Abstract
In the last two decades, emerging research has focused on advancing the explanations of how chronic pain becomes disabling. The fear-avoidance model of pain suggests that fear of reinjury in chronic pain patients leads to avoidance of certain movements that subsequently results in more pain and disability from that lack of movement. The literature supporting this model of pain and disability has allowed specific therapeutic interventions to be developed aimed at reducing pain-related fears in an attempt to reduce the physical symptoms and disability of chronic pain. Studies using cognitive-behavioral interventions to reduce fear-avoidance beliefs are reviewed and the treatments are evaluated based on the studies’ effectiveness. The author concludes that graded exposure in vivo appears to be the most effective treatment for chronic pain in individuals with increased fear and avoidance.
Similar content being viewed by others
References
American Chronic Pain Association. (n.d.). Pain Fact Sheet. Retrieved October 29, 2006, from http://theacpa.org.
Andersson, G. B. J. (1999). Epidemiological features of chronic low-back pain. Lancet, 354, 582–585.
Boersma, K., Linton, S., Overmeer, T., Jansson, M., Vlaeyen, J., & de Jong, J. (2004). Lowering fear-avoidance and enhancing function through exposure in vivo: A multiple baseline study across six patients with back pain. Pain, 108, 8–16.
Ciccone, D. S., & Just, N. (2001). Pain expectancy and work disability in patients with acute and chronic pain: A test of the fear-avoidance hypothesis. The Journal of Pain, 2, 181–194.
Cook, A. J., Brawer, P. A., & Vowles, K. E. (2006). The fear-avoidance model of chronic pain: Validation and age analysis using structural equation modeling. Pain, 121, 195–206.
Crombez, G., Vervaet, L., Lysens, R., Baeyens, F., & Eelen, P. (1998). Avoidance and confrontation of painful, back-straining movements in chronic back pain patients. Behavior Modification, 22, 62–77.
Crombez, G., Vlaeyen, J. W. S., Heuts, P. H. T. G., & Lysens, R. (1999). Pain-related fear is more disabling than pain itself: Evidence on the role of pain-related fear in chronic back pain disability. Pain, 80, 329–339.
De Jong, J. R., Vlaeyen, J. W. S., Onghena, P., Goossens, M. E. J. B., Geilen, M., & Mulder, H. (2005). Fear of movement/(re)injury in chronic low back pain: Education or exposure in vivo as mediator to fear reduction? Clinical Journal of Pain, 21, 9–17.
Flor, H., Fydrich, T., & Turk, D. C. (1992). Efficacy of multidisciplinary pain treatment centers: A meta-analytic review. Pain, 49, 221–230.
Fordyce, W. E., Shelton, J. L., & Dundore, D. E. (1982). The modification of avoidance learning pain behaviors. Journal of Behavioral Medicine, 5, 405–414.
Keefe, F. J., Dunsmore, J., & Burnett, R. (1992). Behavioral and cognitive-behavioral approaches to chronic pain: Recent advances and future directions. Journal of Consulting and Clinical Psychology, 60, 528–536.
Klaber Moffett, J., Jackson, D. A., Gardiner, E. D., Torgerson, D. J., Coulton, S., Eaton, S., et al. (2006). Randomized trial of two physiotherapy interventions for primary care neck and back pain patients: ‘McKenzie’ vs. brief physiotherapy pain management. Rheumatology, 1–8. Retrieved November 8, 2006, from http://rheumatology.oxfordjournals.org.
Kori, S. H., Miller, R. P., & Todd, D. D. (1990). Kinesiophobia: A new view of chronic pain behavior. Pain Management, Jan/Feb, 35–43.
Lethem, J., Slade, P. D., Troup, J. D. G., & Bentley, G. (1983). Outline of a fear-avoidance model of exaggerated pain perception—I. Behaviour Research and Therapy, 21, 401–408.
Linton, S. J., & Ryberg, M. (2001). A cognitive-behavioral group intervention as prevention for persistent neck and back pain in a non-patient population: A randomized controlled trial. Pain, 90, 83–90.
Linton, S. J., Overmeer, T., Janson, M., Vlaeyen, J. W. S., & de Jong, J. R. (2002). Graded in vivo exposure treatment for fear-avoidant pain patients with functional disability: A case study. Cognitive Behaviour Therapy, 31, 49–58.
Lundberg, M., Larsson, M., Ostlund, H., & Styf, J. (2006). Kinesiophobia among patients with musculoskeletal pain in primary healthcare. Journal of Rehabilitation Medicine, 38, 37–43.
Luo, X., Pietrobon, R., Sun, S. X., Liu, G. G., & Hey, L. (2003). Estimated and patterns of direct health care expenditures among individuals with back pain in the United States. Spine, 29, 79–86.
