The fear-avoidance model (or FA model) is a psychiatric model that describes how individuals develop and maintain chronic musculoskeletalpain 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]
^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. PMID6626110.
^ abcAsmundson, 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. PMID9987586.