Assessment Of Fear Avoidance In Chronic Pain - Dr Johan W S Vlaeyen
-
Upload
epicyclops -
Category
Health & Medicine
-
view
8.925 -
download
0
description
Transcript of Assessment Of Fear Avoidance In Chronic Pain - Dr Johan W S Vlaeyen
![Page 1: Assessment Of Fear Avoidance In Chronic Pain - Dr Johan W S Vlaeyen](https://reader034.fdocuments.net/reader034/viewer/2022051611/54b919a14a795991218b45bc/html5/thumbnails/1.jpg)
Assessment of Pain-related Fear in Chronic
PainJohan W.S. Vlaeyen, PhD
Pain and Disability Research ProgramUniversity of Leuven, Belgium
Maastricht University, Netherlands
Edinburgh, Scotland 16 May 2008
Northern British Pain Association
![Page 2: Assessment Of Fear Avoidance In Chronic Pain - Dr Johan W S Vlaeyen](https://reader034.fdocuments.net/reader034/viewer/2022051611/54b919a14a795991218b45bc/html5/thumbnails/2.jpg)
• Pain: a mental representation• The threat value of pain• Management of pain-related fear• Effectiveness• Conclusion
Overview
![Page 3: Assessment Of Fear Avoidance In Chronic Pain - Dr Johan W S Vlaeyen](https://reader034.fdocuments.net/reader034/viewer/2022051611/54b919a14a795991218b45bc/html5/thumbnails/3.jpg)
Traditional Disease Model
Stimuli Behaviour
![Page 4: Assessment Of Fear Avoidance In Chronic Pain - Dr Johan W S Vlaeyen](https://reader034.fdocuments.net/reader034/viewer/2022051611/54b919a14a795991218b45bc/html5/thumbnails/4.jpg)
![Page 5: Assessment Of Fear Avoidance In Chronic Pain - Dr Johan W S Vlaeyen](https://reader034.fdocuments.net/reader034/viewer/2022051611/54b919a14a795991218b45bc/html5/thumbnails/5.jpg)
- 25o
Arntz & Claasens, PAIN 2005
++++ ++ Pain ratings:Mediation: perceived harmfulness
A
Very cold
B
Very hot
Info:
![Page 6: Assessment Of Fear Avoidance In Chronic Pain - Dr Johan W S Vlaeyen](https://reader034.fdocuments.net/reader034/viewer/2022051611/54b919a14a795991218b45bc/html5/thumbnails/6.jpg)
First Conclusion …
![Page 7: Assessment Of Fear Avoidance In Chronic Pain - Dr Johan W S Vlaeyen](https://reader034.fdocuments.net/reader034/viewer/2022051611/54b919a14a795991218b45bc/html5/thumbnails/7.jpg)
Stimuli Behaviour
Mental representation of stimulus
![Page 8: Assessment Of Fear Avoidance In Chronic Pain - Dr Johan W S Vlaeyen](https://reader034.fdocuments.net/reader034/viewer/2022051611/54b919a14a795991218b45bc/html5/thumbnails/8.jpg)
• Pain: a mental representation• The threat value of pain• Management of pain-related fear• Effectiveness• Conclusion
Overview
![Page 9: Assessment Of Fear Avoidance In Chronic Pain - Dr Johan W S Vlaeyen](https://reader034.fdocuments.net/reader034/viewer/2022051611/54b919a14a795991218b45bc/html5/thumbnails/9.jpg)
Pain urges to avoid/escape
![Page 10: Assessment Of Fear Avoidance In Chronic Pain - Dr Johan W S Vlaeyen](https://reader034.fdocuments.net/reader034/viewer/2022051611/54b919a14a795991218b45bc/html5/thumbnails/10.jpg)
Catastrophic interpretations of pain
• I continuously wonder whether the pain will stop
• I think this is terrible and it will never get any better
• I become afriad that the pain will increase• I wonder whether something serious might
happen
When I am in pain…
Pain Catastrophizing Scale
Sullivan et al, 1995
![Page 11: Assessment Of Fear Avoidance In Chronic Pain - Dr Johan W S Vlaeyen](https://reader034.fdocuments.net/reader034/viewer/2022051611/54b919a14a795991218b45bc/html5/thumbnails/11.jpg)
Pain, 2006
Catastrophic interpretations of pain
![Page 12: Assessment Of Fear Avoidance In Chronic Pain - Dr Johan W S Vlaeyen](https://reader034.fdocuments.net/reader034/viewer/2022051611/54b919a14a795991218b45bc/html5/thumbnails/12.jpg)
Catastrophizing
Fear
![Page 13: Assessment Of Fear Avoidance In Chronic Pain - Dr Johan W S Vlaeyen](https://reader034.fdocuments.net/reader034/viewer/2022051611/54b919a14a795991218b45bc/html5/thumbnails/13.jpg)
How does fear of pain develop?
