Assessment Of Fear Avoidance In Chronic Pain - Dr Johan W S Vlaeyen

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Information about Assessment Of Fear Avoidance In Chronic Pain - Dr Johan W S Vlaeyen

Published on July 27, 2008

Author: epicyclops

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Lecture given to the North British Pain Association on 16th May 2008 by Dr Johan Vlaeyen. In this talk, Dr Vlaeyen discusses the mechanisms, assessment and treatment of fear avoidance in patients with chronic pain. Edinburgh, UK. www.nbpa.org.uk

Assessment of Pain-related Fear in Chronic Pain Johan W.S. Vlaeyen, PhD Pain and Disability Research Program University of Leuven, Belgium Maastricht University, Netherlands Edinburgh, Scotland 16 May 2008 Northern British Pain Association

Pain: a mental representation The threat value of pain Management of pain-related fear Effectiveness Conclusion Overview

Pain: a mental representation

The threat value of pain

Management of pain-related fear

Effectiveness

Conclusion

Traditional Disease Model Stimuli Behaviour

 

- 25 o Arntz & Claasens, PAIN 2005 Mediation: perceived harmfulness ++++ ++ Pain ratings: A Very cold B Very hot Info:

First Conclusion …

Stimuli Behaviour Mental representation of stimulus

Pain: a mental representation The threat value of pain Management of pain-related fear Effectiveness Conclusion Overview

Pain: a mental representation

The threat value of pain

Management of pain-related fear

Effectiveness

Conclusion

Pain urges to avoid/escape

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

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

Pain, 2006 Catastrophic interpretations of pain

Catastrophizing Fear

How does fear of pain develop? Ivan Petrovich Pavlov (1849-1936)

Associative Learning US: Food salivation CS: light CR: UR:

Meaning Pain Mental representation of Pain Disuse Nociception US Interoception Proprioception Exteroception CS Defense Arousal Attention Avoidance CR

Meaning CS Kinesiophobia Mental representation of Pain Disuse Defense Arousal Attention Avoidance CR

Bradley et al, PAIN, in Press 1. Arousal Acquisition Threat: shock Safe: no shock Test Test

2. Fear directs attentional focus Body Scanning Selective Attention Problems Disengaging from source of threat Crombez, Van Damme and Eccleston

Body Scanning

Selective Attention

Problems Disengaging from source of threat

3. Escape and Avoidance behavior Vlaeyen et al., Pain, 1995 Avoidance behavior Secs. * Subjective tension VAS *

Vlaeyen & Linton, Pain, 2000 Fear-Avoidance Model Catastrophic misinterpretations DISUSE INJURY/STRAIN PAIN DEFENSE AVOIDANCE ATTENTION DISABILITY

Pain: a mental representation The threat value of pain Management of pain-related fear Effectiveness Conclusion Overview

Pain: a mental representation

The threat value of pain

Management of pain-related fear

Effectiveness

Conclusion

Meaning CS Kinesiophobia Exposure in vivo with response prevention Mental representation of Pain

Fear-Avoidance Model: Clinical applications Educate about paradox of safety seeking behaviors Activate fear network Challenge expectancies with behavioral experiments Vlaeyen et al., CJP 2002

Educate about paradox of safety seeking behaviors

Activate fear network

Challenge expectancies with behavioral experiments

Crombez et al, Health Psychology, 2002

2. Fear hierarchy Exposure in vivo in chronic pain 3. Education 4. Exposure in vivo Treatment Goals

Treatment Goals

http://www.psychology.unimaas.nl/phoda-sev/

Pain: a mental representation Pain urges to escape Management of pain-related fear Effectiveness Conclusion Overview

Pain: a mental representation

Pain urges to escape

Management of pain-related fear

Effectiveness

Conclusion

Clin J Pain, 2002 Baseline Exposure Exercise Baseline Exposure Exercise

Clin J Pain, 2005 EDU EXPOS EDU EXERC

 

Threat value of movements P < .001 Functional disability P = .088 Pain, in press

Pain, in press

Acquisition – Extinction Assymetry Acquisition: learning new rules Extinction : learning exceptions to the rule

Understanding and treating fear of pain. Asmundson GJG, Vlaeyen JWS, Crombez G. Oxford: Oxford University Press, 2004. ISBN 0 19 8525141.

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

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

Maastricht (NL) : Madelon Peters Linda van Cleef Karoline van Gronsveld Jeroen de Jong Hanne Kindermans Maaike Leeuw Ilse Swinkels Jeanine Verbunt Marielle Goossens Saskia Nijst Saskia Ranson Petra Karsdorp Martien Schrooten Leuven (B) : Steven de Peuter Ilse van Diest Omer van den Bergh International: Geert Crombez, Belgium Stephen Morley, UK Mick Sullivan, Canada Gordon Asmundson, Can Steven Linton, Sweden Katja Boersma, Sweden Teamwork:

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