Morley, S., & Vlaeyen, J. W. S. (2005). Epilogue to the special topic series. Clinical Journal of Pain, 21, 69–72.
Philips, H. C. (1987). Avoidance behaviour and its role in sustaining chronic pain. Behaviour Research and Therapy, 25, 273–279.
Philips, H. C., & Jahanshahi, M. (1985). Chronic pain: An experimental analysis of the effects of exposure. Behaviour Research and Therapy, 23, 281–290.
Rose, M. J., Klenerman, L., Atchison, L., & Slade, P. D. (1992). An application of the fear-avoidance model to three chronic pain problems. Behaviour Research and Therapy, 30, 359–365.
Sieben, J. M., Portegijs, P. J. M., Vlaeyen, J. W. S., & Knottnerus, J. A. (2005). Pain-related fear at the start of a new low back pain episode. European Journal of Pain, 9, 635–641.
Sieben, J. M., Vlaeyen, J. W. S., Portegijs, P. J. M., Verbunt, J. A., van Riet-Rutgers, S., & Kester, A. D. M. et al. (2005). A longitudinal study on the predictive validity of the fear-avoidance model in low back pain. Pain, 117, 162–170.
Slade, P. D., Troup, J. D. G., Lethem, J., & Bentley, G. (1983). The fear-avoidance model of exaggerated pain perception—II. Behaviour Research and Therapy, 21, 409–416.
Smeets, R. J. E. M., Vlaeyen, J. W. S., Kester, A. D. M., & Knottnerus, J. A. (2006). Reduction of pain catastrophizing mediates the outcome of both physical and cognitive-behavioral treatment in chronic low back pain. The Journal of Pain, 7, 261–271.
Swinkels-Meewisse, I. E. J., Roelofs, J., Verbeek, A. L. M., Oostendorp, R. A. B., & Vlaeyen, J. W. S. (2003). Fear of movement/(re)injury, disability and participation on acute low back pain. Pain, 105, 371–379.
Vlaeyen, J. W. S., & Crombez, G. (1999). Fear of movement/(re)injury, avoidance and pain disability in chronic low back pain patients. Manual Therapy, 4, 187–195.
Vlaeyen, J. W. S., de Jong, J., Geilen, M., Heuts, P. H. T. G., & van Breukelen, G. (2001). Graded exposure in vivo in the treatment of pain-related fear: A replicated single-case experimental design in four patients with chronic low back pain. Behaviour Research and Therapy, 39, 151–166.
Vlaeyen, J. W. S., de Jong, J., Geilen, M., Heuts, P. H. T. G., & van Breukelen, G. (2002). The treatment of fear of movement/(re)injury in chronic low back pain: Further evidence on the effectiveness of exposure in vivo. The Clinical Journal of Pain, 18, 251–261.
Vlaeyen, J. W. S., de Jong, J. R., Onghena, P., Kerckhoffs-Hanssen, M., & Kole-Snijders, A. M. J. (2002). Can pain-related fear be reduced? The application of cognitive-behavioural exposure in vivo. Pain Research and Management, 7, 144–153.
Vlaeyen, J. W. S., de Jong, J., Sieben, J., & Crombez, G. (2002). Graded exposure in vivo for pain-related fear. In D. C. Turk & R. J. Gatchel (Eds.), Psychological approaches to pain management: A practitioner’s handbook (2nd ed., pp. 210–230). New York: Guilford Press.
Vlaeyen, J. W. S., Kole-Snijders, A. M. J., Boeren, R. G. B., & van Eek, H. (1995). Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain, 62, 363–372.
Vlaeyen, J. W. S., Kole-Snijders, A. M. J., Rotteveel, A. M., Ruesink, R., & Heuts, P. H. T. G. (1995). The role of fear of movement/(re)injury in pain disability. Journal of Occupational Rehabilitation, 5, 235–252.
Vlaeyen, J. W. S., & Linton, S. J. (2000). Fear-avoidance and its consequences in chronic musculoskeletal pain: A state of the art. Pain, 85, 317–332.
Wilson, J. J., & Gil, K. M. (1996). The efficacy of psychological and pharmacological interventions for the treatment of chronic disease-related and non-disease-related pain. Clinical Psychology Review, 16, 573–597.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lohnberg, J.A. A Review of Outcome Studies on Cognitive-Behavioral Therapy for Reducing Fear-Avoidance Beliefs Among Individuals With Chronic Pain. J Clin Psychol Med Settings 14, 113–122 (2007). https://doi.org/10.1007/s10880-007-9062-y
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10880-007-9062-y