Fear-avoidance model

Fear-avoidance model

The fear-avoidance model (or FA model) is a psychiatric model that describes how individuals develop and maintain chronic musculoskeletal pain as a result of attentional processes and avoidant behavior based on pain-related fear.[1][2][3] Introduced by Lethem et al. in 1983, this model helped explain how these individuals experience pain despite the absence of pathology.[3][4][5] If an individual experiences acute discomfort and delays the situation by using avoidant behavior, a lack of pain increase reinforces this behavior.[6][7] Increased vulnerability provides positive feedback to the perceived level of pain and rewards avoidant behavior for removing unwanted stimuli.[2][8] If the individual perceives the pain as nonthreatening or temporary, he or she feels less anxious and confronts the pain-related situation.[9][unreliable medical source?]

Avoidant behavior is healthy when encouraging the individual to avoid stressing injuries and permitting them to heal.[7] However, it is harmful when discouraging the individual from activity after the injury is healed.[7] The resulting hypervigilance and disability restricts normal use of the tissue and deteriorates the individual physically and mentally.[8] Once the avoidant behavior is no longer reinforced, the individual exits the positive feedback loop.[2] In 1993, Waddell et al. developed a Fear-Avoidance Beliefs Questionnaire (FABQ) which showed that fear-avoidance beliefs about physical activities are strongly related to work loss.[3][6]

  1. ^ Leeuw, M.; Goossens, M. L. E. J. B.; Linton, S. J.; Crombez, G.; Boersma, K.; Vlaeyen, J. W. S. (2006). "The Fear-Avoidance Model of Musculoskeletal Pain: Current State of Scientific Evidence". Journal of Behavioral Medicine. 30 (1): 77–94. doi:10.1007/s10865-006-9085-0. PMID 17180640. S2CID 207186847.
  2. ^ a b c Pincus, Tamar; Smeets, Rob J.E.M.; Simmonds, Maureen J.; Sullivan, Michael J.L. (November 2010). "The Fear Avoidance Model Disentangled: Improving the Clinical Utility of the Fear Avoidance Model". The Clinical Journal of Pain. 26 (9): 739–746. doi:10.1097/AJP.0b013e3181f15d45. PMID 20842017. S2CID 18667121.
  3. ^ a b c Vlaeyen, J. W.; Linton, S. J. (2000). "Fear-avoidance and its consequences in chronic musculoskeletal pain: A state of the art". Pain. 85 (3): 317–332. doi:10.1016/s0304-3959(99)00242-0. PMID 10781906. S2CID 14486753.
  4. ^ Lethem, J.; Slade, P. D.; Troup, J. D.; Bentley, G. (1983). "Outline of a Fear-Avoidance Model of exaggerated pain perception--I". Behaviour Research and Therapy. 21 (4): 401–408. doi:10.1016/0005-7967(83)90009-8. PMID 6626110.
  5. ^ From Acute to Chronic Back Pain. Oxford University Press. 2012-01-19. p. 282. ISBN 978-0-19-162572-5. Retrieved 19 July 2012.
  6. ^ a b Herbert H. Zaretsky; Edwin F. Richter; Myron G. Eisenberg (21 June 2005). Medical Aspects Of Disability: A Handbook For The Rehabilitation Professional. Springer Publishing Company. pp. 223–4. ISBN 978-0-8261-7973-9. Retrieved 19 July 2012.
  7. ^ a b c Asmundson, Gordon; Norton, Peter (1999). "Beyond pain: the role of fear and avoidance in chronicity". Clinical Psychology Review. 19 (1): 97–119. doi:10.1016/S0272-7358(98)00034-8. PMID 9987586.
  8. ^ a b Crombez, Geert; Eccleston, Christopher; Van Damme, Stefaan; Vlaeyen, Johan W. S.; Karoly, Paul (Jul 2012). "Fear-avoidance model of chronic pain: the next generation". The Clinical Journal of Pain. 28 (6): 475–483. doi:10.1097/AJP.0b013e3182385392. hdl:1854/LU-2960547. ISSN 1536-5409. PMID 22673479. S2CID 8169305.
  9. ^ Selby, Edward. "Avoidance of Anxiety as Self-Sabotage: How Running Away Can Bite You in the Behind". Psychology Today. Retrieved March 20, 2015.