreted in a catastrophising manner. Here, individuals exaggerate the threat of pain[11]. It has been recognised that these thoughts can lead to pain-related fear, pain hypervigilance, and associated safety seeking behaviours, such as avoidance[2]. However, this emotional distress amplifies the subjective intensity of the pain experience causing the person to enter a chronic phase due to the associated disuse and disability[2]. This in turn can lower the threshold at which the person will experience pain[4].

The correlation between fear and chronic pain-related disability is stable across demographic groups[2]. It has been suggested that gradual exposure to the perceived threatening stimulus can help to re-organise the response to that of non-threatening; however, it is acknowledged that this is fragile and can be context specific[1]. Further to this, it is suggested that further research into the model should investigate the role of pre-existing health beliefs[8].

References[edit | edit source]

  1. ↑ 1.0 1.1 Vlaeyen, JWS., Crombez, G., Linton, SJ. The fear-avoidance model of pain. Pain [Internet]. 2016. [cited 2023 May 22] 157:1588–1589
  2. ↑ 2.0 2.1 2.2 2.3 Rogers, AH., Farris, SG. A meta-analysis of the associations of elements of the fear-avoidance model of chronic pain with negative affect, depression, anxiety, pain-related disability and pain intensity. Eur J Pain [Internet]. 2022 June 12 [cited 2023 May 22]. 26:1611–1635
  3. ↑ Hoegh, M., Pain Science in Practice: What Is Pain Neuroscience? Part 1. J Orthop Sports Phys Ther [Internet]. 2022 Apr [cited 2023 May 22]. 52(4):163-165
  4. ↑ 4.0 4.1 Marieb EN., Human anatomy & physiology. 6th ed. San Francisco: Pearon Benjamin Cummings; 2004. 1187 p
  5. ↑ Misslin, R., The defence system of fear: behaviour and neurocircuitry. Clin Neurophysiol [Internet]. 2003 Jan 27 [cited 2023 May 22]; 33:55–66
  6. ↑ Cannon, W. B., 1929. Bodily changes in pain, hunger, fear and rage: an account of recent researches into the functions of emotional excitement. Appleton-Century-Crofts, New York
  7. ↑ Leeuw, M., Goossens, E.J.B., Linton, S., Crombez, G., Boersma, K., Vlaeyen, J., 2007. The Fear-Avoidance Model of Musculoskeletal Pain: Current State of Scientific Evidence. Journal of Behavioural Medicine, 30(1): 77-94
  8. ↑ 8.0 8.1 Asmundson, GJG., Parkerson, HA., Petter, M., Noel, M., What is the role of fear and escape/avoidance in chronic pain? Models, structural analysis and future directions. Pain Management [Internet]. 2012 May 18 [cited 2023 May 22]; 2(3):
  9. ↑ www.psychomaticmedicine.org (2014) Fear Avoidance Model (photograph). Available at: http://www.psychosomaticmedicine.org/cgi/content-nw/full/67/5/783/F117 (Accessed 11th January 2014)
  10. ↑ 10.0 10.1 Slepian, PM., Ankawi, B., France, CR., Longitudinal Analysis Supports a Fear-Avoidance Model That Incorporates Pain Resilience Alongside Pain Catastrophizing. Ann. behav. med [Internet]. 2020 [cited 2023 May 22]; 54:335–345
  11. ↑ Wideman, TH., Adams, H., Sullivan, MJL., A prospective sequential analysis of the fear-avoidance model of pain. Pain [Internet]. 2009 Apr 22 [cited 2023 May 22]; 145:45–51
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