Cited by 30Musculoskeletal pain and rehabilitationPain Management and TreatmentAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Exposure in vivo as a treatment approach to target pain-related fear: theory and new insights from research and clinical practice

Open access
den Hollander, Marlies, Smeets, Rob J E M, van Meulenbroek, Thijs, van Laake-Geelen, Charlotte C M, Baadjou, Vera A, Timmers, Inge·2022·Physical Therapy

Abstract

Pain-related fear (PRF) can be a significant factor contributing to the development and maintenance of pain-related disability in individuals with persistent pain. One treatment approach to target PRF and related avoidance behavior is exposure in vivo (EXP). EXP has a long history in the field of anxiety, a field that is constantly evolving. This Perspective outlines recent theoretical advancements and how they apply to EXP for PRF, including suggestions for how to optimize inhibitory learning during EXP; reviews mechanistic work from neuroimaging supporting the targeting of PRF in people with chronic pain; and focuses on clinical applications of EXP for PRF, as EXP is moving into new directions regarding who is receiving EXP (eg, EXP in chronic secondary pain) and how treatment is provided (EXP in primary care with a crucial role for physical therapists). Considerations are provided regarding challenges, remaining questions, and promising future perspectives. IMPACT: For patients with chronic pain who have elevated pain-related fear (PRF), exposure is the treatment of choice. This Perspective highlights the inhibitory learning approach, summarizes mechanistic work from experimental psychology and neuroimaging regarding PRF in chronic pain, and describes possible clinical applications of EXP in chronic secondary pain as well as in primary care.

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Crossref · 10.1093/ptj/pzab270

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  • In a feasibility pilot study, participants living with chronic pain rated EPIO as useful, with excellent system usability.

    “In accordance with the Medical Research Council framework for complex intervention evaluation,16,57 the EPIO program was tested in a feasibility pilot study, with participants living with chronic pain rating the program as useful, with excellent system usability.10”

    From Living well with chronic pain: a 12-month randomized controlled trial revealing impact from the digital pain self-management program EPIO (2024) · cites this paper as [16]

    The Clinical Applications and Considerations and Future Directions sections discuss exposure treatment for pain-related fear, including some digital approaches, but do not report an EPIO feasibility pilot. Searches for EPIO, usefulness, and system usability found no passage about participants’ ratings of the program. (LLM, conf=0.75)

    Experimental — accuracy not yet measured

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1 of the 122 references couldn’t be matched to a known paper.

Research works printed but not linked: 4

  1. den Hollander M, Goossens MEJB, de Jong JR, et al. Expose or protect? A randomized controlled trial of exposure in vivo versus physiotherapy in patients with complex regional pain syndrome type 1. Pain. 2016;157:2318-2329.
  2. Telch MJ, Lancaster CL. Is there room for safety behaviors in exposure therapy for anxiety disorders? In: Neudeck P, Wittchen H, eds., Exposure Therapy: Rethinking the Model-Refining the Method. New York, NY, USA: Springer; 2012:313-334.
  3. Wager TD, Atlas LY, Ma L, Roy M, Woo C-W, Kross E. An fMRI- based neurologic signature of physical pain. New Engl. J Med. 2013;368:1388-1397.
  4. Miller RP, Kori SH, Todd DD. The Tampa Scale (unpublished report). Clin J of Pain. 1991;7:51.

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Authors
den Hollander, M., Smeets, R. J. E. M., van Meulenbroek, T., van Laake-Geelen, C. C. M., Baadjou, V. A., & Timmers, I.
Affiliations
  • Adelante Centre of Expertise in Rehabilitation and Audiology, Maastricht, the Netherlands
  • Maastricht University (NL)
Venue
Physical Therapy
Published
2022-01-27
Volume
102
Issue
2
ISSN
  • 0031-9023 (ISSN-L)
  • 1538-6724
OpenAlex
W4206648618
Cited by
30
References
122
Citations by year
2026: 5 · 2025: 6 · 2024: 9 · 2023: 7 · 2022: 3
FWCI
3.74
Type
journal article
Language
en
Open access
Locations
  • Physical Therapy (publishedVersion)
  • PubMed (publishedVersion)
  • Research Publications (Maastricht University) (publishedVersion, other-oa)
  • Research Publications (Maastricht University) (submittedVersion, other-oa)
Funders
European Union's Horizon 2020 (841426)
Topics
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
fear of pain, chronic pain, inhibitory learning, avoidance behavior, pain-related disability, primary care
MeSH terms
Fear, Humans, Implosive Therapy, Phobic Disorders, Psychological Theory, Chronic Pain

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