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Johan W S Vlaeyen - One of the best experts on this subject based on the ideXlab platform.
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reduction of fear of movement related pain and pain related anxiety an associative learning approach using a voluntary movement paradigm
Pain, 2012Co-Authors: Ann Meulders, Johan W S VlaeyenAbstract:Abstract The Fear-Avoidance Model advances fear of pain as a key factor in the origins of chronic pain disability. Initial evidence in those with chronic back pain reveals that exposure therapy reduces fear levels, disability, and pain. Despite the success of exposure in the clinic, fundamental research about its underlying mechanisms lags behind. Using a conditioning paradigm with movements as conditioned stimuli (CS) and a painful shock as unconditioned stimuli (US), we investigated the extinction of experimental fear of movement-related pain and pain-related anxiety (respectively induced by predictable and unpredictable pain). Dependent measures were self-reported fear and eyeblink startle. During acquisition, all groups received both predictable and unpredictable training. In the predictable context, one movement (CS+) was consistently followed by the shock-US, but another movement was not (CS−). In the unpredictable context, joystick movements never signaled the shock-US; shock-US were delivered during the intertrial interval (ITI). During extinction, the extinction group continued training in the predictable context but the CS+ movement was no longer reinforced; the context exposure group continued training in the unpredictable context but ITI shock-US were omitted. The control group continued training after the acquisition reinforcement scheme. Results revealed that fear ratings for the CS+ were extinguished in the extinction group but not in the control group. Interestingly, omitting the ITI shocks not only reduced ITI startle responses in the context exposure group compared with the control group, but also reduced the fear ratings and startle responses elicited by the unpredictable CS. The clinical implications of these findings are discussed.
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fear avoidance Model of chronic pain the next generation
The Clinical Journal of Pain, 2012Co-Authors: Geert Crombez, Johan W S Vlaeyen, Christopher Eccleston, Stefaan Van Damme, Paul KarolyAbstract:Objective: The Fear-Avoidance (FA) Model of chronic pain describes how individuals experiencing acute pain may become trapped into a vicious circle of chronic disability and suffering. We propose to extend the FA Model by adopting a motivational perspective on chronic pain and disability. Methods: A narrative review. Results: There is ample evidence to support the validity of the FA Model as originally formulated. There are, however, some key challenges that call for a next generation of the FA Model. First, the FA Model has its roots in psychopathology, and investigators will have to find a way to account for findings that do not easily fit within such framework. Second, the FA Model needs to address the dynamics and complexities of disability and functional recovery. Third, the FA Model should incorporate the idea that pain-related fear and avoidance occurs in a context of multiple and often competing personal goals. Discussion: To address these 3 key challenges, we argue that the next generation of the FA Model needs to more explicitly adopt a motivational perspective, one that is built around the organizing powers of goals and self-regulatory processes. Using this framework, the FA Model is recast as capturing the persistent but futile attempts to solve pain-related problems to protect and restore life goals.
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fear avoidance Model of chronic musculoskeletal pain 12 years on
Pain, 2012Co-Authors: Johan W S Vlaeyen, Steven J LintonAbstract:It is widely acknowledged that pain is a universal experience that affects human beings across the life span, serving an important protective function. Typical protective behaviors are the withdrawal from the noxious stimulus, nonverbal expressions that signal others for impending harm, and verbal utterances. Some of these occur involuntarily, as a reflex, whereas other behaviors are more deliberate. However, there is accumulating evidence that it is not pain itself, but the meaning of pain that predicts the extent to which individuals engage in these protective behaviors [1,3]. About a decade ago, we summarized the research evidence supporting the role of fear of pain in the development of chronic pain disability, presented a Model incorporating basic mechanisms, but also noted a number of unresolved issues that called for further scientific attention [39] (Fig. 1). In the last decade, the number of studies on this subject has increased exponentially [21], and novel directions are being proposed [6]. Two main stances have emerged. First, although pain has intrinsic threatening features, the threat value of similar pain stimulus may vary across contexts and individuals. Second, protective responding may be adaptive in the short term, but may paradoxically worsen the problem in the long term. In the current updated review, we briefly summarize the progress made since, and highlight a selected number of remaining challenges and areas for future research.
