Fear-avoidance and Endurance-related Responses to Pain: New Models of Behavior and Their Consequences for Clinical Practice

Hasenbring, Monika; Verbunt, Jeanine

doi:10.1097/ajp.0b013e3181e104f2

Cited by 277 publications

(271 citation statements)

References 58 publications

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“…Avoidance behavior is considered a relatively stable response driven by a fear-based motivation to prevent further injury. 9,18,29,54 However, the results of the current study show that avoidance can be influenced by the presence of concomitant, competing goals, such as the goal to retrieve a reward, even without changing pain-related fear itself. 23,40,44,47,49 Thus, avoidance behavior may vary from situation-to-situation, also even within individuals.…”

Section: Discussionmentioning

confidence: 56%

Competing Goals Attenuate Avoidance Behavior in the Context of Pain

Claes¹,

Karos²,

Meulders³

et al. 2014

The Journal of Pain

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Current fear-avoidance models consider pain-related fear as a crucial factor in the development of chronic pain. Yet, pain-related fear often occurs in a context of multiple, competing goals. This study investigated whether pain-related fear and avoidance behavior are attenuated when individuals are faced with a pain avoidance goal and another valued but competing goal, operationalized as obtaining a monetary reward. Fifty-five healthy participants moved a joystick towards different targets. In the experimental condition, a movement to one target (Conditioned Stimulus; CS+) was followed by a painful unconditioned stimulus (pain-US) and a rewarding unconditioned stimulus on 50% (reward-US) of the trials, whereas the CSmovement was not. In the control condition, the CS+ movement was followed by the pain-US only. Results showed that pain-related fear was elevated in response to the CS+ compared to the CS-movement, but that it was not influenced by the reward-US. Interestingly, participants initiated a CS+ movement slower than a CS-movement in the control condition, but not in the experimental condition. Also, in choice trials, participants performed the CS+ movement more frequently in the experimental than in the control condition. These results suggest that the presence of a valued competing goal can attenuate avoidance behavior. Perspective:The current study provides experimental evidence that both pain and competing goals impact on behavioral decision making and avoidance behavior. These results provide experimental support for treatments of chronic pain that include valuable daily life goals pursued by an individual, rather than limiting focus to pain reduction only.

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Section: Discussionmentioning

confidence: 56%

Competing Goals Attenuate Avoidance Behavior in the Context of Pain

Claes¹,

Karos²,

Meulders³

et al. 2014

The Journal of Pain

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show abstract

“…One possible reason for these incongruent findings is that fear-avoidance models consider avoidance as a relatively stable behaviour pattern [13]. Largely neglected, however, is that avoiding pain is often only one goal in a dynamic environment with concomitant, competing goals [15,38,46].…”

Section: Introductionmentioning

confidence: 86%

“…We found that avoidance of pain was inhibited when a competing task-related goal (i.e., earning money) was activated. Current models of disability [13,44] consider pain-related avoidance as a relatively stable behaviour pattern. The present findings suggest that such view might be too narrow, and that pain behaviour should be considered within a dynamic environment of concomitant, often competing, goals [15,38,46].…”

Section: Discussionmentioning

confidence: 99%

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No pain no gain? Pursuing a competing goal inhibits avoidance behavior

Damme

Ryckeghem

Wyffels

et al. 2012

Pain

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This experiment investigated pain-related avoidance behaviour in a context of competing goals. Participants (N = 56) were presented trials of two different tasks of which one could produce pain. They were free to decide whether or not to perform trials of these tasks. In half of the participants a competing goal was activated by instructing them that they would receive a monetary reward corresponding to the number of pain task trials actually performed (competition group). In the other half of the participants no competing goal was installed (control group). Results showed that the competition group showed less frequent avoidance behaviour than the control group. Furthermore, the association between pain-related avoidance behaviour and fear of pain was smaller in the competition group than in the control group. The findings indicate that the emergence of pain-related avoidance behaviour depends upon the motivational context, and that the association between pain-related fear and avoidance is not stable. This study has implications for our understanding of disability, and points to the need to consider avoidance behaviour within a broad context of multiple, often competing, goals.

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“…One may be motivated to ignore the pain and to stay committed to earlier activities and life goals (persistence). Indeed, there is evidence that some patients persist in their activities despite pain 15 . At first sight, it seems adaptive to prevent interference by pain and to continue with activities.…”

Section: Coping With Pain Re-visited: the Pursuit Of Valued Activitiementioning

confidence: 99%

To control or not? A motivational perspective on coping with pain

et al. 2012

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Pain relief is often the primordial treatment objective in pain patients. However, an exclusive focus upon pain relief may have costs. Evidence is accumulating that persistent attempts to gain control over pain may, paradoxically, hinder successful adaptation to pain and increase frustration and limitations due to pain. To better understand these apparently paradoxical findings, we propose to adopt a motivational perspective on coping with pain. Within this perspective, pain control is recast as an attempt to protect and restore valued life goals threatened by pain. This framework explains why some patients engage excessively in pain control strategies despite the costs associated with this, such as overuse of medication. A clinical implication is that cautiousness is warranted in promoting strategies exclusively aimed at pain relief. Beyond standard medical care, interventions should also be aimed at the improvement of functioning despite pain. Certainly those patients for whom there is no definite or sound cure to pain and who increasingly experience emotional and physical problems due to pain might benefit from paramedical help by psychologists and/or physiotherapists.

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Fear-avoidance and Endurance-related Responses to Pain: New Models of Behavior and Their Consequences for Clinical Practice

Cited by 277 publications

References 58 publications

Competing Goals Attenuate Avoidance Behavior in the Context of Pain

Competing Goals Attenuate Avoidance Behavior in the Context of Pain

No pain no gain? Pursuing a competing goal inhibits avoidance behavior

To control or not? A motivational perspective on coping with pain

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