Cited by 499Musculoskeletal pain and rehabilitationPain Management and TreatmentAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

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The treatment of fear of movement/(re) injury in chronic low back pain: further evidence on the effectiveness of exposure in vivo

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Vlaeyen, Johan W. S., de Jong, Jeroen, Geilen, Mario, Heuts, Peter H. T. G., van Breukelen, Gerard·2002·The Clinical Journal of Pain

DOI 10.1097/00002508-200207000-00006

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Abstract

BACKGROUND AND OBJECTIVE: Several cognitive-behavioral factors contribute to the persistence of pain disability in patients with chronic back pain. Fear-avoidance beliefs and fear of movement/(re)injury in particular have been shown to be strong predictors of physical performance and pain disability. Patients reporting substantial pain-related fear might benefit from exposure in vivo to a set of individually tailored, fear-eliciting, and hierarchically ordered physical movements rather than more general graded activity. PATIENTS AND INTERVENTIONS: Six consecutive patients with chronic low back pain who reported substantial fear of movement/(re)injury were included in the study. After a no-treatment baseline measurement period, the patients were randomly assigned to one of two interventions. In the first intervention, patients received exposure in vivo first, followed by graded activity. In the second intervention, the sequence of treatment modules was reversed. Before each treatment module, treatment credibility was assessed. Daily measures of pain-related fear, pain catastrophizing, and pain intensity were completed using visual analog scales. In addition, standardized measures of pain disability, pain-related fear, and pain vigilance were taken before and after each treatment module and at the 1-year follow-up. To obtain more objective data on actual activity levels, an ambulatory activity monitor was carried by the patients during 1 week before and after each treatment module. RESULTS: Time series analysis of the daily measures showed that improvements in pain-related fear and pain catastrophizing occurred only during the exposure in vivo and not during the graded activity, irrespective of the treatment order. Analysis of the pretreatment to post-treatment differences also revealed that decreases in pain-related fear also concurred with decreases in pain disability and pain vigilance and an increase in physical activity levels. All improvements remained at the 1-year follow-up.

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Authors: Vlaeyen, J. W. S., de Jong, J., Geilen, M., Heuts, P. H. T. G., & van Breukelen, G.
Affiliations: Maastricht University (NL)
Corresponding author: Vlaeyen, Johan W. S.
ORCID: Vlaeyen, Johan W. S.
Venue: The Clinical Journal of Pain
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2002-07
Volume: 18
Issue: 4
Pages: 251-261
ISSN: 0749-8047 (ISSN-L)
DOI: 10.1097/00002508-200207000-00006
OpenAlex: W2048514270
Cited by: 499
References: 53
Citations by year: 2026: 8 · 2025: 7 · 2024: 12 · 2023: 9 · 2022: 16 · 2021: 13 · 2020: 18 · 2019: 18 · 2018: 17 · 2017: 27 · 2016: 18 · 2015: 28 · 2014: 18 · 2013: 18 · 2012: 23
FWCI: 13.31
Type: journal article
Language: en
Open access: green
lirias.kuleuven.be
Licence: other-oa
Locations: Clinical Journal of Pain (publishedVersion)
PubMed (publishedVersion)
Lirias (KU Leuven) (submittedVersion, other-oa)
Funders: Nederlandse Organisatie voor Wetenschappelijk Onderzoek
Topics: Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › 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: chronic low back pain, kinesiophobia, fear of reinjury, graded activity, fear-avoidance beliefs, pain catastrophizing, fear of pain, pain-related disability, pain vigilance, physical activity, ambulatory activity monitoring, treatment order
MeSH terms: Activities of Daily Living, Adult, Avoidance Learning, Chronic Disease, Desensitization, Psychologic, Disability Evaluation, Fear, Female, Follow-Up Studies, Humans, Male, Middle Aged, Movement, Pain Measurement, Cognitive Behavioral Therapy, Treatment Outcome, Low Back Pain, Cross-Over Studies, Secondary Prevention

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The treatment of fear of movement/(re) injury in chronic low back pain: further evidence on the effectiveness of exposure in vivo

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