Ivan Petrovich Pavlov (1849-1936)
![Page 14: Assessment Of Fear Avoidance In Chronic Pain - Dr Johan W S Vlaeyen](https://reader034.fdocuments.net/reader034/viewer/2022051611/54b919a14a795991218b45bc/html5/thumbnails/14.jpg)
Associative Learning
US: Food salivation
CS: light
CR:UR:
![Page 15: Assessment Of Fear Avoidance In Chronic Pain - Dr Johan W S Vlaeyen](https://reader034.fdocuments.net/reader034/viewer/2022051611/54b919a14a795991218b45bc/html5/thumbnails/15.jpg)
Meaning
Pain
Mental representatio
n of Pain
Disuse
Nociception
US
Interoception Proprioception Exteroception
CS Defense
Arousal Attention Avoidance
CR
![Page 16: Assessment Of Fear Avoidance In Chronic Pain - Dr Johan W S Vlaeyen](https://reader034.fdocuments.net/reader034/viewer/2022051611/54b919a14a795991218b45bc/html5/thumbnails/16.jpg)
Meaning
Mental representatio
n of Pain
Disuse
Defense
Arousal Attention Avoidance
CR
CS
Kinesiophobia
![Page 17: Assessment Of Fear Avoidance In Chronic Pain - Dr Johan W S Vlaeyen](https://reader034.fdocuments.net/reader034/viewer/2022051611/54b919a14a795991218b45bc/html5/thumbnails/17.jpg)
Acquisition
Threat: shock
Safe: no shock
Bradley et al, PAIN, in Press
Test
1. Arousal
Test
![Page 18: Assessment Of Fear Avoidance In Chronic Pain - Dr Johan W S Vlaeyen](https://reader034.fdocuments.net/reader034/viewer/2022051611/54b919a14a795991218b45bc/html5/thumbnails/18.jpg)
2. Fear directs attentional focus
a. Body Scanning
b. Selective Attention
c. Problems Disengaging from source of threat
Crombez, Van Damme and Eccleston
![Page 19: Assessment Of Fear Avoidance In Chronic Pain - Dr Johan W S Vlaeyen](https://reader034.fdocuments.net/reader034/viewer/2022051611/54b919a14a795991218b45bc/html5/thumbnails/19.jpg)
0
20
40
60
80
100
120
140
160
180
Lifting time
low fearful
high fearful
Avoidance behavior
Secs.
*
0
10
20
30
40
50
60
baseline exposure
Low fearful
High fearful
Subjective tension
VAS
*
3. Escape and Avoidance behavior
Vlaeyen et al., Pain, 1995
![Page 20: Assessment Of Fear Avoidance In Chronic Pain - Dr Johan W S Vlaeyen](https://reader034.fdocuments.net/reader034/viewer/2022051611/54b919a14a795991218b45bc/html5/thumbnails/20.jpg)
Vlaeyen & Linton, Pain, 2000
Catastrophic misinterpretations
DISUSE
INJURY/STRAIN
PAINDEFENSE
AVOIDANCEATTENTION
DISABILITY
Fear-Avoidance Model
![Page 21: Assessment Of Fear Avoidance In Chronic Pain - Dr Johan W S Vlaeyen](https://reader034.fdocuments.net/reader034/viewer/2022051611/54b919a14a795991218b45bc/html5/thumbnails/21.jpg)
• Pain: a mental representation• The threat value of pain• Management of pain-related fear• Effectiveness• Conclusion
Overview
![Page 22: Assessment Of Fear Avoidance In Chronic Pain - Dr Johan W S Vlaeyen](https://reader034.fdocuments.net/reader034/viewer/2022051611/54b919a14a795991218b45bc/html5/thumbnails/22.jpg)
Meaning
Mental representatio
n of PainCS
Kinesiophobia
Exposure in vivo with response
prevention
![Page 23: Assessment Of Fear Avoidance In Chronic Pain - Dr Johan W S Vlaeyen](https://reader034.fdocuments.net/reader034/viewer/2022051611/54b919a14a795991218b45bc/html5/thumbnails/23.jpg)
Fear-Avoidance Model: Clinical applications
a.Educate about paradox of safety seeking behaviors
b.Activate fear network
c.Challenge expectancies with behavioral experiments
Vlaeyen et al., CJP 2002
![Page 24: Assessment Of Fear Avoidance In Chronic Pain - Dr Johan W S Vlaeyen](https://reader034.fdocuments.net/reader034/viewer/2022051611/54b919a14a795991218b45bc/html5/thumbnails/24.jpg)
M o v e m e n t A : t o e t o u c h
M o v e m e n t B : s t r a i g h t l e g r a i s i n g
1 2 3 4
1 2 3 4
O r d e r c o u n t e r b a l a n c e d : A A B B o r B B A A
Crombez et al, Health Psychology, 2002
Bas
elin
eP
AIN
Exp
ecte
dP
AIN
Exp
erie
nced
PA
IN
First trial
Second trial
