Advertisement

De rol van angst bij pijn: theoretische aspecten

  • N. Claes
  • M. E. J. B. Goossens
  • J. W. S. Vlaeyen

Samenvatting

Chronische pijn wordt tegenwoordig vanuit een biopsychosociaal perspectief benaderd, met aandacht voor zowel biologische, psychologische als sociale factoren. Een van de invloedrijkste biopsychosociale modellen voor chronische pijn is het vreesvermijdingsmodel. Volgens dit model is pijngerelateerde angst – oftewel een vaak buitensporige vermijdingsreactie op geanticipeerde pijn – een prominente factor in zowel de ontwikkeling als het behoud van chronische pijnproblemen. Deze pijngerelateerde angst komt meestal tot stand via associatieve leerprocessen, namelijk via pavloviaanse ofwel instrumentele conditionering, rechtstreeks contact, observatie van anderen, of verbale informatie, en is meetbaar aan de hand van verbale, gedragsmatige en psychofysiologische responsen. Pijngerelateerde angst leidt niet alleen tot vermijding van pijnlijke activiteiten, maar kan ook generaliseren tot een veralgemeende inactiviteit, die vaak gepaard gaat met een negatief affect. Door de zeer grote invloed van de angst voor pijn op het dagelijks leven is het reduceren van pijngerelateerde angst vaak een doelwit van behandelingen die patiënten met pijn trachten te activeren. Vaak wordt een beroep gedaan op extinctieprocedures, waarbij de patiënt wordt blootgesteld aan de angst uitlokkende stimuli; dit stelt hem in staat de verwachting dat er catastrofale gevolgen optreden, uit te dagen. Exposure wordt beschouwd als het klinische equivalent van een typische extinctieprocedure.