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pain related fear predicts disability but not pain severity a path analytic approach of the fear avoidance Model
European Journal of Pain, 2010Co-Authors: Els L M Gheldof, Geert Crombez, Eva Van Den Bussche, Jan Vinck, An Van Nieuwenhuyse, Guido Moens, Philippe Mairiaux, Johan W S VlaeyenAbstract:Two studies are reported that tested the Fear-Avoidance (FA) Model using path analytic techniques. In study 1, 429 employees with back pain at baseline and back pain at 18 months follow-up completed questionnaires assessing sociodemographic information, pain severity, negative affect, pain-related fear, and disability. Results indicated that pain severity at baseline predicted pain-related fear and disability at follow-up, and that pain-related fear is rather a consequence than an antecedent of pain severity. Results further revealed that the disposition to experience negative affect has a low impact upon pain severity and disability, and is best viewed as a precursor of pain-related fear. Study 2 included 238 employees without back pain at baseline, but who developed back pain at 1 year follow-up. A similar Model as in study 1 was tested. Overall, results are in line with those of study 1. Results are discussed in terms of theoretical relevance and clinical implications.
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lowering fear avoidance and enhancing function through exposure in vivo a multiple baseline study across six patients with back pain
Pain, 2004Co-Authors: Katja Boersma, Johan W S Vlaeyen, Steven J Linton, Thomas Overmeer, Markus Jansson, Jeroen De JongAbstract:This study investigated the effects of an exposure in vivo treatment for chronic pain patients with high levels of fear and avoidance. The Fear-Avoidance Model offers an enticing explanation of why some back pain patients develop persistent disability, stressing the role of catastrophic interpretations; largely fueled by beliefs and expectations that activity will cause injury and will worsen the pain problem. Recently, an exposure in vivo treatment was developed that aims to enhance function by directly addressing these fears and expectations. The purpose of this study was to describe the short-term, consequent effect of an exposure in vivo treatment. The study employed a multiple baseline design with six patients who were selected based on their high levels of fear and avoidance. The results demonstrated clear decreases in rated fear and avoidance beliefs while function increased substantially. These improvements were observed even though rated pain intensity actually decreased somewhat. Thus, the results replicate and extend the findings of previous studies to a new setting, with other therapists and a new research design. These results, together with the initial studies, provide a basis for pursuing and further developing the exposure technique and to test it in group designs with larger samples.
Steven J Linton - One of the best experts on this subject based on the ideXlab platform.
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fear avoidance Model of chronic musculoskeletal pain 12 years on
Pain, 2012Co-Authors: Johan W S Vlaeyen, Steven J LintonAbstract:It is widely acknowledged that pain is a universal experience that affects human beings across the life span, serving an important protective function. Typical protective behaviors are the withdrawal from the noxious stimulus, nonverbal expressions that signal others for impending harm, and verbal utterances. Some of these occur involuntarily, as a reflex, whereas other behaviors are more deliberate. However, there is accumulating evidence that it is not pain itself, but the meaning of pain that predicts the extent to which individuals engage in these protective behaviors [1,3]. About a decade ago, we summarized the research evidence supporting the role of fear of pain in the development of chronic pain disability, presented a Model incorporating basic mechanisms, but also noted a number of unresolved issues that called for further scientific attention [39] (Fig. 1). In the last decade, the number of studies on this subject has increased exponentially [21], and novel directions are being proposed [6]. Two main stances have emerged. First, although pain has intrinsic threatening features, the threat value of similar pain stimulus may vary across contexts and individuals. Second, protective responding may be adaptive in the short term, but may paradoxically worsen the problem in the long term. In the current updated review, we briefly summarize the progress made since, and highlight a selected number of remaining challenges and areas for future research.
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pain in childbirth and postpartum recovery the role of catastrophizing
European Journal of Pain, 2009Co-Authors: Ida K Flink, Michael J L Sullivan, Magdalena Z Mroczek, Steven J LintonAbstract:This prospective study investigated how pain catastrophizing was related to labor pain intensity and physical recovery after childbirth. Eighty-eight women giving birth for the first time completed the first questionnaire before delivery. Eighty-two of those returned the second questionnaire after delivery. Participants were classified as catastrophizers (n=38) or non-catastrophizers (n=44) based on their scores on the Pain Catastrophizing Scale. Comparison of the groups showed that catastrophizers anticipated and experienced more intense pain (p<.0125) and had poorer physical recovery (p<.0125), measured as the level of self-reported functioning in activities of daily living, than non-catastrophizers. These results extend the association between catastrophizing and pain, to pain and recovery in childbirth and provide support for the Fear-Avoidance Model. It is concluded that pain catastrophizing plays a role in the experience of pain in childbirth and postpartum recovery. Further research is needed to identify appropriate interventions for catastrophizing women during the latter part of pregnancy.
