Taking Your First Step To Overcoming Fear Of Pain


Previously, we were introduced to how pain may develop into fear-avoidance behaviour when one catastrophizes it. We will now explore strategies to manage this problem some of us may be facing.


Fear-Avoidance Model

The Fear-Avoidance Model was used to identify and explain why chronic low back pain (LBP) problems and associated disability develop in some experiencing acute LBP. When pain is catastrophically "misinterpreted", a vicious spiral of dysfunctions happens.


Avoidance behaviour adapted in the acute stage develops into long-term consequences such as disuse and may possibly lower the threshold of subsequent pain. When one engages in fear-avoidance behaviour, there is a tendency to be hyper-vigilant and would find him/her-self scanning the environment for potential sources of threat and selectively attentive to threat-related instead of neutral stimuli.




4+1 Steps Approach To Chronic Pain Management


1) Assessing Attitudes and Beliefs


The therapist will gather information about your attitude towards pain through fear avoidance beliefs questionnaires or by interviewing about your perceptions on the cause, consequences and timeline of pain. This will guide the therapist to better understand your problem and relating to your concerns.


2) Managing Expectations


Previous experiences with poor treatment outcome may cause one to have low expectations when it comes to physiotherapy. Based on the therapist’s clinical reasoning, you will be better informed on the condition and why some treatments are not working successfully as intended.


3) Education


It is then important to use a collaborative approach between the therapist and yourself in discussing the rehabilitation plan and setting the SMART (Specific, Measurable, Attainable, Realistic, Timely) goals. With more knowledge on the condition and debilitating effects of fear-avoidance behaviour, the maladaptive perception of pain can be properly managed.


4) Treatment


Graded exercise therapy takes a time-contingent approach whereby one does not abandon an activity when pain onsets and instead tolerates the increases in pain intensity over time. Also, by having rest periods in between, fatigue can be avoided and allows better recovery after physical activity. When applied in daily living activities, this ‘exposure without danger’ principle will eventually result in signalling ‘no pain’ instead of ‘pain’.


5) Patient-Therapist Relationship


The communication between therapist and patient has to be appropriate as it constitutes the expectations and credibility of the treatment, leading to better care. So, when in doubt, whether in the rehabilitation plan or treatment, do inform your therapist. And keep this relationship healthy and strong.


Find out if you are catastrophizing your pain by completing The Pain Catastrophizing Scale. If the score is above 30, then you are indeed catastrophizing pain


In the other articles we will share with you catastrophizing pain.


If you read through all the above and still have any concern please feel free to contact me +65 8550 5466 as I do provide FREE Physiotherapy consultation over the phone.



Written by: Naazreen

Edited by: Bernice



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