Fear Avoidance Model of Pain

What is pain catastrophizing influenced by?

negative affectivity: hypervigilant for all forms of threat (lowers threshold) anxiety sensitivity: specific tendecncy to reacy anxiously to one's own anxiety and related sensations traumatic experience

What is pain catastrophizing related to?

activity intolerance intensified pain pain-related fear

What is a vicious cycle of fear-avoidance model of pain?

avoidance and hypervigilance leads to inactivity, deconditioning, and depression which further exaggerates pain and disability

How is pain-related fear a vulnerability factor for the inception of acute pain?

avoidance, catastrophizing beliefs and fers are present in pain-free people misconceptions regarding pain are common fearful ppl are more inclined to misinterpret ambugous physical sensations as threatening or painful, so more likely to experience it

Avoidance and Hypervigilance

beneficial in the short term, as it protects the body from further injury and provide time to heal persisitent is dysfunctional, as it leads to more pain, disability, and suffering

What is pain-catastrophizing?

cognitive element pain is interpreted as extremely threatening

How you interpret pain influences what?

degree to which it is felt how incapacitating it is

How is pain-related fear a risk factor for the development of chronic pain?

diminished participation in daily life activities greater perceived disability greater work loss more frequent sick-leave

Cognitive Behavioral Model of Chronic Lower Back Pain

explains why CLBP problems and associated disability deveop in a minority of ppl who experience acute LBP emphasized importance of beliefs people hold about pain non-threatening vs threatening model for general chronic pain as well

Leeuw et al. Pain's relation to fear and anxiety

fear: emotional reation to a specific and immediate threat increased sympathetic arousal defensive behavior interpret stimulus as a threat anxiety: future-oriented affective state, source of threat is more elusive without a clear focus preventive behavior hypervigilance less intense but longer lasting

What are the negative effects of avoidance?

inability or unwillingness to pursue valued activities physical and mental deterioration reduction of positive experiences and social isolation

negative effects

increased disability: leaves less attention available for other tasks and activities, then intesified pain

How are fear and anxiety related?

no clinically clear distinction between fear and anxiety and used interchangeably avoidance and hypervigilance reduce anxiety in the short-term, but not long-term

What are the issues with the fear avoidance model of pain?

not everyone who responds w/ pain-related fear will get trapped in vicuous cycle leading to enduring pain ignores erratic and recurrent courses of LBP influences of contextual factors evidence for interrelations b/twn constructs but less casuality studies

Avoidance

overestimate future pain and its consequences limits opportunity to attune expectations to actual experiences

What is pain-related fear

overpredictions of pain leads to avoidance and hypervigilance

What is the non-threatening pain interpretation pathway?

pain is considered a temporary nuisance physical activities and daily life is resumed (often after period of diminished activity) test and correct pain expectations (in line w/ actual experiences)

Catastrophic misinterpretations pathway

pain is wrongly interpreted as a sign of serious injury or pathology over which one has little/no control leads to excessive fear of pain and injury extends to fear of phys. movements avoidance of phys. activities hypervigilance reduced use of musculoskeletal system and impairments in muscle coordination

What is hypervigilance?

patients scan their bodies for signals of pain or injury selective attention to threat-related stimuli and pain related info difficulties in disengaging attention from these stimuli

Why is pain crucial for survival?

provides low-level feedback about the functioning of our body systems protective mechanisms bring tissue damage into conscious awareness leads ppl to seak treatment

What are pain-related fear responses?

psychophysio (heightened muscle reactivity) behavioral (escape and avoidance) cognitive (bad thoughts)

What are the issues with traditional biomedical models?

they focus on structural and biomedchanical abnormalities that cannot sufficiently explain chronic pain important psyc factor: fear

How is the relationship between pain and severity of problem?

weak pain loses it's survival function when it becomes chronic