Lecture given to the North British Pain Association on 16th May 2008 by Dr Johan Vlaeyen. In this talk, Dr Vlaeyen discusses the mechanisms, assessment and treatment of fear avoidance in patients with chronic pain. Edinburgh, UK. www.nbpa.org.uk

1. 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

3. Traditional Disease Model Stimuli Behaviour

5. - 25 o Arntz & Claasens, PAIN 2005 Mediation: perceived harmfulness ++++ ++ Pain ratings: A Very cold B Very hot Info:

6. First Conclusion …

7. Stimuli Behaviour Mental representation of stimulus

9. Pain urges to avoid/escape

11. Pain, 2006 Catastrophic interpretations of pain

12. Catastrophizing Fear

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

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

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

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

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

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

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

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

24. Crombez et al, Health Psychology, 2002

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

28. Clin J Pain, 2002 Baseline Exposure Exercise Baseline Exposure Exercise

29. Clin J Pain, 2005 EDU EXPOS EDU EXERC

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

32. Pain, in press

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

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

36. 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: