The Opportunity to Avoid Pain May Paradoxically Increase Fear

The Journal of Pain : Official Journal of the American Pain Society
Christine van VlietJohan W S Vlaeyen

Abstract

Fear-avoidance models propose that pain-related fear may spur avoidance behavior leading to chronic pain disability. Pain-related fear elicits avoidance behavior, which is typically aimed at reducing fear. We hypothesized that engaging in avoidance may (paradoxically) increase rather than decrease pain-related fear (ie, bidirectionality hypothesis). In a between-subject design, participants (n = 64) were randomly assigned to the avoidance group or the control group. Avoidance group participants were led to believe they could avoid full exposure to a painful heat stimulus by pressing the stop button, whereas control group participants believed they were exposed to the full painful heat stimulus at all times. In reality and unknown to the participants, the intensity and duration of the heat stimulus was independent of the avoidance response, and was identical in both groups. During the test, the avoidance response (ie, pressing the stop button) was no longer available. As expected, pain-related fear levels were higher after avoiding the painful heat stimulus. Interestingly, in the avoidance group, pain-related fear increased after receiving instructions that avoidance would be possible, even before actually engaging in avoidance ...Continue Reading

Citations

Oct 5, 2019·Pain Reports·Thomas JanssensJohan W S Vlaeyen
Jul 28, 2020·Annals of Behavioral Medicine : a Publication of the Society of Behavioral Medicine·Christine M van VlietJohan W S Vlaeyen
Dec 11, 2019·Annual Review of Clinical Psychology·Johan W S Vlaeyen, Geert Crombez
Oct 18, 2019·Neuroscience and Biobehavioral Reviews·Inge TimmersLaura E Simons
Sep 22, 2019·The Journal of Pain : Official Journal of the American Pain Society·Christine M van VlietJohan W S Vlaeyen
Dec 22, 2019·International Journal of Psychophysiology : Official Journal of the International Organization of Psychophysiology·Nadia ZacharioudakisOmer Van den Bergh
Apr 9, 2021·European Journal of Pain : EJP·Susanne BeckerMarcel Schweiker
May 25, 2021·The Journal of Pain : Official Journal of the American Pain Society·Rena GatzounisAnn Meulders
Jun 1, 2021·Physiology & Behavior·Hanna MellesAnita Jansen

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