Request an Appointment

    Full name

    Phone Number

    Email

    Preferred Date

    Preferred Time

    New or existing client

    NewExisting

    Practitioner

    AnyDr Fiona McIntyreDr Matthias HouvenagelDr Chelsey Kedmenec

    Additional Information

    We're open on Saturdays! Book online now
    Chronic pain: How pain catastrophising and fear of avoidance affects your pain levels Home / Blog / Chronic pain: How pain catastrophising and fear of avoidance affects your pain levels

    Chronic pain syndrome is a complex multifactorial disease that affects 1 in 5 Australians over the age of 45. It is the third largest disease burden (surpassed by cancer and cardiovascular disease), and costs approximately 139 billion dollars through reduced quality of life and productivity losses. 

    Typically speaking, pain is a normal sensation felt as a reaction to illness or injury which subsides after the cause is gone. However, chronic pain can result from the unfortunate conclusion of improperly managed acute pain or injury that lasts for more than 3 months, to constant never ending pain. Chronic pain can also develop as a result of certain disorders such as but not limited to:

    • Arthritis and other joint problems
    • Back pain
    • Headaches
    • Muscle strains and sprains
    • Repetitive stress injuries, when the same movement over and over puts strain on a body part
    • Fibromyalgia, a condition that causes muscle pain throughout the body
    • Nerve damage

    The characterisation of chronic pain is usually accompanied by far more than just pain and dysfunction, but also presents with psychological manistifisations including stress, anxiety, depression, pain cataphrosing, fear and avoidance of movement. This creates complexity and difficulty in patient management – not only are practitioners required to tackle the problem in a biological/structural direction, but are also required to treat (or aid in the treatment of) the psychological manifestation of chronic pain; hence the biopsychosoical model of chronic pain. 

     

    The mind map below shows how all factors (biological, psychological and social) affect pain, and how pain affects them right back – highlighting that treating the structural factors of pain usually won’t provide the long term benefits that patients are looking for.

    In this blog I will address only two of the many factors that affect the incidence of chronic pain which is pain catastrophising, and fear of avoidance. During pain or injury our peripheral nerves send signals up through the central nervous system into the brain where it is processed and acknowledged.

     

    The Amygdala is part of the brain that associates particular events with fear and anxiety. E.g when a patient bends over to pick something up and feels pain, the event will be associated with pain, and the Amygdala can create fear and anxiety around that particular movement. In the acute stage of injury this is inherently good to reduce movement in the area to stop further damage. However long-term fear of movement and pain catastrophising can lead to chronic pain and disability even after tissue damage has long healed.  

    The flow chart below gives a simple view of the vicious cycle of pain catastrophising and fear of avoidance. 

     

     

    The fear-avoidance model of chronic pain based on the fear-avoidance model of Vlaeyen and Linton, and the fear-anxiety-avoidance model of Asmudson et al. (picture taken from Domenech, Julio & Sanchís-Alfonso, Vicente & Espejo, Begoña. (2011). Influence of Psychological Factors on Pain and Disability in Anterior Knee Pain Patients. 10.1007/978-0-85729-507-1_9.) 

     

    Amongst various other biological and psychological factors, catastrophising and fear can cause sensitisation to pain (central sensitisation), exacerbating the feeling of pain, disuse of musculoskeletal structures and increase risk of long-term disability. 

    So, what is the take home message? Your pain is real, yes it hurts! But the more we focus on our pain and fear, the greater chance you may fall down the hole of chronic pain and disability. Rather embrace your pain, understand that pain is a normal biological function and get moving. 

     

    – Dr. Tayyar Celiker (Osteopath) – BSc (Clin Sc), MHSc (Osteo) 

     


     

    References:

    Australian Institute of Health and Welfare. (2020). Chronic pain in Australia. Canberra: AIHW 

    Domenech, Julio & Sanchís-Alfonso, Vicente & Espejo, Begoña. (2011). Influence of Psychological Factors on Pain and Disability in Anterior Knee Pain Patients. 10.1007/978-0-85729-507-1_9. 

    Craig A. Wassinger, Gisela Sole. (2021) Agreement and screening accuracy between physical therapists ratings and the ?rebro Musculoskeletal Pain Questionnaire in screening for risk of chronic pain during Musculoskeletal evaluation. Physiotherapy Theory and Practice 0:0, pages 1-7.

     

    Leave a Comment

    Your email address will not be published, all comments are approved before posted

    YOU MAY ALSO LIKE...

    Protect Your Shoulders

    Let’s talk about one of the most functional, but prone to injury areas in the human body, the shoulder complex.

     Shoulder Anatomy

    The shoulder is comprised of three bo...

    read more

    Love your knees!

    The knee joint is the largest joint in the human body and is also quite a complex one, as it is actually made up of 2 joints. There are 3 bones that form these two joints. They are the femur (thigh bone), tibia (shin bone) and the patella (knee cap). The ...

    read more

    Strengthen Your Core

    What is your core? Your core is a group of muscles that sit in your torso. They stabilise and control the pelvis and spine. When most people think of their core, they envision a chiseled 6-8 pack. Unfortunately, the core goes ...

    read more

    The Effect of Stress on your Immune System

    As we all know, our lives right now are quite stressful as we try to deal with the containment of COVID-19. Things are happening now that have never happened in some people’s lifetimes which can be scary and confronting. It’s normal to be anxious abou...

    read more

    How can your Osteopath help your child?

    Osteopathy is a holistic approach to the body that considers the interconnectedness of the body's muscles, joints and systems. Typically adults are the ones getting treated, but at Ascot Vale Osteopathy, we treat children f...

    read more

    Anti-Inflammation Diet

    There is an enormous amount of interest in anti-inflammation diets out there and rightfully so. Chronic inflammation is very common and is tied to a large list of serious illnesses such as diabetes, cancers, auto-immune con...

    read more

    Psoas – Back pain and Breathing

    Psoas is a strong and powerful muscle, yet often overlooked, and tt can be responsible for a host of ailments. The Psoas muscle originates from the T12 and Lumbar spinal segments, where it blends in with fibers of the diaphragm (your primary breathing ...

    read more