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Mental Being Research
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Musculoskeletal Pain
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1. Leeuw, M. et al. The Fear-Avoidance Model of Musculoskeletal Pain: Current State of Scientific Evidence. J Behav Med. 2006 Dec 20; [Epub ahead of print]
The fear-avoidance model is a cognitive-behavioral account that explains why some acute low back pain sufferers develop a chronic pain problem.
This paper reviews the current state of scientific evidence for:
- Pain severity
- Pain catastrophizing (thinking a problem worse than it is)
- Attention to pain
- Escape/avoidance behavior
- Disability
- Disuse
- Vulnerabilities.
This review of the literature also discusses support for the contribution of pain-related fear in the inception of low back pain, the development of chronic low back pain from an acute episode, and how to maintain enduring pain.
Available evidence on recent clinical applications is also provided, and unresolved issues that need further exploration are discussed.
2. Vlaeyen JW, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain. 2000 Apr; 85(3):317-32.
Some individuals with musculoskeletal pain develop a chronic pain syndrome. This is in part due to a so-called 'fear-avoidance' model.
The central concept of this model is fear of pain. 'Confrontation' and 'Avoidance' are suggested as the two extreme responses to this fear.
People that 'Confront' their fear have a reduction of fear over time, and thus a reduction in pain.
People that 'Avoid' their fear tend to develop more frequent episodes of pain and create a phobic state of the pain.
This paper discusses the research over the past 10 years (prior to the year 2000) that have refined the fear-avoidance model, and attempts to describe the role of pain-related fear, and its immediate and long-term consequences in the initiation and maintenance of chronic pain disability.
Although there are a number issues associated with chronic pain, pain-related fear and avoidance appears to be an essential feature of the development of a chronic problem for a substantial number of patients.
3. Boersma K, Linton SJ. 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. Clin J Pain. 2006 Feb;22 (2):160-6.
Understanding the psychological processes that underlie the development of a chronic pain problem is important to improve prevention and treatment.
This study intended to test whether distinct profiles of variables within the fear-avoidance model could be identified and could be related to disability in a meaningful way.
81 people were analyzed and placed into one of five categories based on several factors including fear and avoidance beliefs, catastrophizing: (believing a problem is worse than it is), and depression.
These groups were then analyzed on various functions of health such as: pain, healthcare usage, and sick leave from work.
This study showed that the majority of the 'groups' of people reported long term sick leave during follow-up analyzes.
Others (70%) of people classified as 'Depressed' reported the highest percentage of healthcare usage, and (42%) of another group reported greater than 10 healthcare visits.
This paper illustrates that distinct profiles of psychological functioning could be determined and may be meaningfully to predict future disability.
These profiles give support to the fear-avoidance model and underscore the need to address the psychological aspects of the pain experience early on.
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