It is widely recognized that psychological factors play a central role in the adjustment process and subsequent management of chronic pain. The role of anxiety, and specifically pain-related fear, has received particular attention. Paralleling developments in the anxiety disorders literature, psychological models of pain-related fear now highlight the importance of cognitive processes in its maintenance and treatment. However, theoretical and treatment advances in the anxiety disorders literature have not been widely applied to the pain field. In particular, certain cognitive processes, specifically safety-seeking behaviours and imagery, which appear to be involved in the maintenance of pain-related fear. This paper explores how these concepts may apply to pain-related fear and demonstrates how they may aid conceptualization and be used to guide a more cognitively orientated and efficacious treatment.who believes that their pain signals damage and who interprets the sensations they experience when they attempt a certain activity as harmful will become fearful of carrying out such activities. Understanding the difference between acute and chronic pain is central to its management and underpins the cognitive-behavioural approach as described in this paper.The role of pain-related fear † in the development and/or maintenance of long-term disability has received much attention in the literature. Fear of pain has been proposed to be more disabling than even the pain itself (Waddell et al. 1993). The object of fear can be wide-ranging, encompassing fears such as the pain itself, movement and (re)injury, long-term disability, loss of identity and social isolation (Morley & Eccleston, 2004). The pain-related-fear literature has developed from a purely behavioural approach (Fordyce et al. 1982; Lethem et al. 1983) to the incorporation and emphasis of cognitive factors. This reflects a similar shift from behavioural to cognitive-behavioural models of anxiety disorders in non-pain populations.Vlaeyen and colleagues' cognitive-behavioural model of pain-related fear (Vlaeyen et al. 1995a, b;Vlaeyen & Linton, 2000) pays attention to cognitive factors, such as pain catastrophizing and hypervigilance, in addition to behavioural factors. The model suggests that a vicious cycle becomes established as a result of negative appraisals about the pain and its consequences (specifically catastrophic thinking and misinterpretation), avoidance of the threat situation/object, hypervigilance to possible signals of threat, subsequent 'deconditioning' of the body as a result of reduced muscular activity, depression and long-term disability. To date, this model has provided the foundation for theory-driven cognitive-behavioural interventions of pain-related fear, with specific foci on education and graded exposure (e.g. Vlaeyen et al. 2002Vlaeyen et al. , 2004. Recent research developments, including a randomized controlled study (Woods & Asmundson, 2007) lend support to the hypotheses proposed in this model and suggest interventions based o...
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