The Nature and Treatment of Pain-Related Fear in Chronic Musculoskeletal Pain

Abstract

Musculoskeletal pain is one of the most frequently reported complaints in primary care. The last decade’s research has evidenced the important role of pain-related fear in the maintenance and exacerbation of chronic pain problems. In this article we review the current state of the art regarding the nature, development, and consequences of pain-related fear. We also discuss the implications for therapy, including mass media campaigns, education, exercise therapy, and exposure in vivo. Finally, we propose directions for future research, including the need to tailor treatments to individual patient characteristics, the role of interoceptive conditioning, implications of the context dependency of learning, and the consideration of implicit versus explicit attitudes toward feared painful stimuli.