Lecture 14: Fear avoidance model of Pain

how you interpret pain influnces..?

1) degree of pain felt 2) incapacitation

Pain catastrophizing is related to

1) disability- act intolerance 2) inc pain 3) pain related fear

Pain catastrophizing influence

1) neg affect = hypervigilant to all threats 2) anxiety-sensitive = (specific tendency to react anxiously to one's own anxiety and anxiety-related sensations (fear of fear)) 3) traumatic experience

Fear avoidance behavior model

1) non-threat pain int pathway 2) catastrophic pain int path

what does avoidance and hypervigilance do?

1) reduce anxiety of short term, 2) counterproductive in long run

Cognitive behavioral model fr CLBP

- explanation of why CLBP problems & associated disability =minority of people who experience acute LBP - Emphasized iimport of beliefs (interpretations) ppl have about pain---> disable/avoidance: • Non-threatening • Threatening - model for chronic pain in gen

2) Catastrophic misinterpretations pathway

-Pain = erroneously interpreted as a =sign of serious injury OR pathology = little or no control -Leads =xcessive fear of pain & injury • =fear of physical movements • Avoidance = physical activities • Hypervigilance • Reduced= musculoskeletal system + impairments in muscle coordination (guarded movements)

Fear avoidance model of pain has led to:

1) therapeutic intervent 2) research

Vicious cycle of A&H

-inc inactivity/depression/deconditioning =inc disability&pain

Unresolved issue

-not everyone have vicious cycle= 1!) leave out context facts, 2) ignore erratic and recurrent course -only correl research, less causal

Pain related fear responses?

1) behavior (escape, avoid) 2) Cognitive (catastrophisizing thoughts) 3) Psychophysiological (heightened muscle reactivity)

Important psych factor

Fear

Can traditional biomedical models that focus on structural and biomechanical abnormalities sufficiently explain chronic pain?

No

Pain catastrophizing

Pain=extreme threat cognitive elemnt

What's the benefit of pain?

Survival: 1) low-level feedback about functioning of our bodily systems 2) Protective mechanism = tissue damage into conscious awareness 3) Leads to seeking treatment

Pain-related fear = risk factor for the development of chronic pain?

during acute phase: inc = !) sick leave !) work loss !)perveived disability, Red= !) daily activity

Leeuw et al.: Fear definition and what happens

emotional reaction to a specific, intifiable and immediate threat: 1) inc SA 2) defense mode- fight/flight 3) see stimulus as threat

Leeuw et al.: Anxiety def & what happens

future oriented, no clear focus, elusive source of threat: 1) hypervigilant 2) less intense, long-lasting 3) preventative beha (avoidance, etc)

avoidance/hypervigilane

good in short term (give tiem to heal), bad in long run= inc pain/disability

Pain-related fear

inc fear to pain: leads to= 1) avoidance/hypervigilance

Pain-related fear = vulnerability factor for the inception of acute pain?

in pain free people= !) catastrop pain, !) pain rel fear, pain avoidance -misconception bout pain-in gen pop= inc lbp-tissue damage -so yes,

Hypervigilance:

inc att to pain causing env & threat-rel stimuli scan body=putative signal for pain stimuli cant disengage from this att Negative affect: intensify pain, inc diability=can't do other act

is there a clinical distinct between fear and anxiety?

no- used interchangeably

Avoidance

overestimate pain and consequences limit opportunity to line up expectation w/ actual act NEgative: -inability to do valued act -physical & mental deterioration-inc vuln -red post exp & social isolation

1) non-threat pain int pathway

pain=temp nuisance -resume phy act test & correct pain expectations- in line w/ actual exp injury=>pain=>no fear=> confront=> recovery

Influence of acute and chronic stress

psychological and social factor

Problem w/ pain

weak rship between pain and severity of prob

When does pain lose survival benefits?

when it's chronic

• Pain-related fear and anxiety: when does it appear?

when stimuli related to pain are perceived as threat: 1) work-related activity 2) movement 3) possible injust

is pain a psych experience?

yes