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psychological processes underlying the development of a chronic pain problem a prospective study of the relationship between profiles of psychological variables in the fear avoidance Model and disability
The Clinical Journal of Pain, 2006Co-Authors: Katja Boersma, Steven J LintonAbstract:Objectives: Understanding the psychological processes that underlie the development of a chronic pain problem is important to improve prevention and treatment. The aim of this study was to test whe ...
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how does persistent pain develop an analysis of the relationship between psychological variables pain and function across stages of chronicity
Behaviour Research and Therapy, 2005Co-Authors: Katja Boersma, Steven J LintonAbstract:The Fear-Avoidance Model is an attempt to underscore the importance of cognitive and behavioral factors, in a chain of events linking pain to disability. However, it is not clear at what time point the psychological variables within the Model begin to be prominent. The aim of this study was to investigate the role of these psychological variables in the development of a chronic musculoskeletal pain problem. Three stages of chronicity, defined by duration of pain, provided a proxy for the developmental process: 3 years (N=89). Subjects completed questionnaires on fear of movement, catastrophizing, depression, pain and function. The results indicate that the relationship between fear of movement and function is moderated by the stage of chronicity. Regression analyses showed that fear of movement did not explain any variance in the group with pain duration 3 years. This suggests that the time point in the development of a musculoskeletal pain problem might be an essential aspect of the importance of the relationship between psychological components and function.
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lowering fear avoidance and enhancing function through exposure in vivo a multiple baseline study across six patients with back pain
Pain, 2004Co-Authors: Katja Boersma, Johan W S Vlaeyen, Steven J Linton, Thomas Overmeer, Markus Jansson, Jeroen De JongAbstract:This study investigated the effects of an exposure in vivo treatment for chronic pain patients with high levels of fear and avoidance. The Fear-Avoidance Model offers an enticing explanation of why some back pain patients develop persistent disability, stressing the role of catastrophic interpretations; largely fueled by beliefs and expectations that activity will cause injury and will worsen the pain problem. Recently, an exposure in vivo treatment was developed that aims to enhance function by directly addressing these fears and expectations. The purpose of this study was to describe the short-term, consequent effect of an exposure in vivo treatment. The study employed a multiple baseline design with six patients who were selected based on their high levels of fear and avoidance. The results demonstrated clear decreases in rated fear and avoidance beliefs while function increased substantially. These improvements were observed even though rated pain intensity actually decreased somewhat. Thus, the results replicate and extend the findings of previous studies to a new setting, with other therapists and a new research design. These results, together with the initial studies, provide a basis for pursuing and further developing the exposure technique and to test it in group designs with larger samples.
Laura E Simons - One of the best experts on this subject based on the ideXlab platform.
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anxiety sensitivity and fear of pain in paediatric headache patients
European Journal of Pain, 2015Co-Authors: Stefanie Cappucci, Laura E SimonsAbstract:Anxiety sensitivity (AS), which refers to distress related to the potential sensations and consequences associated with anxiety (Asmundson & Taylor, 1996), including heightened interoceptive awareness may be a precursor to the development of pain-related fear where physiological cues are interpreted as precursors to aversive pain-related outcomes. AS has consistently been associated with a greater fear of pain in adult headache (Asmundson et al., 1999), chronic musculoskeletal pain populations, and non-clinical samples (Asmundson et al., 1999; Greenberg and Burns, 2003; Ocanez et al., 2010), linking these overlapping but distinct constructs. Due to this robust association in adult headache populations and the absence of a similarly comprehensive pediatric Model, pediatric headache presents as an appropriate genesis point for the development of this link in pediatric chronic pain. This relationship may result from high levels of interoceptive fear conditioning, such that chronic pain patients with heightened AS may be increasingly associating interoceptive cues with painful experiences (De Peuter et al., 2011). The fear avoidance Model, in fact, cites interoceptive fear conditioning as a potential cause for the acquisition of pain-related fear in chronic pain patients (Vlaeyen and Linton, 2012). Because fear of pain plays such a pivotal role in the maintenance of chronic pain in children, (Asmundson et al., 2012; Simons and Kaczynski, 2012), it is useful to understand any predictors of fear of pain that may render them more susceptible to chronic pain development. Initial inquiries into AS in healthy children and adolescents suggest a relationship between anxiety sensitivity and fear of pain (Muris et al., 2001a; Muris et al., 2001b). These results were confirmed in a small sample of children with chronic pain, though the authors were unable to substantiate an association between AS and disability, likely due the sample size (n=21) (Martin et al., 2007). Relatedly, somatic complaints, enigmatic physiological or bodily symptoms, are also common in highly anxious children (Beidel et al., 1991). Heightened interoceptive awareness may be related to an intensified somatic experience. Given the evidence for the links between AS and somatization (Mahrer et al., 2012), somatization and disability (Harris et al., 2009), and AS and FOP (Muris et al., 2001b) we are also interested in determining if the impact of AS on somatic complaints is FOP mediated. In the current study, we examined the relationship between AS and fear of pain and their influence on pain-related outcomes (Figure 1). Specifically we are interested in testing whether fear of pain mediates the relationship between anxiety sensitivity and pain related disability, and between anxiety sensitivity and somatic complaints in a large pediatric headache sample. Figure 1 Hypothesized Model of the relationship between anxiety sensitivity and pain-related disability in pediatric chronic headache patients
