Department of Experimental-Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, Gent, Belgium.
Clin J Pain. 2012 Jul;28(6):475-83. doi: 10.1097/AJP.0b013e3182385392.
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.
A narrative review.
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.
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.
慢性疼痛的恐惧回避（FA）模型描述了经历急性疼痛的个体如何陷入慢性残疾和痛苦的恶性循环。我们建议通过采用对慢性疼痛和残疾的动机视角来扩展 FA 模型。
叙述性综述。
有充分的证据支持最初提出的 FA 模型的有效性。然而，有一些关键的挑战需要下一代 FA 模型来应对。首先，FA 模型根植于精神病理学，研究人员将不得不找到一种方法来解释那些不容易符合该框架的发现。其次，FA 模型需要解决残疾和功能恢复的动态和复杂性。第三，FA 模型应该纳入这样一种观点，即与疼痛相关的恐惧和回避发生在多个且经常相互竞争的个人目标的背景下。
为了解决这 3 个关键挑战，我们认为下一代 FA 模型需要更明确地采用动机视角，该视角围绕目标和自我调节过程的组织力量构建。使用这个框架，FA 模型被重新塑造为捕捉到为保护和恢复生活目标而持续但徒劳的解决与疼痛相关问题的尝试。
