Assessment Of Fear Avoidance In Chronic Pain - Dr Johan W S Vlaeyen

Assessment of Pain-related Fear in Chronic Pain Johan W.S. Vlaeyen, PhD Pain and Disability Research Program University of Leuven, Belgium Maastricht University, Netherlands Edinburgh, Scotland 16 May 2008 Northern British Pain Association

Pain: a mental representation

The threat value of pain

Management of pain-related fear

Effectiveness

Conclusion

Overview

Traditional Disease Model Stimuli Behaviour

- 25 o Arntz & Claasens, PAIN 2005 Mediation: perceived harmfulness ++++ ++ Pain ratings: A Very cold B Very hot Info:

First Conclusion …

Stimuli Behaviour Mental representation of stimulus

Effectiveness

Conclusion

Overview

Pain urges to avoid/escape

Catastrophic interpretations of pain

I continuously wonder whether the pain will stop

I think this is terrible and it will never get any better

I become afriad that the pain will increase

I wonder whether something serious might happen

When I am in pain… Pain Catastrophizing Scale Sullivan et al, 1995

Pain, 2006 Catastrophic interpretations of pain

Catastrophizing Fear

How does fear of pain develop? Ivan Petrovich Pavlov (1849-1936)

Associative Learning US: Food salivation CS: light CR: UR:

Meaning Pain Mental representation of Pain Disuse Nociception US Interoception Proprioception Exteroception CS Defense Arousal Attention Avoidance CR

Meaning CS Kinesiophobia Mental representation of Pain Disuse Defense Arousal Attention Avoidance CR

Bradley et al, PAIN, in Press 1. Arousal Acquisition Threat: shock Safe: no shock Test Test

2. Fear directs attentional focus

Body Scanning

Selective Attention

Problems Disengaging from source of threat

Crombez, Van Damme and Eccleston

3. Escape and Avoidance behavior Vlaeyen et al., Pain, 1995 Avoidance behavior Secs. * Subjective tension VAS *

Vlaeyen & Linton, Pain, 2000 Fear-Avoidance Model Catastrophic misinterpretations DISUSE INJURY/STRAIN PAIN DEFENSE AVOIDANCE ATTENTION DISABILITY

Effectiveness

Conclusion

Overview

Meaning CS Kinesiophobia Exposure in vivo with response prevention Mental representation of Pain

Fear-Avoidance Model: Clinical applications

Educate about paradox of safety seeking behaviors

Activate fear network

Challenge expectancies with behavioral experiments

Vlaeyen et al., CJP 2002

Crombez et al, Health Psychology, 2002

2. Fear hierarchy Exposure in vivo in chronic pain 3. Education 4. Exposure in vivo

Treatment Goals

http://www.psychology.unimaas.nl/phoda-sev/

Pain urges to escape

Effectiveness

Conclusion

Overview

Clin J Pain, 2002 Baseline Exposure Exercise Baseline Exposure Exercise

Clin J Pain, 2005 EDU EXPOS EDU EXERC

Threat value of movements P < .001 Functional disability P = .088 Pain, in press

Pain, in press

Acquisition – Extinction Assymetry Acquisition: learning new rules Extinction : learning exceptions to the rule

Understanding and treating fear of pain. Asmundson GJG, Vlaeyen JWS, Crombez G. Oxford: Oxford University Press, 2004. ISBN 0 19 8525141.

Conclusions

Pain-related fear is a normal response to longlasting pain

Fear-related defensive responses may have paradoxical effects

Other goals may overule this primary goal

Multiple goals may lead to conflicting responses

Maastricht (NL) : Madelon Peters Linda van Cleef Karoline van Gronsveld Jeroen de Jong Hanne Kindermans Maaike Leeuw Ilse Swinkels Jeanine Verbunt Marielle Goossens Saskia Nijst Saskia Ranson Petra Karsdorp Martien Schrooten Leuven (B) : Steven de Peuter Ilse van Diest Omer van den Bergh International: Geert Crombez, Belgium Stephen Morley, UK Mick Sullivan, Canada Gordon Asmundson, Can Steven Linton, Sweden Katja Boersma, Sweden Teamwork: