Understanding and Coping With Chronic Pain Using the Fear-Avoidance Model

Understanding and Coping With Chronic Pain Using the Fear-Avoidance Model

If you’re an avid reader of our Expert articles, then you’re aware that we published a series on the Fight-or-Flight system and, more specifically, the relationship between chronic pain and stress. We know this is a topic that affects many people, so we wanted to take a bit more time to explore chronic pain a little further.



Are you struggling to find ways to cope with chronic pain? Well, you’re not alone. In fact, more than three million people in the United States alone are dealing with chronic pain at this very moment, according to the Mayo Clinic. 

While it might bring you comfort to realize that you’re not alone, that doesn’t change the fact that you’re still suffering. As you are aware, chronic pain can be a hidden burden and affect much more than your physical wellbeing. Understanding how it begins and progresses is an important step in your recovery, and we are here to help walk you through it. 

What Is Chronic Pain?
Like we discussed in the Fight-or-Flight series, pain functions as a warning that something isn’t quite right. Depending on the trigger, pain can be felt as an achy, throbbing, stabbing, shooting, or pinching sensation. And, at times, the pain can feel like it’s crippling and never-ending. 

When this occurs, sensory receptors in the body quickly relay the stimulus through nerves that reach the spinal cord and brainstem. There, the sensation is registered as “pain.” Interestingly, it’s not until the message reaches the brain that we perceive that stimulus as “painful.” Because of this process, most pain medications typically aim to block these signals before they reach the brain. 

Chronic Pain Is Not the Same as Acute (New) Pain
Before you understand the facts about chronic pain, it’s important to know how pain begins. 

Acute pain refers to new pain signals that were previously not there. Under normal circumstances, such signals are sent as a warning, often in the event of an injury, and stop when the healing is complete. 

This process begins to malfunction when the pain signals persist longer than the healing time.  At times, pain signals can misfire for weeks, months, or even years, sometimes leading to a source of chronic pain.

Possible Causes of Chronic Pain
The exact cause of chronic pain is unclear. Many theories have been proposed, but there is one theory that has gained widespread acceptance: the Fear-Avoidance Model. 

The Fear-Avoidance Model describes the manner in which people suffer from a seemingly endless cycle of chronic pain. Additionally, it emphasizes how you develop chronic, musculoskeletal pain as a result of avoidant behavior that is based upon fear. 

The model states that having a negative perspective about pain, like having “worst-case scenario” thoughts, can result in feelings of pain-related fear, avoiding daily activities, and being hyper aware of your body. Consequently, you begin to avoid the activities and movements that (1) you fear will trigger pain, and; (2) are more likely to overestimate your risk of future pain. Ultimately, your avoidance patterns lead to sleep disturbances, anxiety, depression, disability, and overall poor quality of life; which in turn can affect your work, social, and personal life. 

The takeaway point is this: being lost in fear avoidance behaviors perpetuates chronic pain, much like gasoline to the flame. In order to move towards recovery, according to the Fear-Avoidance Model, it is imperative that you stop reinforcing avoidance behaviors. And one way to do this is to make small steps towards your favorite activities without negatively thinking about pain. 

However, be aware that there are certain injuries or illnesses that may lead to chronic pain independent of the fear-avoidance cycle. These may include: nerve damage, post-viral or infection, arthritis, or cancer.

Treatments for Chronic Pain
Many recommended treatments for chronic pain include cognitive behavioral therapy, meditation, exercise, relaxation techniques, acupuncture, and, as a last resort, surgery.

There is strong evidence that says physical activity can help treat chronic pain. Exercise has been shown to have physical, mental, and emotional benefits with short and long-term pain relief. Perhaps most importantly, regular exercise can also reduce your risk for clinical depression and anxiety, which has been known to amplify the effects of chronic pain. 

Chances are, you are already doing many things to combat your chronic pain. But if you’re not, then take a look at this list below. 

1. Stretching
Yes, everyone knows that stretching can increase flexibility and decrease stiffness. But did you also know that regular stretching can stop those pain signals from firing so frequently? 

When coupled with slow and purposeful breathing techniques, stretching can reset the pain receptors in your joints and muscles. Unsure where to start? Try these videos:

Yoga Strap Stretching
Morning/Nighttime Routine
PNF for the Lower Body
PNF for the Upper Body

2. Walking
This is the easiest way to increase your level of activity throughout the day. Take the stairs, get up from your desk and walk every hour, and park farther away at the grocery store. When you’re off from work, convince your family or friends to take a nature hike - being outside + exercise is a win/win for your mental and physical health.

3. Low impact activities
We could go on and on about the health benefits of low impact exercise, like water-based movements, yoga, Tai Chi, or Pilates. All of these options are highly modifiable, making them ideal for virtually every fitness level.

Water-based exercise is a gentle reintroduction to movement since the buoyancy of the water decreases the amount of stress on your joints. However, it’s extremely important that you pair any water-based movements with land exercises since the carryover is minimal. 

Yoga and Pilates combine exercise with relaxation and breathing techniques. Tai Chi has been used for thousands of years, and is known for its meditative movements. These options can be self-led or practiced within a group setting. 

Try these videos to get you started:

Yoga/Pilates Blend
At the Lake Cooldown
Quick Yoga/Pilates Stretch
Restorative Flow

4. Strength training
We understand that you may be reluctant to pick up the weights again, but there really is no substitute for weight training. Begin slowly by using your own body weight and progress to using light weights/resistance to improve muscle strength. Focus on 1-2 different muscle groups every other day to avoid risk of injury, and be sure to stretch on your rest days.

5. Relaxation exercises
Remember the amygdala hijack? Refresh your memory on this here: What Happens During Fight or Flight and 4 Ways to Prevent It

Using relaxation techniques can go a long way in conquering the amygdala hijack. If you recall, breathing and relaxation exercises can slow the heart rate and adrenaline response, which dulls the effects of an amygdala hijack. What’s more, learning how to relax muscles can lessen the firing of those pain signals.

Try Foursquare breathing: take a deep breath so that your abdomen expands, then blow out your breath, so your abdomen contracts. Inhale for a count of four, hold for a four count, then exhale for a four count, and hold for a count of four.  Repeat 8-10 times.

Another option is to practice guided imagery. Breathe slowly and deeply, and imagine yourself in a calm, tranquil scene. Think about the colors, sounds, smells, and feelings while imagining yourself in a tranquil scene. Try this for 5-10 minutes every day.

Related: Breathing Workout - Breathing Exercises for Stress, Overwhelm, and Exhaustion

It is important to slowly reintroduce movement, exercise, and activities in a gradual manner. You can increase the time, type, or intensity as your body and mind become accustomed to the activity.

What else can you be doing to diminish chronic pain patterns? Try making these lifestyle changes that have a significant effect on your pain signals, sensitivity to stimuli, or healing time. 

  • Stop smoking
  • Prioritize self care
  • Eat well
  • Engage in regular exercise
  • Practice good sleep behaviors and aim for 6-8 hours of sleep per night
  • Decrease alcohol consumption

It is important to remember that chronic pain is also a completely personal and highly-individualized experience. There are multiple factors that can affect it, such as the weather, your mood, your sleeping patterns, fluid intake, and amount of processed food that you eat, just to name a few. Realize that you may need a combination of treatments to manage and treat your chronic pain, and never underestimate the power and influence of your thoughts. Remember, consistency is key and we are looking to introduce gentle movement while also changing your perception of pain. 

Have you struggled with chronic pain? What tools have you used to cope with it?

Written for Fitness Blender by Kayla C, PT, DPT
Board-Certified Neurological Clinical Specialist