Literatuur

  1. Asmundson GJG, Wright KD. Biopsychosocial approaches to pain. In: Hadjistavropoulos T, Craig KD, editors. Pain: psychological perspectives. Mahwah, New Jersey: Lawrence Erlbaum Associates; 2004, p. 35–57.Google Scholar
  2. Asmundson GJG, Norton GR, Vlaeyen JWS. Fear-avoidance models of chronic pain: an overview. In: Asmundson GJG, Vlaeyen JWS, Crombez G, editors. Understanding and treating fear of pain. 1st ed. Oxford: Oxford University Press; 2004, p. 3–24.Google Scholar
  3. Bailey KM, Carleton RN, Vlaeyen JWS, Asmundson GJG. Treatments addressing pain-related fear and anxiety in patients with chronic musculoskeletal pain: a preliminary review. Cogn Behav Ther. 2010;39(1):46–63.CrossRefPubMedGoogle Scholar
  4. Bandura A. Influence of models reinforcement contingencies on the acquistion of imitative responses. J Pers Soc Psychol. 1965;1(6):589–95.CrossRefPubMedGoogle Scholar
  5. Boddez Y, Baeyens F, Hermans D, Beckers T. Reappraisal of threat value: loss of blocking in human aversive conditioning. Span J Psychol. 2013;2013(16):E84.CrossRefGoogle Scholar
  6. Bouton ME. Context, time, and memory retrieval in the interference paradigms of Pavlovian learning. Psychol Bull. 1993.Google Scholar
  7. Bouton ME. Learning and behavior: a contemporary synthesis. Sunderland, MA: Sinauer Associates; 2007.Google Scholar
  8. Bradley MM, Miccoli L, Escrig MA, Lang PJ. The pupil as a measure of emotional arousal and autonomic activation. Psychophysiology. 2008;45(4):602–7.CrossRefPubMedPubMedCentralGoogle Scholar
  9. Burns JW, Mullen JT, Higdon LJ, Wei JM, Lansky D. Validity of the Pain Anxiety Symptoms Scale (PASS): Prediction of physical capacity variables. Pain. 2000;84(2–3):247–52.CrossRefPubMedGoogle Scholar
  10. Crombez G, Baeyens F, Eelen P. Pijn en pijnresponsen. Gedragstherapie. 1993;26(3):153–78.Google Scholar
  11. Crombez G, Eccleston C, Damme S van, Vlaeyen JWS, Karoly P. Fear-avoidance model of chronic pain: the next generation. Clin J Pain. 2012;28(6):475–83.CrossRefPubMedGoogle Scholar
  12. Crombez G, Kissi A. The future is bright: on the behavioural consequences of rule-following. In Main CJ, Keefe FJ, Jensen MP, Vlaeyen JWS, Vowles KE, editors. Fordyce’s behavioral methods for chronic pain and illness: republished with invited commentaries. Washington, USA: IASP Press; 2015, p. 113–20.Google Scholar
  13. Domjan M. Pavlovian conditioning: basic concepts. In: the essentials of conditioning and learning. 3rd ed. Belmont, CA USA: Thomson Wadsworth; 2005, p. 45–65.Google Scholar
  14. Eccleston C, Crombez G. Pain demands attention: a cognitive-affective model of the interruptive function of pain. Psychol Bull. 1999;125(3):356–66.CrossRefPubMedGoogle Scholar
  15. Elliot AJ, Covington MV. Approach and avoidance motivation. Educ Psychol Rev. 2001;13(2):73–92.CrossRefGoogle Scholar
  16. Fordyce WE. Behavioral methods for chronic pain and illness. St. Louis: Mosby Company; 1976.Google Scholar
  17. Gamsa A. The role of psychological factors in chronic pain. I. A half century of study. Pain. 1994;57:5–15.CrossRefPubMedGoogle Scholar
  18. Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC. The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychol Bull. 2007;133(4):581–624.CrossRefPubMedGoogle Scholar
  19. Goodman JE, McGrath PJ. Mothers’ modeling influences childrenʼs pain during a cold pressor task. Pain. 2003;104(3):559–65.CrossRefPubMedGoogle Scholar
  20. Goossens MEJB, Verbunt JA. PHODA-Youth: opstellen van een angsthiërarchie. Hoensbroek: Adelante; 2016.Google Scholar
  21. Grillon C. Startle reactivity and anxiety disorders: aversive conditioning, context, and neurobiology. Biol Psychiatry. 2002;52(10):958–75.CrossRefPubMedGoogle Scholar
  22. Grillon C, Baas J. A review of the modulation of the startle reflex by affective states and its application in psychiatry. Clin Neurophysiol. 2003;114(9):1557–79.CrossRefPubMedGoogle Scholar
  23. Gureje O, Korff M von, Simon GE, Gater R. Persistent pain and well-being: a World Health Organization Study in Primary Care. [Research Support, U.S. Gov’t, P.H.S.]. JAMA. 1998;280(2):147–51.CrossRefPubMedGoogle Scholar
