Testing the Fear-Avoidance Model

Take two people with the same back injury. Why does one get better and the other gets worse?

Scientists think fear of pain may have something to do with it. A theory called the fear-avoidance (FA) model of pain has been proposed. Fear of pain or reinjury changes the way the person moves. They may avoid any movements that might cause pain. FA leads to disuse, depression, and disability.

In this study, researchers compare FA responses of adults to chronic pain by age. They used the Tampa Scale of Kinesiophobia (TSK) to test for fear of movement/(re)injury. They found that the TSK was the best fit for chronic pain patients divided into groups by age.

Older adults (55 years old and older) had less pain-related fear compared to middle-aged or younger adults. But when present, the fear of (re)injury was more likely to lead to depression and disability in older adults.

Young patients are more likely to "catastrophize" their pain. Their negative thinking exaggerates pain. Catastrophic thinking fuels fear leading to greater disability when compared to patients who don't catastrophize.

The authors conclude by saying the results of their study confirm the FA theory. Fear of pain does predict who will become a chronic pain patient. In fact fear of pain is a better predictor of disability than pain itself. FA tests can help show who will be disabled six months from now. Education may help prevent or at least reduce pain-related fear.

Andrew J. Cook, et al. The Fear-Avoidance Model of Chronic Pain: Validation and Age Analysis Using Structural Equation Modeling. In Pain. April 2006. Vol. 121. No. 3. Pp. 195-206.

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