The Fear-Avoidance Model

Hey everyone,
Being that this is not very accessible to most people, I wanted to introduce you to something the scientific literature calls the Fear-Avoidance Model. The model itself has some age (2000), but has gained huge attention over the last 15 years, along with compounding evidence. It's a highly cited paper (more than 2600 citations, which is fairly immense) with some very interesting conclusions. The big idea is this:

• Acute pain becomes chronic pain through two things: fear of pain, and avoidance of activity.

• Fear of pain has a symbiotic role with pain catastrophizing (described as misinterpretation of the consequences of pain), both of which act together to direct attention towards, and amplify the pain. They have a sort of chicken & egg relationship.

• Fear of pain acts on behavior, creating a pattern of avoidance, which in turns increases sensitivity to pain.

• There are debates on whether anxious or depressive behaviors are stronger predictors of developing chronic pain.

A follow-up study was also done, which I'll link here. The ideas behind TMS are far more mainstream than they seem at first, but I think they may not be as accessible to medical professionals as they should be.

The original paper (Vlaeyen 2000): https://lirias.kuleuven.be/bitstream/123456789/206277/2/Vlaeyen,+Linton_2000.pdf

Follow-up paper (Vlaeyen 2012): https://www.researchgate.net/profil...2_years_on/links/0fcfd50143ae6e7c4c000000.pdf

Edit: Something worth mentionning; in their model, other things like hypervigilance and catastrophization also matter, but they are seen as originating from the first big two.

 

Thanks for the article. Reassuring to see some hard science regarding the psychological contributors to pain. Do you know of any scientific research that's got something optimistic to say about treatment and/or prognosis? I think it holds me back to think that mainstream science's current position is basically that people don't really get better from chronic pain. For me, the Sarno and Schubiner studies don't cut it. Best, E.

 

There are plenty of studies right now on the effect of attention and emotional state on pain. Both seem to be thought to be two different effects, but also mutually dependent. There was this study on the pain-relief effect of an improvement in emotional states and bringing attention away from the pain, both individually and simultaneously. It was something on the order of morphine, if I recall, but I'll try to find it.

In any case, the literature seems to mention two different effects touching respectively attention and emotional state: pain sensation and emotional sensation (as in, you feel negatively from pain). Both of which seem to be essential parts of the chronic pain experience.

It's worth noting that Sarno's advice is consistent with theory that didn't exist during his time, touching those two dimensions of emotion and attention. Reassuring yourself that there's nothing wrong with you, bringing your attention away, and returning to normal, etc.

 

Nice graphic, Forest. At the end of my weekly yoga session, the instructor has us do "I am" statements. She suggests "I am slow to anger" etc. I always say either "I am healthy" or "I am strong." I like those messages.

 

I am wondering how people feel about this. I most certainly fixate on my pain and fear it tremendously, but I do force myself to do activities, regardless. So in relation to the model stated above I fulfil only one of the two aspects in the fear - avoidance model. I fear pain, but don't limit my activities. Do you think the fact I fear my pain so much and that I fixate on it could be enough to create TMS?

 

So it seems Dr. Sarno's work successfully, in a pioneering way nailed down four important things:

-don't fear the pain
-resume activity
-there is nothing wrong with you (related to don't fear the pain, and resume activity)
-bring your attention to something else

That is a pretty great list, now being supported by these studies...

Andy B

 

Forest, I have another point to make in addition to my last post. I said I don't limit my physical activities and that is true, but I have altered my life path due to the fear of my pain. I have let it paralyze me in a sense. For example I want to head in a different direction in my career but for some reason having pain is stopping me dead in my tracks. Would this type of 'inactivity' be similar to actual physical inactivity? If so, then maybe I do fit the model, fulfilling both requirements- fearing pain and activity avoidance.

I will snowshoe, travel and on and on, but I find it difficult to make life changes.

 

I am not sure exactly, but a career change for sure. I have sold real estate for a long time, but don't any longer. I am in limbo and feel stuck. Also, my 18 year old daughter went to the west coast of Canada for university so life has changed for me here, in Toronto- that is for sure. There are probably other things I am not thinking of right now.