Illness behaviour, fear avoidance and chronic pain development
Pain, especially chronic pain (pain lasting over 3 months) can have significant impacts on our happiness and quality of life. The experience of pain is a personal thing and can present very differently in people depending on their outlook, personality and a multitude of other factors.
Our beliefs about our pain can even shape the progression of physical injury through protective behaviour and avoiding certain physical activity. Sometimes our drive to protect ourselves from hurting an injured area can even create problems in parts of our body that we use to compensate.
Enter the fear avoidance model of chronic pain:
While these two pathways are certainly not fixed or universal, they can provide a helpful framework to understand how injuries and pain can shape our thinking and behaviour surrounding a physical injury.
To the left is the pathway we should try and avoid, but all too often find ourselves falling into. It’s easy to see why. When something hurts- really hurts, it can dominate our thinking and cause us to worry, sometimes allowing it to control the kind of behaviour or movement we are prepared to engage with. This in turn may lead us to shy away from physical activity that we once did without a second thought and negatively affect other aspects of our physical or mental health.
The path on the right is where we should be aiming when experiencing chronic pain. Information and education, gradual exposure to movement and exercise, or simply sheer will and determination can lead us to understand our experience of pain can lead us to lose the fear we have developed around it. This gives us the power to confront the situation we are in and begin recovery. Even if the underlying problem is chronic, there is nearly always a way in which we can improve and recover to some degree.
Pain is not always indicative of damage, but rather exists as a tool to alert the body, sometimes even if we are safe to move. It is always possible to move the needle on our experience of injury and pain through confrontation, knowledge and graded exposure.
Things can always get better.
Luke Bramley
Registered Osteopath
