Fear avoidance

What is fear avoidance?

Fear avoidance refers to purposefully not doing some actions because you are worried about making the pain worse.  This is a common behaviour that many people with long term pain (chronic pain) face and maybe you have experienced this too.

Why are you fearful of pain?

Fear of pain can happen when the meaning of pain is misunderstood.  People with chronic pain often believe that that "pain equals harm". They are convinced that pain is a signal of threat or harm to their well-being and that their body needs to be carefully protected to prevent further damage.  You would have probably learnt this through experiences in the past, from people you know or through the media, such as the internet, television programmes and magazines.  For example, if you experience shooting pain in the back while lifting a heavy object, you are likely to stop lifting because you associate lifting with pain.  Friends, family and even health care professionals may also have reinforced this fear through their advice of prolonged rest, without realising it. 

How do you behave as a result of this fear?

This fear may make you avoid activities or movement that you believe will increase pain or result in re-injury. Even if you do not try to avoid the situation, you might be more careful when performing the feared activity. For example: knee pain is likely to cause you to avoid putting weight on that leg. In the long run, you may start using a walking stick to walk so as to avoid using the pain affected leg.  Such behaviour can causd the leg to become weaker, tighter and hence, more painful in walking.  In time, you may choose to walk lesser.

What are the consequences?

At the beginning, such behaviour is likely automatic and sensible as it may temporarily reduce your pain. However, this is not helpful in the long run and your pain is likely to worsen over time. By moving less, you have reduced strength in your muscles. Lack of movement weakens your muscles, makes you less fit, and over time makes you less able to do things you like to (increased disability).  Eventually more activities will become difficult and will begin to cause more pain. You will find that you will not be able to do as much as before or less than you would like to. This can be the start of a downward spiral of increasing avoidance, disability and pain.

In the end, you may decide to give up many of your usual activities that gave you a sense of purpose. You may give up your work, family and social life. You may feel that you are no longer able to do the things you used to be able to do and this lowers your confidence to manage pain. As a result, you can become socially isolated, depressed and helpless.

What can we do to overcome fear avoidance?

When patients understand pain as non-threatening (not harmful), fear of pain is unlikely, they will resume their daily activities and their confidence will improve. By gradually increasing your activity level in a gradual and steady manner despite your pain, these fears will ease, especially when you see for yourself that nothing really bad happens. You may initially feel more pain, but that is normal and it will settle as you gain more strength and flexibility. You might find it helpful to see a physiotherapist or psychologist for guidance and expert help in this area.

Summary

  • Many people who experience chronic pain tend to arrange their lives to avoid activities that they anticipate would trigger pain.
  • Pain-related fear arises when pain is misinterpreted to be a signal of harm.
  • Such wrongful expectancies and unhelpful beliefs lead to avoidance of movement and guarding behaviours. Overtime, these learned behaviours limit your lifestyle and leads to emotional distress.
  • The best treatment for reducing your fear is to confront your fear by gradually increasing your activity level, preferably with the help of a healthcare professional.