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How Does Fear Contribute to Low Back Pain?

The Fear-Avoidance Model has been validated and adopted in the pain and physical therapy literature. It explains how the experience of low back pain can initiate negative cognitive, emotional, and behavioral responses. Fear of pain leads to catastrophizing and subsequent fear of movement. This creates a vicious cycle as the lack of activity contributes to further pain and disability, adding fuel to the fear-induced fire.

This clinical commentary assesses the Fear-Avoidance Model and how clinicians can better help pains with chronic pain, catastrophizing, and pain-related fear.

Key contributors to pain-related fear are as follows: radiological reports, negative explicit and implicit advice from clinicians, cultural beliefs about the structural vulnerability of the spine, the belief that pain is a sign of damage poor pain-control coping strategies, the perception that pain is uncontrollable, repeated failed attempts to control pain, and frequent worry about pain.

Pain-related fear can be lessened by gaining control over the pain. This can be accomplished through cognitive reframing and addressing the previously mentioned concerns.

Our past experiences and beliefs about pain influence how we will experience and respond to pain.


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