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Fear-Avoidance as a Risk Factor for the Development of Chronic Back Pain and Disability 

Fear-Avoidance as a Risk Factor for the Development of Chronic Back Pain and Disability
Fear-Avoidance as a Risk Factor for the Development of Chronic Back Pain and Disability

Linda Vancleef

, Ida Flink

, Steven J. Linton

, and Johan Vlaeyen

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date: 16 May 2022

Chronic musculoskeletal pain syndromes are responsible for enormous costs for healthcare and society (Linton 1998; Phillips et al. 2008; Picavet and Schouten 2003; Verhaak et al. 1998). Nowadays, the biopsychosocial perspective on pain offers a good foundation for a better insight into how pain can become a persistent problem (Fordyce 1976>; Turk and Flor 1999). In this perspective, pain and pain disability are influenced by the dynamic interaction among biological, psychological, and social factors.

The present chapter focuses on the role of fear and avoidance in the development and maintenance of chronic low back pain (CLBP). In the following paragraphs, an overview on the aetiology of low back pain (LBP), the conceptualization of fear and avoidance, and the development of fear-avoidance models will be provided. Furthermore, empirical evidence on the role of fear and avoidance behaviour in chronic pain, stemming from studies conducted in pain patients and in healthy volunteers, will be reviewed. This chapter will then continue with a discussion on how to assess fear of pain both at a direct and indirect level. Finally, this chapter will end with perspectives on the cognitive-behavioural management of chronic pain in patients who are characterized by increased pain-related fear and avoidance behaviour.

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