Fear-Avoidance Model of Chronic Pain

Abstract

Objective: The fear-avoidance (FA) model of chronic pain describes how individuals experiencing acute pain may become trapped into a vicious circle of chronic disability and suffering. We propose to extend the FA model by adopting a motivational perspective on chronic pain and disability. Methods: A narrative reviewResults: There is ample evidence to support the validity of the FA model as originally formulated. There are, however, some key challenges that call for a next generation of the FA model. First, the FA model has its roots in psychopathology, and investigators will have to find a way to account for findings that do not easily fit within such framework. Second, the FA model needs to address the dynamics and complexities of disability and functional recovery. Third, the FA model should incorporate the idea that pain-related fear and avoidance occurs in a context of multiple and often competing personal goals. Discussion:To address these three key challenges, we argue that the next generation of the FA model needs to more explicitly adopt a motivational perspective, one that is built around the organizing powers of goals and self-regulatory processes.Using this framework, the FA model is recast as capturing the persistent but futile attempts to solve pain-related problems in order to protect and restore life goals.

Acceptance: What's in a Name? A Content Analysis of Acceptance Instruments in Individuals With Chronic Pain

“…First, it may distract clinicians and researchers from the actual construct that is at stake. For example, attempts to avoid or control pain, but not willingness to experience pain, will easily be framed within a fear-avoidance model 6,50 . Second, it may lead to spurious correlations with particular outcomes.…”

The Psychological Flexibility Model: A Basis for Integration and Progress in Psychological Approaches to Chronic Pain Management

“…Not surprisingly, as the FA model sits within the cognitive behavioral tradition, the treatment approaches emerging from it have focused primarily on reducing fearful thoughts and feelings as mediators of avoidance and disability. As a recent review of the model clarifies, "at the core of the FA model is how patients interpret pain" (p 476) 12 and changing these interpretations is the key process of change within this approach.…”

“…Needs for revising this model have already been noted, and we will return to these. 12 By way of evaluating current models, it seems none have been fully adequate so far, if measured according their ability to integrate current findings or guide research and treatment development. Whether they support progress is a slightly more difficult criterion to evaluate as it requires looking at developments accrued over time.…”

“…31,47 Further Analysis: Another Next Generation of the Fear Avoidance Model Recently some of those involved in the development of the FA model proposed that it needs to meet several important challenges and that this would create a next generation of the model. 12 Three primary elements of the model were identified as lacking: (a) a model of normal psychological processes rather than pathological ones, (b) a proposal for how recovery from fear and avoidance is to occur, and (c) appreciation of the context of multiple goals, meaning, in their 12 It is suggested here that the PF model actually addresses each of the proposed challenges to the FA model, creates a model with greater scope, and with no loss of precision. PF is a model of normal human behavior that also proposes how it can fail to serve goals, health, and wellness.…”

Impact of male partner responses on sexual function in women with vulvodynia and their partners: A dyadic daily experience study.

“…A growing body of pain research suggests that it is not the pain itself, but rather the extent to which pain interferes with valued, daily activities that is the primary motivation for patients to seek treatment, and may be the key trigger for their subsequent coping and recovery (Crombez, Eccleston, Van Damme, Vlaeyen, & Karoly, 2012). Only one prior study has investigated the association between male partner responses and sexual function -the primary measure of disability in vulvodynia (Rosen et al, 2010).…”