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Assessment of Pain-related Fear in Chronic Pain Johan W.S. Vlaeyen, PhD Pain and Disability Research Program University of...
<ul><li>Pain: a mental representation </li></ul><ul><li>The threat value of pain </li></ul><ul><li>Management of pain-rela...
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
<ul><li>Pain: a mental representation </li></ul><ul><li>The threat value of pain </li></ul><ul><li>Management of pain-rela...
Pain urges to avoid/escape
Catastrophic interpretations of pain <ul><li>I continuously wonder whether the pain will stop </li></ul><ul><li>I think th...
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 Aro...
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 <ul><li>Body Scanning </li></ul><ul><li>Selective Attention </li></ul><ul><li>Problems ...
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 AVOI...
<ul><li>Pain: a mental representation </li></ul><ul><li>The threat value of pain </li></ul><ul><li>Management of pain-rela...
Meaning CS Kinesiophobia Exposure in vivo with response prevention Mental representation of Pain
Fear-Avoidance Model: Clinical applications <ul><li>Educate about paradox of safety seeking behaviors </li></ul><ul><li>Ac...
Crombez et al,  Health Psychology, 2002
2.  Fear hierarchy Exposure in vivo in chronic pain 3.  Education 4.  Exposure in vivo <ul><li>Treatment Goals </li></ul>
http://www.psychology.unimaas.nl/phoda-sev/
<ul><li>Pain: a mental representation </li></ul><ul><li>Pain urges to escape </li></ul><ul><li>Management of pain-related ...
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. ...
Conclusions <ul><ul><li>Pain-related fear is a normal response to longlasting pain </li></ul></ul><ul><ul><li>Fear-related...
Maastricht (NL) : Madelon Peters Linda van Cleef Karoline van Gronsveld Jeroen de Jong Hanne Kindermans Maaike Leeuw Ilse ...
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Assessment Of Fear Avoidance In Chronic Pain - Dr Johan W S Vlaeyen

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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

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

  1. 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
  2. 2. <ul><li>Pain: a mental representation </li></ul><ul><li>The threat value of pain </li></ul><ul><li>Management of pain-related fear </li></ul><ul><li>Effectiveness </li></ul><ul><li>Conclusion </li></ul>Overview
  3. 3. Traditional Disease Model Stimuli Behaviour
  4. 5. - 25 o Arntz & Claasens, PAIN 2005 Mediation: perceived harmfulness ++++ ++ Pain ratings: A Very cold B Very hot Info:
  5. 6. First Conclusion …
  6. 7. Stimuli Behaviour Mental representation of stimulus
  7. 8. <ul><li>Pain: a mental representation </li></ul><ul><li>The threat value of pain </li></ul><ul><li>Management of pain-related fear </li></ul><ul><li>Effectiveness </li></ul><ul><li>Conclusion </li></ul>Overview
  8. 9. Pain urges to avoid/escape
  9. 10. Catastrophic interpretations of pain <ul><li>I continuously wonder whether the pain will stop </li></ul><ul><li>I think this is terrible and it will never get any better </li></ul><ul><li>I become afriad that the pain will increase </li></ul><ul><li>I wonder whether something serious might happen </li></ul>When I am in pain… Pain Catastrophizing Scale Sullivan et al, 1995
  10. 11. Pain, 2006 Catastrophic interpretations of pain
  11. 12. Catastrophizing Fear
  12. 13. How does fear of pain develop? Ivan Petrovich Pavlov (1849-1936)
  13. 14. Associative Learning US: Food salivation CS: light CR: UR:
  14. 15. Meaning Pain Mental representation of Pain Disuse Nociception US Interoception Proprioception Exteroception CS Defense Arousal Attention Avoidance CR
  15. 16. Meaning CS Kinesiophobia Mental representation of Pain Disuse Defense Arousal Attention Avoidance CR
  16. 17. Bradley et al, PAIN, in Press 1. Arousal Acquisition Threat: shock Safe: no shock Test Test
  17. 18. 2. Fear directs attentional focus <ul><li>Body Scanning </li></ul><ul><li>Selective Attention </li></ul><ul><li>Problems Disengaging from source of threat </li></ul>Crombez, Van Damme and Eccleston
  18. 19. 3. Escape and Avoidance behavior Vlaeyen et al., Pain, 1995 Avoidance behavior Secs. * Subjective tension VAS *
  19. 20. Vlaeyen & Linton, Pain, 2000 Fear-Avoidance Model Catastrophic misinterpretations DISUSE INJURY/STRAIN PAIN DEFENSE AVOIDANCE ATTENTION DISABILITY
  20. 21. <ul><li>Pain: a mental representation </li></ul><ul><li>The threat value of pain </li></ul><ul><li>Management of pain-related fear </li></ul><ul><li>Effectiveness </li></ul><ul><li>Conclusion </li></ul>Overview
  21. 22. Meaning CS Kinesiophobia Exposure in vivo with response prevention Mental representation of Pain
  22. 23. Fear-Avoidance Model: Clinical applications <ul><li>Educate about paradox of safety seeking behaviors </li></ul><ul><li>Activate fear network </li></ul><ul><li>Challenge expectancies with behavioral experiments </li></ul>Vlaeyen et al., CJP 2002
  23. 24. Crombez et al, Health Psychology, 2002
  24. 25. 2. Fear hierarchy Exposure in vivo in chronic pain 3. Education 4. Exposure in vivo <ul><li>Treatment Goals </li></ul>
  25. 26. http://www.psychology.unimaas.nl/phoda-sev/
  26. 27. <ul><li>Pain: a mental representation </li></ul><ul><li>Pain urges to escape </li></ul><ul><li>Management of pain-related fear </li></ul><ul><li>Effectiveness </li></ul><ul><li>Conclusion </li></ul>Overview
  27. 28. Clin J Pain, 2002 Baseline Exposure Exercise Baseline Exposure Exercise
  28. 29. Clin J Pain, 2005 EDU EXPOS EDU EXERC
  29. 31. Threat value of movements P < .001 Functional disability P = .088 Pain, in press
  30. 32. Pain, in press
  31. 33. Acquisition – Extinction Assymetry Acquisition: learning new rules Extinction : learning exceptions to the rule
  32. 34. Understanding and treating fear of pain. Asmundson GJG, Vlaeyen JWS, Crombez G. Oxford: Oxford University Press, 2004. ISBN 0 19 8525141.
  33. 35. Conclusions <ul><ul><li>Pain-related fear is a normal response to longlasting pain </li></ul></ul><ul><ul><li>Fear-related defensive responses may have paradoxical effects </li></ul></ul><ul><ul><li>Other goals may overule this primary goal </li></ul></ul><ul><ul><li>Multiple goals may lead to conflicting responses </li></ul></ul>
  34. 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:

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