Treatment of pain-related fear in chronic (persistent) pain: the role of safety-seeking behaviour and imagery

Abstract

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...

Interaction of job‐limiting pain and political skill on job satisfaction and organizational citizenship behavior

“…Other studies have documented the importance of identifying individual-level coping mechanisms (Davis et al, 2004;Gatchel et al, 2007). For example, recent research has verified the moderating properties of spirituality (Wachholtz et al, 2007), self-efficacy (Cannella et al, 2007), emotional intelligence (Saklofske et al, 2007), cognitive control (Paez-Blarrina et al, 2008) and safety seeking propensity (Jamani and Clyde, 2008) in this research domain.…”

The devil in the corner: A mixed‐methods study of metaphor use by those with spinal cord injury‐specific neuropathic pain

“…The communal coping model of pain (Sullivan, 2012) states that catastrophizing is a form of interpersonal communication used to cope with pain, motivated by proximity or support-seeking, and to solicit empathic responses. However, catastrophizing is a significant predictor of pain behaviour (Thibault, Loisel, Durand, & Sullivan, 2008), and it is suggested that metaphor use may be a form of catastrophizing (Jamani & Clyde, 2008), causing the sufferer to pay increased attention to the pain. Such language use may increase the risk of negative emotional states and hypervigilance (Holmes et al, 2007;Villemure & Bushnell, 2009).…”

“…Enriched understanding, therefore, may be reached by returning to the original transcripts with a focus on rates of metaphor use and functions of such language. This can provide a foundation for evidence‐based integration of imagery‐based interventions with cognitive‐behavioural techniques (Jamani & Clyde, ).…”

The Rescripting of Pain Images

“…Images of people in pain (pain sufferers) have received scant interest, despite the recognition over 50 years ago of the influence of cognitive factors on pain experience (Melzack and Wall, 1965). Images experienced by pain sufferers have been reported by clinicians (Winterowd, Beck and Greuner, 2003;Jamani and Clyde, 2008) and researchers (Potter, 2007;Gillanders, Potter and Morris, in press;Philips, 2011;Berna et al, 2011). However, the effect of distressing imagery upon the pain experience, and the systematic modification of images in pain management programs has not been addressed.…”