Pain-related fear, disability, and the fear-avoidance model of chronic pain

Zale, Emily L; Ditre, Joseph W

doi:10.1016/j.copsyc.2015.03.014

Cited by 203Musculoskeletal pain and rehabilitationPediatric Pain Management TechniquesPain Management and Treatment

Pain-related fear, disability, and the fear-avoidance model of chronic pain

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Zale, Emily L, Ditre, Joseph W·2015·Current Opinion in Psychology

DOI 10.1016/j.copsyc.2015.03.014PMC PMC4383173

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Abstract

Chronic pain is a significant public health concern that imposes substantial burdens on individuals and healthcare systems, and factors that contribute to the development and maintenance of pain-related disability are of increasing empirical and clinical interest. Consistent with the fear-avoidance model of chronic pain, greater pain-related fear has consistently been associated with more severe disability and may predict the progression of disability over time. Recent evidence indicates that treatments designed to reduce pain-related fear are efficacious for improving disability outcomes, and several clinical trials are currently underway to test tailored intervention content and methods of dissemination. Future research in this area is needed to identify factors (e.g., substance use, comorbid psychopathology) that may influence interrelations between pain-related fear, response to treatment, and disability.

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The fear-avoidance model of chronic pain explains the relationship between pain and anxiety present among many patients with OUD.
“The fear-avoidance model of chronic pain helps to explain the relationship between pain and anxiety that is present among many patients with OUD 47.”
From Effects of a trauma-informed mindful recovery program on comorbid pain, anxiety, and substance use during primary care buprenorphine treatment: A proof-of-concept study (2023) · cites this paper as [47]
The Fear-Avoidance Model and Pain-Related Fear section (page not provided) describes pain-related anxiety as an anxious or fearful response to pain and explains how pain-related fear and avoidance can reinforce each other. The Psychosocial Factors section discusses other forms of substance use, but does not establish that this relationship is present among many patients with opioid use disorder (OUD). (LLM, conf=0.86)
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The Biopsychosocial Puzzle of Painful Sex
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Effect of Electroacupuncture on Pain Perception and Pain-Related Affection: Dissociation or Interaction Based on the Anterior Cingulate Cortex and S1
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Effects of a trauma-informed mindful recovery program on comorbid pain, anxiety, and substance use during primary care buprenorphine treatment: A proof-of-concept study
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Graded Chronic Pain Scale
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How useful is the Making Every Contact Count Healthy Conversation Skills approach for supporting people with musculoskeletal conditions?
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Using Illness Perceptions to Cluster Chronic Pain Patients
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The Relationship Between Fear-Avoidance Beliefs, Disability, and Physical Capacity in Patients with Chronic Low Back Pain
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The relationship between injury-related fear and physical activity in people with a history of anterior cruciate ligament reconstruction
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Putting the fear-avoidance model into practice – what can patients with chronic low back pain learn from patients with Achilles tendinopathy and vice versa?
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Integrative Treatment Strategies for Chronic Back Pain: A Literature Review with Clinical Recommendations
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Values-Based Behavioral Activation for Chronic Pain in Primary Care: A Pilot Study
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Association Between Activity Pacing and Negative Emotions in Patients With Chronic Pain
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Peer Support for Chronic Pain in Online Health Communities: Quantitative Study on the Dynamics of Social Interactions in a Chronic Pain Forum
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Psychologic Impacts on Diabetic Neuropathic Pain
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The nucleus accumbens-prefrontal connectivity as a predictor of chronic low back pain
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The impact of pelvic balance, physical activity, and fear-avoidance on the outcome after decompression and instrumented fusion for degenerative lumbar stenosis
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Movement Sonification of Familiar Music to Support the Agency of People with Chronic Pain
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How Might We Screen for Psychological Factors in People With Pelvic Pain? An e-Delphi Study
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Pain-side related difference in cross-sectional area of the longus colli muscle and its relationship with standing balance in persons with non-specific neck pain
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Phenotyping of chronic pain in breast cancer survivors: an original study using the cancer pain phenotyping (CANPPHE) Network multidisciplinary international guidelines
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Inconsistent Time-Dependent Effects of Tetramethylpyrazine on Primary Neurological Disorders and Psychiatric Comorbidities
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Whiplash-Associated Disorders. Biopsychosocial Profiles of Pain Perception in Forensic Cases of Victims of Motor Vehicle Accidents
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Attachment and symptom reporting in adolescents and young adults after a concussion
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Individual Variation in Pain Sensitivity and Implicit Negative Bias Toward Pain
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Physiotherapy Outcomes Are Associated With Shorter Waiting Times, More Treatment Sessions and Younger Age: Analysis of a Clinical Database
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Evaluation of cognitive deficits and limit of stability in chronic low back pain patients with and without fear-avoidance beliefs
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Perceived discrimination and problematic opioid use among Black individuals with chronic musculoskeletal pain.
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“Pushed to Their Limits”
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Identifying potential action points for reducing kinesiophobia among atrial fibrillation patients: a network and DAG analysis
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Pain anxiety and rehabilitation outcomes after acquired brain injury
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Associations between biased threat interpretations, fear and avoidance of pain and pain‐linked disability in adolescent chronic pain patients
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Disability in people with chronic low back pain treated in primary care
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Authors: Zale, E. L., & Ditre, J. W.
Affiliations: Syracuse University (US)
Corresponding author: Ditre, Joseph W
ORCID: Zale, Emily L
Ditre, Joseph W
Venue: Current Opinion in Psychology
Publisher: Elsevier BV
Published: 2015-10
Volume: 5
Pages: 24-30
ISSN: 2352-250X (ISSN-L)
DOI: 10.1016/j.copsyc.2015.03.014
PMC: PMC4383173
OpenAlex: W2068772825
Cited by: 203
References: 57
Citations by year: 2026: 30 · 2025: 31 · 2024: 37 · 2023: 17 · 2022: 21 · 2021: 21 · 2020: 14 · 2019: 14 · 2018: 10 · 2017: 4 · 2016: 2 · 2015: 1
FWCI: 0.71
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Current Opinion in Psychology (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: National Institute on Drug Abuse (R21DA034285, R21DA038204)
Topics: Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
Keywords: chronic pain, fear of pain, disability, fear-avoidance model, pain-related disability, disability progression, treatment response, substance use, comorbid psychopathology

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Pain-related fear, disability, and the fear-avoidance model of chronic pain

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