  24. Helsen K, Goubert L, Peters ML, Vlaeyen JWS. Observational learning and pain-related fear: an experimental study with colored cold pressor tasks. J Pain. 2011;12(12):1230–9.CrossRefPubMedGoogle Scholar
  25. Helsen K, Leeuw M, Vlaeyen JWS. Fear and pain. In: Encyclopedia of Pain. Berlin/Heidelberg: Springer; 2013, p. 1261–7.Google Scholar
  26. Hollander ML den, Jong JR de, Volders S, Goossens MEJB, Smeets RJEM, Vlaeyen JWS. Fear reduction in patients with chronic pain: a learning theory perspective. Expert Rev Neurother. 2010;10(11):1733–45.CrossRefGoogle Scholar
  27. Houben RMA, Ostelo RWJG, Vlaeyen JWS, Wolters PMJC, Peters M, Berg SGMS. Health care providers’ orientations towards common low back pain predict perceived harmfulness of physical activities and recommendations regarding return to normal activity. Eur J Pain. 2005;9(2):173–8.CrossRefPubMedGoogle Scholar
  28. Hout JH van den, Vlaeyen JW, Houben RM, Soeters AP, Peters ML. The effects of failure feedback and pain-related fear on pain report, pain tolerance, and pain avoidance in chronic low back pain patients. Pain. 2001;92(1–2):247–57. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11323146.
  29. Houwer J de, Crombez G, Baeyens F, Hermans D. On the generality of the affective Simon effect. Cogn Emot. 2013;2001(15):189–206.Google Scholar
  30. International Association for the Study of Pain (IASP). (2011). Part III: Pain Terms. A current list with definitions and notes on usage. Retrieved 22, 2016, from http://www.iasp-pain.org/files/Content/ContentFolders/Publications2/ClassificationofChronicPain/Part_III-PainTerms.pdf.
  31. Jong JR de, Vlaeyen JWS, Onghena P, Cuypers C, Hollander ML den, Ruijgrok J. Reduction of pain-related fear in complex regional pain syndrome type I: the application of graded exposure in vivo. Pain. 2005;116(3):264–75.CrossRefPubMedGoogle Scholar
  32. Kori SH, Miller RP, Todd DD. Kinesiophobia: a new view of chronic pain behavior. Pain Manage. 1990;3(1):35–43.Google Scholar
  33. Krieglmeyer R, Deutsch R. Comparing measures of approach–avoidance behaviour: the manikin task vs. two versions of the joystick task. Cogn Emot. 2010;24(5):810–28.CrossRefGoogle Scholar
  34. Kugler K, Wijn J, Geilen M, Jong JR de, Vlaeyen JWS. The Photograph series of daily activities (PHODA). Heerlen, The Netherlands: institue for rehabilitation research and school for physiotherapy; 1999.Google Scholar
  35. Lang PJ. Fear reduction and fear behavior: problems in treating a construct. In: Shlien JM, editor. Research in psychotherapy. Washington, DC: APA. 1968, p. 90–102.Google Scholar
  36. Lang PJ, McTeague LM. The anxiety disorder spectrum: fear imagery, physiological reactivity, and differential diagnosis. Anxiety Stress Coping. 2009;22(1):5–25.CrossRefPubMedPubMedCentralGoogle Scholar
  37. Leeuw M, Goossens MEJB, Linton SJ, Crombez G, Boersma K, Vlaeyen JWS. The fear-avoidance model of musculoskeletal pain: current state of scientific evidence. J Behav Med. 2007;30(1):77–94.CrossRefPubMedGoogle Scholar
  38. Leeuw M, Goossens MEJB, Breukelen GJP van, Jong JR de, Heuts PHTG, Smeets RJEM, Vlaeyen JWS. Exposure in vivo versus operant graded activity in chronic low back pain patients: results of a randomized controlled trial. Pain. 2008;138(1):192–207.CrossRefPubMedGoogle Scholar
  39. Lethem J, Slade PD, Troup JDG, Bentley G. Outline of a fear-avoidance model of exaggerated pain perception – I. Behav Res Ther. 1983;21(4):401–8.CrossRefPubMedGoogle Scholar
  40. Lissek S, Orme K, Mcdowell DJ, Johnson LL, Luckenbaugh DA, Baas JM, Grillon C. Emotion regulation and potentiated startle across affective picture and threat-of-shock paradigms. Biol Psychol. 2007;76(1–2):124–33.CrossRefPubMedPubMedCentralGoogle Scholar
  41. Lissek S, Powers AS, McClure EB, Phelps EA, Woldehawariat G, Grillon C, Pine DS. Classical fear conditioning in the anxiety disorders: a meta-analysis. Behav Res Ther. 2005;43(11):1391–424.CrossRefPubMedGoogle Scholar
  42. Lissek S, Rabin S, Heller RE, Lukenbaugh D, Geraci M, Pine DS, Grillon C. Overgeneralization of conditioned fear as a pathogenic marker of panic disorder. Am J Psychiatry. 2010;167(1):47–55.CrossRefPubMedGoogle Scholar
  43. McCracken LM, Vowles KE, Eccleston C. Acceptance-based treatment for persons with complex, long standing chronic pain: a preliminary analysis of treatment outcome in comparison to a waiting phase. Behav Res Ther. 2005;43(10):1335–46.CrossRefPubMedGoogle Scholar
