Fear reduction in patients with chronic pain: a learning theory perspective

Hollander, Marlies den; Jong, Jeroen R. de; Volders, Stéphanie; Goossens, Mariëlle E. J. B.; Smeets, Rob; Vlaeyen, Johan W.S.

doi:10.1586/ern.10.115

Cited by 95 publications

(57 citation statements)

References 111 publications

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“…Both pain catastrophizing and FABs are key components of the Fear-Avoidance Model,54 which has been used extensively to explain the development of pain and disability in patients with MSK pain. However, although strong evidence exists for the predictive value of each of these model components,55,56 studies investigating the causal nature of these relationships have suggested that the model does not work in the hypothesized order 57,58. This model was not tested in full as part of the present study, but the results add to the evidence base for FABs being potential mediators of treatment outcome, even though the exact pathways through which this factor contributes has not been fully clarified as yet.…”

Section: Discussionmentioning

confidence: 99%

Mediators of Treatment Effect in the Back In Action Trial

Mansell

Hill

Main

et al. 2017

The Clinical Journal of Pain

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Objectives: To test whether change in fear-avoidance beliefs was a mediator of the effect of treatment on disability outcome, and to test an analytical approach, latent growth modeling, not often applied to mediation analysis.Methods: Secondary analysis was carried out on a randomized controlled trial designed to compare an intervention addressing fear-avoidance beliefs (n = 119) with treatment as usual (n = 121) for patients with low back pain, which found the intervention to be effective. Latent growth modelling was used to perform a mediation analysis on the trial data to assess the role of change in fearavoidance beliefs on disability outcome. The product of coefficients with bias-corrected bootstrapped confidence intervals was used to calculate the mediating effect.Results: A statistically significant mediating effect of fear-avoidance beliefs on the effect of treatment on disability outcome was found (standardized indirect effect À0.35; bias-corrected 95% CI, À 0.47 to À 0.24). Poor fit of the model to the data suggested that other factors not accounted for in this model are likely to be part of the same mediating pathway.Discussion: Fear-avoidance beliefs were found to mediate the effect of treatment on disability outcome. Measurement of all potential mediator variables in future studies would help to more strongly identify which factors explain observed treatment effects. Latent growth modelling was found to be a useful technique to apply to studies of treatment mediation, suggesting that future studies could use this approach.Key Words: mediation analysis, latent growth modeling, low back pain (Clin J Pain 2017;33:811-819) W orldwide, the prevalence of low back pain (LBP) has been estimated to be 9.4% (95% confidence interval [CI], 9.0-9.8), 1 with lifetime prevalence estimates of between 51% and 84%. 2 In the UK, LBP has been found to affect between 49% and 80% of the population at some point in their lifetime, leading to high costs in terms of health care, workplace absence, 3 and impact on individual quality of life. 4 In the UK, musculoskeletal (MSK) conditions are predominantly managed in primary care, with back pain being the most common reason for patient health care visits. 5 Although the prognosis of patients with an acute episode of LBP is often good, 6,7 prognosis varies substantially for individual patients 8 and persisting symptoms are reported by many patients up to a year after their initial consultation. 6,8 Psychological factors (eg, fear-avoidance behaviors and beliefs, 9-17 catastrophizing thoughts, 9,18 self-efficacy, 9,19 and depression 9,11,14,20 ) have been found to be strong predictors of LBP outcomes and evidence suggests that they are potentially important in influencing the effect of treatment. Guidelines on the management of LBP also recommend screening for and management of psychological factors. 21,22 However, it remains unclear how interventions addressing psychological factors improve patient outcomes, 23 with mixed results being found in primary care populations in pa...

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Section: Discussionmentioning

confidence: 99%

Mediators of Treatment Effect in the Back In Action Trial

Mansell

Hill

Main

et al. 2017

The Clinical Journal of Pain

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“…Learning theory posits that the aversive signal of pain may be passed to neutral stimuli (like physical movement behaviors), which contributes to avoidant behavior. In vivo exposure therapy extinguishes threat, fear, and behavioral avoidance through progressively increasing engagement in painful behaviors in the absence of catastrophic outcomes; when these behaviors are performed without serious negative consequences, patients may realize that their expectations about the consequences of physical movement and pain are unrealistic 24,42. Consistent with exposure treatments for phobias and other anxiety disorders, in vivo exposure treatment for fear of pain involves development of a personalized, graded hierarchy of activities that elicit a fearful response, psychoeducation related to pain, fear, and behavior, and ultimately slow and systematic exposure to activities related to the individual’s fear hierarchy 41.…”

Section: Psychological Intervention As An Approach To Pain Managementmentioning

confidence: 99%

Psychological therapies for the management of chronic pain

Sturgeon¹

2014

PRBM

195

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Pain is a complex stressor that presents a significant challenge to most aspects of functioning and contributes to substantial physical, psychological, occupational, and financial cost, particularly in its chronic form. As medical intervention frequently cannot resolve pain completely, there is a need for management approaches to chronic pain, including psychological intervention. Psychotherapy for chronic pain primarily targets improvements in physical, emotional, social, and occupational functioning rather than focusing on resolution of pain itself. However, psychological therapies for chronic pain differ in their scope, duration, and goals, and thus show distinct patterns of treatment efficacy. These therapies fall into four categories: operant-behavioral therapy, cognitive-behavioral therapy, mindfulness-based therapy, and acceptance and commitment therapy. The current article explores the theoretical distinctiveness, therapeutic targets, and effectiveness of these approaches as well as mechanisms and individual differences that factor into treatment response and pain-related dysfunction and distress. Implications for future research, dissemination of treatment, and the integration of psychological principles with other treatment modalities are also discussed.

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“…Fear and anxiety also have a significant role in both acute and chronic pain (Ploghaus et al, 1999; den Hollander et al, 2010). The expectation of the pain modulates (usually increases) the pain sensation as well as playing a role in anxiety and phobia (Ploghaus et al, 2003).…”

Section: Habenula and Behaviors Associated With Chronic Painmentioning

confidence: 99%

Unmasking the mysteries of the habenula in pain and analgesia

Shelton

Becerra

Borsook

2012

Progress in Neurobiology

107

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The habenula is a small bilateral structure in the posterior–medial aspect of the dorsal thalamus that has been implicated in a remarkably wide range of behaviors including olfaction, ingestion, mating, endocrine and reward function, pain and analgesia. Afferent connections from forebrain structures send inputs to the lateral and medial habenula where efferents are mainly projected to brainstem regions that include well-known pain modulatory regions such as the periaqueductal gray and raphe nuclei. A convergence of preclinical data implicates the region in multiple behaviors that may be considered part of the pain experience including a putative role in pain modulation, affective, and motivational processes. The habenula seems to play a role as an evaluator, acting as a major point of convergence where external stimuli is received, evaluated, and redirected for motivation of appropriate behavioral response. Here, we review the role of the habenula in pain and analgesia, consider its potential role in chronic pain, and review more recent clinical and functional imaging data of the habenula from animals and humans. Even through the habenula is a small brain structure, advances in structural and functional imaging in humans should allow for further advancement of our understanding of its role in pain and analgesia.

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Fear reduction in patients with chronic pain: a learning theory perspective

Cited by 95 publications

References 111 publications

Mediators of Treatment Effect in the Back In Action Trial

Mediators of Treatment Effect in the Back In Action Trial

Psychological therapies for the management of chronic pain

Unmasking the mysteries of the habenula in pain and analgesia

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