Empirical support for the main components of the fear-avoidance model

The fear avoidance model has offered a fruitful framework within which the development and maintenance of persisting pain complaints can be understood. Empirical support for the model has been found within the area of CLBP, osteoarthritis, neck pain, and chronic headache (e.g. Fritz et al. 2001; Leeuw et al. 2007a; Vlaeyen and Linton 2000; Waddell et al. 1993). This paragraph reviews experimental evidence for the main components of the fear-avoidance model.

Pain catastrophizing

Pain catastrophizing is conceived as a cognitive construct that represents the tendency to make exaggerated negative or threatening interpretations of pain (Sullivan et al. 1995). Pain catastrophizing has often been found closely related to fear of pain. In addition, a few studies have reported about the predictive value of pain catastrophizing for pain-related fear (Leeuw et al. 2007c; Vlaeyen et al. 1995b; 2004b). Elevated levels of pain-catastrophizing have been consistently found related to pain disability in chronic pain samples, acute pain samples, and pain-free volunteers (Peters et al. 2005; Severeijns et al. 2005; Sullivan et al. 2005; Turner et al. 2004). Furthermore, persons who tend to catastrophize about pain are found to show more hypervigilance for pain- related information, less tolerance for pain, and to report increased pain intensity levels when experiencing pain (Crombez et al. 2002a; Haythornthwaite et al. 2003; Peters et al. 2005; Sullivan et al. 2005; Turner et al. 2002). In prospective studies, pain catastrophizing has been found predictive of elevated pain intensity levels during a painful procedure or after an operation (Edwards et al. 2004; Sullivan et al. 1995; Vlaeyen et al. 2004b). For more detailed information on pain catastrophizing see also Chapter 13.

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