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Featured Article By Alan

Fear Avoidance.

In the PT community there has been some resurgence of talk about avoiding pain and its effect on getting back to normal life.  Now, I am not saying that getting better is about doing everything that hurts. 

                People are motivated to avoid activities in which they have experienced acute episodes of pain in order to decrease the likelihood of experiencing that pain again and/or causing further physical damage.  This is good for Acute or recent pain.  This can become a bad adaptive behavior once the acute phase is over.  This concept of fear avoidance and negative outcomes has been studied for over 3 decades.  

                The basic concept is that if a person interprets the experience of pain (which is associated with or without an actual injury) as significantly threatening and begins to catastrophize about it, then pain-related fear evolves.  The negative thoughts lead to avoidance of activities and hypervigilance in monitoring body and pain sensations.  This is followed by a withdrawal for recreational and family activities.  The withdrawal can lead to depression, deconditioning, and disability.  The self-imposed barriers to physical activity further compounds the nature of the cyclic nature of physical decline.

                People who view the pain as non-threatening, and who do not catastrophize, pain related Fear Avoidance does not develop and normalization of daily activities and rapid recovery are likely to occur. 

                 There is significant evidence that there is a relationship between Fear Avoidance and disability.  Turk and Monarch found that fear of movement and re-injury may be a better predictor of physical functional limitations than the actual underlying biomechanical and/or pathophysiological variables.   Davis and Colleagues. Also found the Fear Avoidance and a longer duration of low back pain episodes. 

                The take home message to this summary of research is that it is not uncommon for patients with pain symptoms to experience emotional distress, such as fear or anxiety.  There is no doubt that the anticipation of the pain can capture a person’s focus.  This focus and constant vigilance and the false belief that these sensations will lead to re-injury or the progression of serious disease.  The result is that a person goes through a vicious cycle and downward spiraling into a lower and lower level of physical activity and an increase in the number of activities that a person cannot do.  The hypervigilance leads to poorer outcomes despite whatever the extent of the original injury.