![Page 25: Assessment Of Fear Avoidance In Chronic Pain - Dr Johan W S Vlaeyen](https://reader034.fdocuments.net/reader034/viewer/2022051611/54b919a14a795991218b45bc/html5/thumbnails/25.jpg)
2. Fear hierarchy
Exposure in vivo in chronic pain
3. Education
4. Exposure in vivo
1. Treatment Goals
![Page 26: Assessment Of Fear Avoidance In Chronic Pain - Dr Johan W S Vlaeyen](https://reader034.fdocuments.net/reader034/viewer/2022051611/54b919a14a795991218b45bc/html5/thumbnails/26.jpg)
http://www.psychology.unimaas.nl/phoda-sev/
![Page 27: Assessment Of Fear Avoidance In Chronic Pain - Dr Johan W S Vlaeyen](https://reader034.fdocuments.net/reader034/viewer/2022051611/54b919a14a795991218b45bc/html5/thumbnails/27.jpg)
• Pain: a mental representation• Pain urges to escape• Management of pain-related fear• Effectiveness• Conclusion
Overview
![Page 28: Assessment Of Fear Avoidance In Chronic Pain - Dr Johan W S Vlaeyen](https://reader034.fdocuments.net/reader034/viewer/2022051611/54b919a14a795991218b45bc/html5/thumbnails/28.jpg)
0
2
4
6
8
10
Baseline Exposure Exercise
0
2
4
6
8
10
Baseline Exposure Exercise
Clin J Pain, 2002
![Page 29: Assessment Of Fear Avoidance In Chronic Pain - Dr Johan W S Vlaeyen](https://reader034.fdocuments.net/reader034/viewer/2022051611/54b919a14a795991218b45bc/html5/thumbnails/29.jpg)
0123456789
10
A B C X F
0123456789
10
A B D X F
EDU EXPOS EDU EXERC
Clin J Pain, 2005
![Page 30: Assessment Of Fear Avoidance In Chronic Pain - Dr Johan W S Vlaeyen](https://reader034.fdocuments.net/reader034/viewer/2022051611/54b919a14a795991218b45bc/html5/thumbnails/30.jpg)
012345678910
A B C D
fear pain push the baby buggy lift a child
![Page 31: Assessment Of Fear Avoidance In Chronic Pain - Dr Johan W S Vlaeyen](https://reader034.fdocuments.net/reader034/viewer/2022051611/54b919a14a795991218b45bc/html5/thumbnails/31.jpg)
0
10
20
30
40
50
60
Baseline POST Follow-up
EXPGA
Threat value of movements
P < .001
0
10
20
30
40
50
60
Baseline POST Follow-up
EXPGA
Functional disability
P = .088
Pain, in press
![Page 32: Assessment Of Fear Avoidance In Chronic Pain - Dr Johan W S Vlaeyen](https://reader034.fdocuments.net/reader034/viewer/2022051611/54b919a14a795991218b45bc/html5/thumbnails/32.jpg)
Pain, in press
![Page 33: Assessment Of Fear Avoidance In Chronic Pain - Dr Johan W S Vlaeyen](https://reader034.fdocuments.net/reader034/viewer/2022051611/54b919a14a795991218b45bc/html5/thumbnails/33.jpg)
Acquisition – Extinction Assymetry
Acquisition: learning new rules Extinction:
learning exceptions to
the rule
![Page 34: Assessment Of Fear Avoidance In Chronic Pain - Dr Johan W S Vlaeyen](https://reader034.fdocuments.net/reader034/viewer/2022051611/54b919a14a795991218b45bc/html5/thumbnails/34.jpg)
Understanding and treating fear of pain. Asmundson GJG, Vlaeyen JWS, Crombez G. Oxford: Oxford University Press, 2004.ISBN 0 19 8525141.
![Page 35: Assessment Of Fear Avoidance In Chronic Pain - Dr Johan W S Vlaeyen](https://reader034.fdocuments.net/reader034/viewer/2022051611/54b919a14a795991218b45bc/html5/thumbnails/35.jpg)
Conclusions
• Pain-related fear is a normal response to longlasting pain
• Fear-related defensive responses may have paradoxical effects
• Other goals may overule this primary goal
• Multiple goals may lead to conflicting responses
![Page 36: Assessment Of Fear Avoidance In Chronic Pain - Dr Johan W S Vlaeyen](https://reader034.fdocuments.net/reader034/viewer/2022051611/54b919a14a795991218b45bc/html5/thumbnails/36.jpg)
Maastricht (NL):Madelon PetersLinda van CleefKaroline van GronsveldJeroen de JongHanne KindermansMaaike LeeuwIlse SwinkelsJeanine VerbuntMarielle GoossensSaskia NijstSaskia RansonPetra KarsdorpMartien SchrootenLeuven (B):Steven de PeuterIlse van DiestOmer van den Bergh
International:Geert Crombez, BelgiumStephen Morley, UKMick Sullivan, CanadaGordon Asmundson, CanSteven Linton, SwedenKatja Boersma, Sweden
Teamwork: