The opportunity to avoid pain may paradoxically increase fear

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Fear-avoidance models propose that pain-related fear may spur avoidance behaviour leading to chronic pain disability. Pain-related fear elicits avoidance behaviour, which is typically aimed at reducing fear. We hypothesized that engaging in avoidance may (paradoxically) increase rather than decrease pain-related fear (i.e. bidirectionality hypothesis). In a between-subject design, participants (N=64) were randomly assigned to the avoidance group or the control group. Avoidance group participants were led to believe they could avoid full exposure to a painful heat stimulus by pressing the stop-button, while control group participants believed they were exposed to the full painful heat stimulus at all times. In reality and unknown to the participants, the intensity and duration of the heat stimulus was independent of the avoidance response, and was identical in both groups. During the test, the avoidance response (i.e. pressing the stop-button) was no longer available. As expected, pain-related fear levels were higher after avoiding the painful heat stimulus. Interestingly, in the avoidance group, pain-related fear increased after receiving instructions that avoidance would be possible, even before actually engaging in avoidance behaviour. In the control group, no significant change was observed in pain-related fear throughout the experiment. The eyeblink startle measures did not corroborate this data pattern.

PERSPECTIVE: These observations provide partial support for the bidirectionality hypothesis between avoidance behaviour and fear. These findings may have clinical implications and suggest that allowing avoidance behaviours during treatment may thwart fear reduction.

Original languageEnglish
Pages (from-to)1222-1230
Number of pages9
JournalThe Journal of Pain
Volume19
Issue number10
Early online date16 May 2018
DOIs
Publication statusPublished - Oct 2018

Keywords

  • Pain intensity
  • avoidance
  • pain-related fear
  • threat
  • heat pain
  • CHRONIC MUSCULOSKELETAL PAIN
  • SAFETY BEHAVIORS
  • ANXIETY
  • EXPOSURE
  • CONSEQUENCES
  • FIBROMYALGIA
  • ACQUISITION
  • DISORDERS
  • PLACEBO

Cite this

@article{19bd94766d974fe9862c1a7bca0c1b48,
title = "The opportunity to avoid pain may paradoxically increase fear",
abstract = "Fear-avoidance models propose that pain-related fear may spur avoidance behaviour leading to chronic pain disability. Pain-related fear elicits avoidance behaviour, which is typically aimed at reducing fear. We hypothesized that engaging in avoidance may (paradoxically) increase rather than decrease pain-related fear (i.e. bidirectionality hypothesis). In a between-subject design, participants (N=64) were randomly assigned to the avoidance group or the control group. Avoidance group participants were led to believe they could avoid full exposure to a painful heat stimulus by pressing the stop-button, while control group participants believed they were exposed to the full painful heat stimulus at all times. In reality and unknown to the participants, the intensity and duration of the heat stimulus was independent of the avoidance response, and was identical in both groups. During the test, the avoidance response (i.e. pressing the stop-button) was no longer available. As expected, pain-related fear levels were higher after avoiding the painful heat stimulus. Interestingly, in the avoidance group, pain-related fear increased after receiving instructions that avoidance would be possible, even before actually engaging in avoidance behaviour. In the control group, no significant change was observed in pain-related fear throughout the experiment. The eyeblink startle measures did not corroborate this data pattern.PERSPECTIVE: These observations provide partial support for the bidirectionality hypothesis between avoidance behaviour and fear. These findings may have clinical implications and suggest that allowing avoidance behaviours during treatment may thwart fear reduction.",
keywords = "Pain intensity, avoidance, pain-related fear, threat, heat pain, CHRONIC MUSCULOSKELETAL PAIN, SAFETY BEHAVIORS, ANXIETY, EXPOSURE, CONSEQUENCES, FIBROMYALGIA, ACQUISITION, DISORDERS, PLACEBO",
author = "{van Vliet}, {Christine M} and Ann Meulders and Vancleef, {Linda M G} and Vlaeyen, {Johan W S}",
note = "Copyright {\circledC} 2018. Published by Elsevier Inc.",
year = "2018",
month = "10",
doi = "10.1016/j.jpain.2018.05.003",
language = "English",
volume = "19",
pages = "1222--1230",
journal = "The Journal of Pain",
issn = "1526-5900",
publisher = "Churchill Livingstone",
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}

The opportunity to avoid pain may paradoxically increase fear. / van Vliet, Christine M; Meulders, Ann; Vancleef, Linda M G; Vlaeyen, Johan W S.

