Avoidance behaviour and its role in sustaining chronic pain

doi:10.1016/0005-7967(87)90005-2

Behaviour Research and Therapy

Volume 25, Issue 4, 1987, Pages 273-279

https://doi.org/10.1016/0005-7967(87)90005-2 Get rights and content

Abstract

Avoidance behaviour is a prominent and extensive component of chronic pain behaviour. Its unadaptive consequences are delineated and the puzzling issue of its persistence is raised. An explanation is put forward emphasizing the functional relationship between cognitions and avoidance behaviour. A psychological model which emphasizes the important role of cognitions in influencing avoidance behaviour is advanced. The research and clinical implications of this model are discussed.

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Citation Excerpt :
Subsequent research into the effect of cognition (pain catastrophising, pain anticipation, pain memory) and affect (anxiety, depression) on pain perception and coping has led to the incorporation of a cognitive dimension into the primarily behavioural approach to chronic pain (Turk et al., 1983). Several iterations of the fear-avoidance model of chronic pain have been proposed to explain how different interpretations of the same pain experience could determine whether a person would confront the pain and be on the road of recovery, or display the chronic pain behaviour that would eventually lead to disuse, depression and disability (Lethem et al., 1983; Slade et al., 1983; Philips, 1987; Vlaeyen et al., 1995; Asmundson and Taylor, 1996; Vlaeyen and Linton, 2000; Asmundson et al., 2004). There are subtle differences in the emphasis of each iteration of the fear-avoidance model, but the key cognitive factors at play are the interpretation and meaning people ascribe to the pain experience.
Cognitive Behavioural Therapy (CBT) is a form of evidence-based talking therapy that emphasises the importance of behaviour and conscious thoughts in shaping our emotional experiences. As pain becomes increasingly accepted as not only a sensory but also an emotional experience, success in using CBT to treat emotional disorders has resulted in the incorporation of cognitive-behavioural principles into the management of chronic pain. Outcomes of CBT-informed interdisciplinary pain management programmes are modest at best, despite rapid methodological improvements in trial design and implementation. Whilst the field searches for new treatment directions, a hybrid CBT approach that seeks to simultaneously tackle pain and its comorbidities shows promise in optimising treatment effectiveness and flexibility. This article provides a brief description of the core characteristics of CBT and the transformation this therapeutic model has brought to our understanding and management of chronic pain. Current evidence on efficacy of CBT for chronic pain is then reviewed, followed by a critical consideration of the advantages and disadvantages of the new hybrid treatment approach that conceptualises and treats chronic pain in connection with its comorbidities. Recent progress made in the area of pain and insomnia is highlighted as an example to project therapeutic innovations in the near future.
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Avoidance behaviour and its role in sustaining chronic pain

Abstract

Pain

Pain

Pain

Pain

Pain

Pain

Pain

J. psychosom. Res.

Pain

The pain behaviour checklist: factor analysis and validation

Br. J. clin. Psychol.

A perceptual/defensive/recuperative model of fear in pain

Behav. Brain Sci.

Mood and memory

Am. Psychol.

Memory for pain: Relation between past and present pain intensity

Pain

Chronic pain: Electromechanical recording device for measuring patients' activity patterns

Arch phys. Med. Rehab.