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the fear avoidance Model of chronic pain examination for pediatric application
The Journal of Pain, 2012Co-Authors: Laura E Simons, Karen J KaczynskiAbstract:Abstract The current study examined the Fear Avoidance (FA) Model of chronic pain in pediatric chronic pain patients. Multiple structural equation Models were tested in the current study with pairwise parameter comparisons made between younger children (8–12 years) and adolescents (13–17 years). Within a sample of 350 children and adolescents, we examined functional disability and depressive symptoms in separate Models with the following predictor variables—pain, pain catastrophizing, fear of pain, and avoidance of activities—after controlling for duration of pain. For a subset of patients (n = 151), we also tested a brief prospective outcome Model with baseline predictor variables and functional disability at 1-month follow-up. The FA Models predicting functional disability concurrently and prospectively were an excellent fit to the data. The theorized FA Model for depression was a poor fit. When the Model was modified to include direct pathways from the cognitive processes of pain catastrophizing and fear of pain to depressive symptoms, the Model fit was significantly improved. In the examination of developmental differences between younger children and adolescent patients, duration of pain contributed to the Model for younger children, whereas pain-related fears were more influential for adolescent patients. Perspective The FA Model of chronic pain appears to be applicable for pediatric patients with some modification to account for developmental differences across childhood. We discuss the developmental, theoretical, and clinical implications of these results.
Michael E Robinson - One of the best experts on this subject based on the ideXlab platform.
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the development of a technology based hierarchy to assess chronic low back pain and pain related anxiety from a fear avoidance Model
The Journal of Pain, 2016Co-Authors: Kristen S Springer, Steven Z George, Michael E RobinsonAbstract:Abstract Previous studies have not examined the assessment of chronic low back pain (CLBP) and pain-related anxiety from a fear avoidance Model through the use of motion-capture software and virtual human technologies. The aim of this study was to develop and assess the psychometric properties of an interactive, technologically based hierarchy that can be used to assess patients with pain and pain-related anxiety. We enrolled 30 licensed physical therapists and 30 participants with CLBP. Participants rated 21 video clips of a 3-D animated character (avatar) engaging in activities that are typically feared by patients with CLBP. The results of the study indicate that physical therapists found the virtual hierarchy clips acceptable and depicted realistic patient experiences. Most participants with CLBP reported at least 1 video clip as being sufficiently anxiety-provoking for use clinically. Therefore, this study suggests a hierarchy of fears can be created out of 21 virtual patient video clips paving the way for future clinical use in patients with CLBP. Perspective This report describes the development of a computer-based virtual patient system for the assessment of back pain-related fear and anxiety. Results show that people with back pain as well as physical therapists found the avatar to be realistic, and the depictions of behavior anxiety- and fear-provoking.
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fear of pain not pain catastrophizing predicts acute pain intensity but neither factor predicts tolerance or blood pressure reactivity an experimental investigation in pain free individuals
European Journal of Pain, 2006Co-Authors: Erin A Dannecker, Michael E RobinsonAbstract:Previous studies of the Fear-Avoidance Model of Exaggerated Pain Perception have commonly included patients with chronic low back pain, making it difficult to determine which psychological factors led to the development of an “exaggerated pain perception”. This study investigated the validity of the Fear-Avoidance Model of Exaggerated Pain Perception by considering the influence of fear of pain and pain catastrophizing on acute pain perception, after considering sex and anxiety. Thirty-two males and 34 females completed the State-Trait Anxiety Inventory, the Fear of Pain Questionnaire, and the Coping Strategies Questionnaire. Subjects underwent a cold pressor procedure and tolerance, pain intensity, and blood pressure reactivity were measured. Sex, anxiety, fear of pain, and pain catastrophizing were simultaneously entered into separate multiple regression Models to predict different components of pain perception. Tolerance was not predicted by fear of pain, pain catastrophizing, or anxiety. Pain intensity at threshold and tolerance were significantly predicted by fear of pain, only. Blood pressure reactivity to pain was significantly predicted by anxiety, only. These results suggest that fear of pain may have a stronger influence on acute pain intensity when compared to pain catastrophizing, while neither of the factors predicted tolerance or blood pressure reactivity.
