Fear reduction in patients with chronic pain: a learning theory perspective

Abstract

Acute pain informs the individual that there is an imminent threat of body damage, and is associated with the urge to escape and avoid. Fear learning takes place when neutral stimuli receive the propensity to predict the occurrence of pain, and when defensive responses are initiated in anticipation of potential threats to the integrity of the body. Fear-avoidance models have been put forward featuring the role of individual differences in catastrophic interpretations of pain in the modulation of learning and avoidance. Based on extensive literature on fear reduction in anxiety disorders; cognitive–behavioral treatments have been developed and applied to patients with chronic pain reporting substantial pain-related fear. In this article, we discuss mechanisms underlying the acquisition, the assessment and extinction of pain-related fear through the cognitive–behavioral treatment of pain-related fear. Finally, we provide a number of critical notes and directions for future research in the field of chronic pain and pain-related fear.

Keywords::

• chronic pain
• conditioning
• extinction
• learning
• pain-related fear

Financial & competing interests disclosure

The contribution of Mariëlle Goossens was supported by ZonMw, program Rehabilitation Research, Grant No. 60-60500-98015. Participation of Johan WS Vlaeyen was supported by the NWO Social Science Research Council of the Netherlands, VICI Grant No. 453-04-003, and an Odysseus Grant by the Fund for Scientific Research – Flanders, Belgium (FWO). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from the disclosed.

No writing assistance was utilized in the production of this manuscript.