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How is Fear Avoidance Behavior Related To Pain?


Updated October 16, 2012

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Question: How is Fear Avoidance Behavior Related To Pain?

Giving into fear of pain can get you into long-term trouble with your back. In addition, fear avoidance beliefs often lead to isolation, depression and being sedentary.


Fear avoidance behavior, or FAB, is the avoiding of activities you think may bring on pain, or make your existing pain worse.

Fear avoidance is adaptive behavior, usually in response to dysfunctional beliefs and fears regarding pain.

You may even show fear avoidance behavior after you’ve been on the road to recovery for a while. Unfortunately, giving into the fear and/or aberrant beliefs about your pain when you're in the chronic stage of injury can augment a disability that may be associated with the condition. (During an episode of acute back pain, fear avoidance behavior actually may play an important role in limiting further damage to the area.)

At what Point does Fear of Pain Become A Problem?

Although some diagnostic tools do exist, clinicians are still looking for reliable and accurate ways to measure the presence of fear avoidance behavior in their patients.

According to the International Association for the Study of Pain (IASP), “establishing a cutoff point for ‘clinical levels’ of fear of pain is difficult." The IASP says this is because, as is mentioned above, fear of pain is often useful: it helps us know when to stay away from activities that could be harmful. But once you have more fear than actual risk for hurting yourself during an activity, fear avoidance becomes counterproductive, the IASP says.

The IASP also says that during an acute episode of pain, fear avoidance works in a fairly direct manner. Either you experience pain when you do something that would normally be problem-free (for example, bending down to pick up an object or a child), or you somehow instinctively know that you're doing something you shouldn’t. In other words, acute pain usually warns you to be “afraid” of certain movements, which is for your own good.

But as the injury starts to heal, continuing to avoid activity can lead to a sedentary lifestyle. Research shows that spines are much better off with regular exercise and activity. Granted, if you have been diagnosed with a back problem, getting a therapeutic exercise program prescribed specifically for you (based on your condition) by a licensed health provider is probably the safest and most effective route to staying active.


What's the Bottom Line Regarding Fear of Pain After A Back Problem?

The bottom line is you need to be responsible for monitoring your fears as your healing progresses. It’s also a good idea to monitor what you believe about pain, and how it affects or alters your participation in life. Doing your research to see if your beliefs have a grounding in fact is a great way to accomplish this. Ask your doctor or physical therapist any questions you have. There’s no need to carry fear of movement—also known as fear avoidance behavior—forward into your life after a back injury.


International Association for the Study of Pain. Fear Avoidance and Musculoskeletal Pain. 2009. Accessed Sept 2012. http://www.iasp-pain.org/AM/AMTemplate.cfm?Section=HOME&TEMPLATE=/CM/ContentDisplay.cfm&SECTION=HOME&CONTENTID=9551

Lundberg M, Frennered K, Hägg O, Styf J.The impact of fear-avoidance model variables on disability in patients with specific or nonspecific chronic low back pain.Spine (Phila Pa 1976). 2011 Sep 1;36(19):1547-53.

Verbunt JA, Seelen HA, Vlaeyen JW, van der Heijden GJ, Knottnerus JA.Fear of injury and physical deconditioning in patients with chronic low back pain.Arch Phys Med Rehabil. 2003 Aug;84(8):1227-32.

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