Kevin E Vowles - One of the best experts on this subject based on the ideXlab platform.
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the fear avoidance Model of chronic pain validation and age analysis using structural equation Modeling
Pain, 2006Co-Authors: Andrew J Cook, Peter A Brawer, Kevin E VowlesAbstract:Abstract The cognitive-behavioral, Fear-Avoidance (FA) Model of chronic pain (Vlaeyen JWS, Kole-Snijders AMJ, Boeren RGB, van Eek H. Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain 1995a;62:363–72) has found broad empirical support, but its multivariate, predictive relationships have not been uniformly validated. Applicability of the Model across age groups of chronic pain patients has also not been tested. Goals of this study were to validate the predictive relationships of the multivariate FA Model using structural equation Modeling and to evaluate the factor structure of the Tampa Scale of Kinesiophobia (TSK), levels of pain-related fear, and fit of the FA Model across three age groups: young (⩽40), middle-aged (41–54), and older (⩾55) adults. A heterogeneous sample of 469 chronic pain patients provided ratings of catastrophizing, pain-related fear, depression, perceived disability, and pain severity. Using a confirmatory approach, a 2-factor, 13-item structure of the TSK provided the best fit and was invariant across age groups. Older participants were found to have lower TSK fear scores than middle-aged participants for both factors (FA, Harm). A modified version of the Vlaeyen JWS, Kole-Snijders AMJ, Boeren RGB, van Eek H (Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain 1995a;62:363–72.) FA Model provided a close fit to the data (χ2 (29) = 42.0, p > 0.05, GFI = 0.98, AGFI = 0.97, CFI = 0.99, RMSEA = 0.031 (90% CI 0.000–0.050), p close fit = 0.95). Multigroup analyses revealed significant differences in structural weights for older vs. middle-aged participants. For older chronic pain patients, a stronger mediating role for pain-related fear was supported. Results are consistent with a FA Model of chronic pain, while indicating some important age group differences in this Model and in levels of pain-related fear. Longitudinal testing of the multivariate Model is recommended.
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the fear avoidance Model of chronic pain validation and age analysis using structural equation Modeling
Pain, 2006Co-Authors: Andrew J Cook, Peter A Brawer, Kevin E VowlesAbstract:The cognitive-behavioral, Fear-Avoidance (FA) Model of chronic pain (Vlaeyen JWS, Kole-Snijders AMJ, Boeren RGB, van Eek H. Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain 1995a;62:363-72) has found broad empirical support, but its multivariate, predictive relationships have not been uniformly validated. Applicability of the Model across age groups of chronic pain patients has also not been tested. Goals of this study were to validate the predictive relationships of the multivariate FA Model using structural equation Modeling and to evaluate the factor structure of the Tampa Scale of Kinesiophobia (TSK), levels of pain-related fear, and fit of the FA Model across three age groups: young ( or =55) adults. A heterogeneous sample of 469 chronic pain patients provided ratings of catastrophizing, pain-related fear, depression, perceived disability, and pain severity. Using a confirmatory approach, a 2-factor, 13-item structure of the TSK provided the best fit and was invariant across age groups. Older participants were found to have lower TSK fear scores than middle-aged participants for both factors (FA, Harm). A modified version of the Vlaeyen JWS, Kole-Snijders AMJ, Boeren RGB, van Eek H (Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain 1995a;62:363-72.) FA Model provided a close fit to the data (chi(2)(29)=42.0, p>0.05, GFI=0.98, AGFI=0.97, CFI=0.99, RMSEA=0.031 (90% CI 0.000-0.050), p close fit=0.95). Multigroup analyses revealed significant differences in structural weights for older vs. middle-aged participants. For older chronic pain patients, a stronger mediating role for pain-related fear was supported. Results are consistent with a FA Model of chronic pain, while indicating some important age group differences in this Model and in levels of pain-related fear. Longitudinal testing of the multivariate Model is recommended.