In: The Journal of Pain, Vol. 19, No. 10, 10.2018, p. 1222-1230.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - The opportunity to avoid pain may paradoxically increase fear

AU - van Vliet, Christine M

AU - Meulders, Ann

AU - Vancleef, Linda M G

AU - Vlaeyen, Johan W S

N1 - Copyright © 2018. Published by Elsevier Inc.

PY - 2018/10

Y1 - 2018/10

N2 - Fear-avoidance models propose that pain-related fear may spur avoidance behaviour leading to chronic pain disability. Pain-related fear elicits avoidance behaviour, which is typically aimed at reducing fear. We hypothesized that engaging in avoidance may (paradoxically) increase rather than decrease pain-related fear (i.e. bidirectionality hypothesis). In a between-subject design, participants (N=64) were randomly assigned to the avoidance group or the control group. Avoidance group participants were led to believe they could avoid full exposure to a painful heat stimulus by pressing the stop-button, while control group participants believed they were exposed to the full painful heat stimulus at all times. In reality and unknown to the participants, the intensity and duration of the heat stimulus was independent of the avoidance response, and was identical in both groups. During the test, the avoidance response (i.e. pressing the stop-button) was no longer available. As expected, pain-related fear levels were higher after avoiding the painful heat stimulus. Interestingly, in the avoidance group, pain-related fear increased after receiving instructions that avoidance would be possible, even before actually engaging in avoidance behaviour. In the control group, no significant change was observed in pain-related fear throughout the experiment. The eyeblink startle measures did not corroborate this data pattern.PERSPECTIVE: These observations provide partial support for the bidirectionality hypothesis between avoidance behaviour and fear. These findings may have clinical implications and suggest that allowing avoidance behaviours during treatment may thwart fear reduction.

AB - Fear-avoidance models propose that pain-related fear may spur avoidance behaviour leading to chronic pain disability. Pain-related fear elicits avoidance behaviour, which is typically aimed at reducing fear. We hypothesized that engaging in avoidance may (paradoxically) increase rather than decrease pain-related fear (i.e. bidirectionality hypothesis). In a between-subject design, participants (N=64) were randomly assigned to the avoidance group or the control group. Avoidance group participants were led to believe they could avoid full exposure to a painful heat stimulus by pressing the stop-button, while control group participants believed they were exposed to the full painful heat stimulus at all times. In reality and unknown to the participants, the intensity and duration of the heat stimulus was independent of the avoidance response, and was identical in both groups. During the test, the avoidance response (i.e. pressing the stop-button) was no longer available. As expected, pain-related fear levels were higher after avoiding the painful heat stimulus. Interestingly, in the avoidance group, pain-related fear increased after receiving instructions that avoidance would be possible, even before actually engaging in avoidance behaviour. In the control group, no significant change was observed in pain-related fear throughout the experiment. The eyeblink startle measures did not corroborate this data pattern.PERSPECTIVE: These observations provide partial support for the bidirectionality hypothesis between avoidance behaviour and fear. These findings may have clinical implications and suggest that allowing avoidance behaviours during treatment may thwart fear reduction.

KW - Pain intensity

KW - avoidance

KW - pain-related fear

KW - threat

KW - heat pain

KW - CHRONIC MUSCULOSKELETAL PAIN

KW - SAFETY BEHAVIORS

KW - ANXIETY

KW - EXPOSURE

KW - CONSEQUENCES

KW - FIBROMYALGIA

KW - ACQUISITION

KW - DISORDERS

KW - PLACEBO

U2 - 10.1016/j.jpain.2018.05.003

DO - 10.1016/j.jpain.2018.05.003

M3 - Article

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VL - 19

SP - 1222

EP - 1230

JO - The Journal of Pain

JF - The Journal of Pain

SN - 1526-5900

IS - 10

ER -