The fear-avoidance model of musculoskeletal pain: current state of scientific evidence.
Research studies focusing on the fear-avoidance model have expanded considerably since the review by Vlaeyen and Linton (Vlaeyen J. W. S. & Linton, S. J. (2000). Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain, 85(3), 317--332). The fear-avoidance model is a cognitive-behavioral account that explains why a minority of acute low back pain sufferers develop a chronic pain problem. This paper reviews the current state of scientific evidence for the individual components of the model: pain severity, pain catastrophizing, attention to pain, escape/avoidance behavior, disability, disuse, and vulnerabilities. Furthermore, support for the contribution of pain-related fear in the inception of low back pain, the development of chronic low back pain from an acute episode, and the maintenance of enduring pain, will be highlighted. Finally, available evidence on recent clinical applications is provided, and unresolved issues that need further exploration are discussed.
Leeuw
Maaike
M
Department of Medical, Clinical, and Experimental Psychology, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands. M.Leeuw@DMKEP.Unimaas.nl
Goossens
Mariëlle E J B
ME
Linton
Steven J
SJ
Crombez
Geert
G
Boersma
Katja
K
Vlaeyen
Johan W S
JW
D000339:Affect; D001007:Anxiety / Q000453:epidemiology / Q000523:psychology; D001288:Attention; D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy; D004924:Escape Reaction; D005239:Fear; D006801:Humans; D009043:Motor Activity; D020966:Muscular Disorders, Atrophic; D009140:Musculoskeletal Diseases / Q000150:complications*; D010146:Pain / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*