  44. McCracken LM, Zayfert C, Gross RT. The pain anxiety symptoms scale: development and validation of a scale to measure fear of pain. Pain. 1992;50(1):67–73.CrossRefPubMedGoogle Scholar
  45. McNeil DW, Rainwater AJ. Development of the fear of pain questionnaire-III. J Behav Med. 1998;21(4):389–410.CrossRefPubMedGoogle Scholar
  46. Melzack R, Casey KL. Sensory, motivational, and central control determinants of pain: a new conceptual model. In: Kenshalo DR, editor. The skin senses. Springfield, Illinois: Charles C Thomas; 1968, p. 423–39.Google Scholar
  47. Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965;150:971–9.CrossRefPubMedGoogle Scholar
  48. Merskey H, Bogduk N. IASP task force on taxonomy, part III: pain terms, a current list with definitions and notes on usage. IASP Task Force on Taxonomy. 1994;209–214.Google Scholar
  49. Meulders A, Franssen M, Fonteyne R, Vlaeyen JWS. Acquisition and extinction of operant pain-related avoidance behavior using a 3 degrees-of-freedom robotic arm. Pain, (Advance online publication) 2016.Google Scholar
  50. Meulders A, Vandebroek N, Vervliet B, Vlaeyen JWS. Generalization gradients in cued and contextual pain-related fear: an experimental study in healthy participants. Front Hum Neurosci. 2013;7:345.CrossRefPubMedPubMedCentralGoogle Scholar
  51. Meulders A, Vansteenwegen D, Vlaeyen JWS. The acquisition of fear of movement-related pain and associative learning: a novel pain-relevant human fear conditioning paradigm. Pain. 2011;152(11):2460–9.CrossRefPubMedGoogle Scholar
  52. Meulders A, Vlaeyen JWS. Reduction of fear of movement-related pain and pain-related anxiety: an associative learning approach using a voluntary movement paradigm. Pain. 2012;153(7):1504–13.CrossRefPubMedGoogle Scholar
  53. Meulders A, Vlaeyen JWS. The acquisition and generalization of cued and contextual pain-related fear: an experimental study using a voluntary movement paradigm. Pain. 2013;154(2):272–82.CrossRefPubMedGoogle Scholar
  54. Miller RP, Kori SH, Todd DD. The Tampa Scale. Tampa, Fla: Unpublished Report; 1991.Google Scholar
  55. Mineka S, Öhman A. Phobias and preparedness: the selective, automatic, and encapsulated nature of fear. Biol Psychiatry. 2002;52(10):927–37.CrossRefPubMedGoogle Scholar
  56. Mineka S, Sutton J. Contemporary learning theory perspectives on the etiology of fears and phobias. In: Craske MG, Hermans D, Vansteenwegen D, editors. Fear and learning: from basic processes to clinical implications. Washington: APA; 2006, p. 75–97.Google Scholar
  57. Moayedi M, Davis KD. Theories of pain: from specificity to gate control. J Neurophysiol. 2013;109(1):5–12.CrossRefPubMedGoogle Scholar
  58. Muris P, Bodden D, Merckelbach H, Ollendick TH, King N. Fear of the beast: a prospective study on the effects of negative information on childhood fear. Behav Res Ther. 2003;41(2):195–208.CrossRefPubMedGoogle Scholar
  59. Olsson A, Phelps EA. Learned fear of ‘unseen’ faces after pavlovian, observational, and instructed fear. Psychol Sci. 2004;15(12):822–8.CrossRefPubMedGoogle Scholar
  60. Ostelo RWJG, Vlaeyen JW. Attitudes and beliefs of health care providers: extending the fear-avoidance model. Pain. 2008;135(1–2):3–4.CrossRefPubMedGoogle Scholar
  61. Pavlov IP. Conditioned reflexes: an investigation of the physiological activity of the cerebral cortex. London: Dover; 1927.Google Scholar
  62. de Peuter S, Jong J de, Crombez G, Vlaeyen JWS. The nature and treatment of pain-related fear in chronic musculoskeletal pain. J Cogn Psychother. 2009;23(1):85–103.CrossRefGoogle Scholar
  63. Pierce WD, Cheney CD. Behavior analysis and learning. 5th ed. Oxon: Psychology Press; 2013.Google Scholar
  64. Riediger M, Freund AM. Interference and facilitation among personal goals: differential associations with subjective well-being and persistent goal pursuit. Pers Soc Psychol Bull. 2004;30(12):1511–23.CrossRefPubMedGoogle Scholar
  65. Roelofs J, McCracken LM, Peters ML, Crombez G, Breukelen G van, Vlaeyen JWS. Psychometric evaluation of the pain anxiety symptoms scale (PASS) in chronic pain patients. J Behav Med. 2004;27(2):167–83.CrossRefPubMedGoogle Scholar
