Research Group Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.
Experimental Health Psychology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands.
Pain. 2021 Mar 1;162(3):875-885. doi: 10.1097/j.pain.0000000000002079.
The fear-avoidance model of chronic pain predicts that catastrophic (mis)interpretation of pain elicits pain-related fear that in turn may spur avoidance behaviour leading to chronic pain disability. Here, we investigated whether performing a movement to avoid a painful stimulus in the context of a novel movement increases threat and pain-related fear towards this novel movement and whether avoidance behaviour persisted when given the choice between performing the acquired movement to avoid a painful stimulus or an alternative, novel movement. Applying a robotic arm-reaching task, participants could choose between 2 movements to reach a target location: a short, but painful movement trajectory, or a longer nonpainful movement trajectory. After avoidance acquisition, the option to choose the painful trajectory was removed. The experimental group (N = 50) could choose between the longest trajectory or a novel intermediate trajectory, whereas the control group (N = 50) was allowed to only perform the novel trajectory. In a final test, participants of both groups were allowed to choose any of the 3 trajectories. After acquisition, experimental group participants showed elevated pain expectancy and pain-related fear towards the novel trajectory, compared with the control group. During test, the experimental group participants persisted in performing the longest pain-free (avoidance) trajectory and were less likely to choose the novel trajectory. In addition, these participants maintained higher levels of pain-related fear for the novel trajectory compared with the control group. These findings suggest that avoidance in the context of other neutral activities/movements may lead to the development and maintenance of threat appraisals and irrational fears.
慢性疼痛的恐惧回避模型预测，对疼痛的灾难性（错误）解释会引发与疼痛相关的恐惧，而这种恐惧反过来又可能刺激回避行为，导致慢性疼痛残疾。在这里，我们研究了在新运动的背景下进行运动以避免疼痛刺激是否会增加对这种新运动的威胁和与疼痛相关的恐惧，以及当有选择地进行习得的运动以避免疼痛刺激或替代的新运动时，回避行为是否会持续。通过应用机械臂伸展任务，参与者可以在 2 种到达目标位置的运动之间进行选择：短但疼痛的运动轨迹，或较长但无疼痛的运动轨迹。回避习得后，选择疼痛轨迹的选项被删除。实验组（N=50）可以在最长轨迹或新的中间轨迹之间进行选择，而对照组（N=50）只能执行新轨迹。在最后的测试中，两组参与者都可以选择 3 个轨迹中的任意一个。习得后，实验组参与者对新轨迹的疼痛预期和与疼痛相关的恐惧高于对照组。在测试过程中，实验组参与者坚持执行最长的无疼痛（回避）轨迹，并且不太可能选择新轨迹。此外，与对照组相比，这些参与者对新轨迹的疼痛相关恐惧保持较高水平。这些发现表明，在其他中性活动/运动的背景下进行回避可能会导致威胁评估和不合理恐惧的发展和维持。
