3 Things to Know about Fear-Avoidance (and how it’s tied to chronic pain)

Date:  October 18, 2017


3 Things to Know about Fear-Avoidance (and how it’s tied to chronic pain)

It’s just a simple thing…until it isn’t.

Everyone experiences pain at some point in their lives, however, a small number of people continue to experience long-term pain. When somebody has experienced pain for more than three months, they are often diagnosed with “chronic pain,” which is as pain that persists long after the initial injury, and may be psychological in nature.

When it comes to spine, muscle, and nervous system pain, it has been well-established that those who experience chronic pain will often avoid certain activities due to fear of making the injury worse.1 Although this might be helpful to prevent harm in the short term, if allowed to persist, avoiding everyday activities (and exercises that may be good for your health), can lead to physical and psychological consequences that can contribute to disability and chronic pain.2

This phenomenon is known as “fear-avoidance,” which, simply enough, means that we avoid certain activities because we fear they will have a negative impact on our health and well-being, specifically with respect to pain.

Three things are needed to define a fear-avoidant behaviour2:

  1. An initial injury that causes pain: After an initial injury, like an ankle sprain, a pain signal is sent to the brain to protect the body from further damage.
  2. How someone interprets their pain: An extremely negative interpretation of pain results in psychological (depression) and behavioural (avoidance of activity) fear responses, may eventually lead to a decrease in function.
  3. How someone’s perception changes as a result of their pain: A change in pain perception that leads to an individual cycling back to the initial stage of injury, which leads to more pain instead of recovery.

Current evidence has shown that fear-avoidance is related to increased pain, physical disability, and depression in individuals with chronic pain.2 Fear-avoidance–based treatments (which include education about fear and avoidance and an exercise program) have been successful in reducing chronic pain.3

If you want to learn more about how to reduce fear-avoidance behaviours and how to remain active, visit your family chiropractor.

Pain changes everything. Chiropractic care changes pain.



1. Meier ML, Stämpfli P, Vrana A, Humphreys BK, Seifritz E, Hotz-Boendermaker S. Fear avoidance beliefs in back pain-free subjects are reflected by amygdala-cingulate responses. Front Hum Neurosci. 2015;9:424. doi: http://doi.org/10.3389/fnhum.2015.00424.

2. Turk DC, Wilson HD. Fear of pain as a prognostic factor in chronic pain: conceptual models, assessment, and treatment implications. Curr Pain Headache Rep. 2010;14(2):88-95. doi: http://doi.org/10.1007/s11916-010-0094-x.

3. Leeuw M, Goossens ME, Linton SJ, Crombez G, Boersma K, Vlaeyen JW. The fear-avoidance model of musculoskeletal pain: current state of scientific evidence. J Behav Med. 2007;30(1):77-94. doi: 10.1007/s10865-006-9085-0.