  66. Roelofs J, Peters ML, Deutz J, Spijker C, Vlaeyen JWS. The Fear of Pain Questionnaire (FPQ): further psychometric examination in a non-clinical sample. Pain. 2005;116(3):339–46.CrossRefPubMedGoogle Scholar
  67. Skinner BF. ‘Superstition’ in the pigeon. J Exp Psychol. 1948;38(2):168–72.CrossRefPubMedGoogle Scholar
  68. Swinkels-Meewisse IEJ, Roelofs J, Oostendorp RAB, Verbeek ALM, Vlaeyen JWS. Acute low back pain: pain-related fear and pain catastrophizing influence physical performance and perceived disability. Pain. 2006;120(1–2):36–43.CrossRefPubMedGoogle Scholar
  69. Trost Z, France CR, Vervoort T, Lange J, Goubert L. Learning about pain through observation: the role of pain related fear. J Behav Med. 2014;37(2):257–65.CrossRefPubMedGoogle Scholar
  70. Vandenbroucke S, Crombez G, Ryckeghem DML van, Brass M, Damme S van, Goubert L. Vicarious pain while observing another in pain: an experimental approach. Front Hum Neurosci. 2013, p. 265.Google Scholar
  71. Vervliet B, Raes F. Criteria of validity in experimental psychopathology: application to models of anxiety and depression. Psychol Med. 2013;43(11):2241–4.CrossRefPubMedGoogle Scholar
  72. Vlaeyen J, Linton SJ. Fear-avoidance model of chronic musculoskeletal pain: 12 years on. Pain. 2012;153(6):1144–7.CrossRefPubMedGoogle Scholar
  73. Vlaeyen JW, Crombez G, Linton SJ. The fear-avoidance model of pain. Pain. 2016;157(8):1588–9. doi: 10.1097/j.pain.0000000000000574.
  74. Vlaeyen JW, Kole-Snijders AM, Boeren RG, Eek H van. Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain. 1995;62(3):363–72.CrossRefPubMedGoogle Scholar
  75. Vlaeyen JW, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain. 2000;85(3):317–32.CrossRefPubMedGoogle Scholar
  76. Vlaeyen JWS. Learning to predict and control harmful events. Pain. 2015;156:S86–93.CrossRefPubMedGoogle Scholar
  77. Vlaeyen JWS, Crombez G, Linton SJ. The fear-avoidance model of pain: We are not there yet. Comment on wideman et al. ‘A prospective sequential analysis of the fear-avoidance model of pain’ [Pain, 2009] and Nicholas ‘First things first: reduction in catastrophizing before fear of movement’. Pain. 2009;146(1–2):222; author reply 222–3.Google Scholar
  78. Vlaeyen JWS, Jong J de, Geilen M, Heuts PHTG, Breukelen G van. The treatment of fear of movement/(re)injury in chronic low back pain: further evidence on the effectiveness of exposure in vivo. Clin J Pain. 2002;18(4):251–61.Google Scholar
  79. Vlaeyen JWS, Hanssen M, Goubert L, Vervoort T, Peters M, Breukelen G van, Morley S. Threat of pain influences social context effects on verbal pain report and facial expression. Behav Res Ther. 2009;47(9):774–82.CrossRefPubMedGoogle Scholar
  80. Vlaeyen JWS, Morley S, Linton SJ, Boersma K, Jong JR de. Pain-related fear: exposure-based treatment for chronic pain. Seattle: IASP Press; 2012.Google Scholar
  81. Volders S, Leeuw M, Vlaeyen JWS, Crombez G. Disability, fear of movement. In: Encyclopedia of pain. Berlin/Heidelberg: Springer; 2013, p. 1015–21.Google Scholar
  82. Volders S, Meulders A, Peuter S de, Vervliet B, Vlaeyen JWS. Safety behavior can hamper the extinction of fear of movement-related pain: an experimental investigation in healthy participants. Behav Res Ther. 2012;50(11):735–46.CrossRefPubMedGoogle Scholar
  83. Watson JB, Rayner R. Conditioned emotional reactions. J Exp Psychol. 1920;3(1):1–14.CrossRefGoogle Scholar
  84. Wertli MM, Rasmussen-Barr E, Weiser S, Bachmann LM, Brunner F. The role of fear avoidance beliefs as a prognostic factor for outcome in patients with nonspecific low back pain: a systematic review. Spine J. 2014;14(5):816–36.e4.Google Scholar
  85. Zale EL, Lange KL, Fields SA, Ditre JW. The relation between pain-related fear and disability: a meta-analysis. J Pain. 2013;14(10):1019–30.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Bohn Stafleu van Loghum 2017

Authors and Affiliations

  • N. Claes
    • 1
  • M. E. J. B. Goossens
    • 2
  • J. W. S. Vlaeyen
    • 3
  1. 1.Vakgroep GezondheidspsychologieKU LeuvenLeuvenBelgium
  2. 2.Vakgroep Revalidatiegeneeskunde, Vakgroep Clinical Psychological ScienceUniversiteit MaastrichtMaastrichtThe Netherlands
  3. 3.KU LeuvenLeuvenBelgium

Personalised recommendations