Don’t get boxed in: pathways to attenuate the spreading of pain-related avoidance behavior

Pain is a signal of (potential) bodily harm. Therefore, it makes sense to avoid movements that have been experienced with pain – at least until tissues have healed if damage is present. Because movements similar to the original painful one are likely to be painful as well, avoiding these makes sense as well. The current PhD project demonstrated that (pain-free) participants indeed show such spreading (or generalization) of pain-related avoidance to similar movements in the lab. However, generalization becomes problematic when movements that are dissimilar to the original painful one are avoided as well, leading to a large range of movements being avoided. Such excessive avoidance can disrupt daily life and interfere with valued activities, and may contribute to the development and maintenance of chronic pain disability. Therefore, the current PhD project investigated ways to attenuate generalization of pain-related avoidance in the lab, to eventually help optimize treatment of chronic pain disability. Results showed that induced positive emotions were associated with less generalization of avoidance, thus demonstrating the potential of targeting positive emotions. Results also showed that poor proprioceptive accuracy – the accuracy with which one can perceive the position and motion of the body and body segments – was associated with excessive avoidance, indicating that training proprioceptive accuracy may be a way to reduce avoidance.