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Fear-Avoidance Model of Chronic Pain: The Next Generation

Crombez, Geert PhD*; Eccleston, Christopher PhD; Van Damme, Stefaan PhD*; Vlaeyen, Johan W.S. PhD‡,§; Karoly, Paul PhD

doi: 10.1097/AJP.0b013e3182385392
Special Topic Series

Objective: The fear-avoidance (FA) model of chronic pain describes how individuals experiencing acute pain may become trapped into a vicious circle of chronic disability and suffering. We propose to extend the FA model by adopting a motivational perspective on chronic pain and disability.

Methods: A narrative review.

Results: There is ample evidence to support the validity of the FA model as originally formulated. There are, however, some key challenges that call for a next generation of the FA model. First, the FA model has its roots in psychopathology, and investigators will have to find a way to account for findings that do not easily fit within such framework. Second, the FA model needs to address the dynamics and complexities of disability and functional recovery. Third, the FA model should incorporate the idea that pain-related fear and avoidance occurs in a context of multiple and often competing personal goals.

Discussion: To address these 3 key challenges, we argue that the next generation of the FA model needs to more explicitly adopt a motivational perspective, one that is built around the organizing powers of goals and self-regulatory processes. Using this framework, the FA model is recast as capturing the persistent but futile attempts to solve pain-related problems to protect and restore life goals.

*Department of Experimental-Clinical and Health Psychology, Ghent University, Gent

Research Group on Health Psychology, Department of Psychology, University of Leuven, Leuven, Belgium

Centre for Pain Research, University of Bath, Bath, UK

§Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands

Arizona State University, Tempe, AZ

Supported in part by Grant BOF/GOA2006/001 of Ghent University (G.C.), FWO project G.017807 (G.C.) and a FWO-Odysseus Grant (J.W.S.V.). The authors declare no conflict of interest.

Reprints: Geert Crombez, PhD, Department of Experimental-Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, B-9000 Gent, Belgium (e-mail:

Received August 18, 2011

Accepted September 17, 2011

© 2012 Lippincott Williams & Wilkins, Inc.