From fear of movement-related pain and avoidance to chronic pain disability: a state-of-the-art review

This review addresses recent developments in fear of movement-related pain and avoidance research, adopting a contemporary learning approach focusing on cognitive, emotional, and behavioral factors, and emphasizing the role of the motivational context including pain-avoidance goals but also other valued life goals. We particularly demonstrated the role of classical conditioning in the acquisition, generalization, and extinction of fear of movement-related pain, and how safety-seeking behavior during exposure-based treatment may hamper genuine extinction causing relapse. We further highlighted the importance of newly developed methods to study operant conditioning of behavioral avoidance itself, and its relationship with individual vulnerability factors (e.g. catastrophizing) and resiliencies (e.g. positive affect) to further our understanding of mechanisms underlying the development and persistence of chronic pain disability.