Fear-Avoidance & Pain

Fear of pain / doing yourself harm and avoidance of activities as a consequence of this fear can have a big impact on the development and maintenance of chronic pain.

Pain is usually seen as a signal that something is wrong or damaged and you should avoid using the part that hurts in order that it can repair. For acute (short-term) pain this is a helpful response and action. However for long-term pain the ‘pain message’ is not giving helpful or accurate information about harm. 


The (Pain Gate & Pathways) explains the difference between acute pain and chronic pain. Acute pain alerts you to damage and the need for time to heal. Chronic pain, on the other hand, is a result of long-term habitual responses in the nervous system, which have built up over time after initial damage has repaired. It might be useful to re-read that handout now.


Chronic pain messages are often still seen as a signal of ‘threat’, which raises fear and ongoing avoidance of activities. The fear and avoidance lead to more pain. Fear itself causes anxiety, tension and greater vigilance to the pain message all of which increase your pain levels. Avoidance of activities leads to physical disuse (increasing weakness, stiffness and loss of fitness/stamina) and low mood/depression, all of which also increase your pain levels. The increasing pain can lead to further fear and avoidance and a vicious cycle builds up.

When there is no perception of ‘threat’ or fear of harm associated with the pain, it becomes possible to address the consequences of fear and avoidance. Reduction in anxiety and vigilance will reduce the pain messages reaching the brain (Pain Gate and Pathways & The Relaxation Response). Beginning to re-engage in currently avoided activities can bring a sense of achievement and positive mood (Goal Setting & Pacing). Gradual increases in activity will improve fitness strength and stamina and overall pain levels. (Benefits of Exercise).

Thoughts of threat (fear) associated with chronic pain can be managed by learning about the development and nature of chronic pain (Pain Gate & Pathways) and by the techniques discussed in the handout on Thoughts and Pain Management.


NB: It is important to remain aware of any new or different pain and speak to your doctor about this. 



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