Fear Avoidance Model

The fear avoidance model is useful in preventing acute LBP developing into chronic LBP and in understanding that exaggerated pain perception in chronic LBP maintains pain and pain behaviours that are maladaptive; patients are described as having types of roles

  • Avoiders
  • Confrontors 

Fear Avoidance Model 1

Figure 1: Fear avoidance/confrontation impact

The following exert from the ‘Back Book’ (Roland M et al 2007) describes the characteristics of both types, these are obviously the extremes but illustrate the principle:

  • The avoider gets frightened by the pain and worries about the future.
    • The avoider is afraid that hurting always means further damage – it doesn’t.
    • The avoider rests a lot, and just waits for the pain to get better
  • The coper knows that the pain will get better and does not fear the future
  1. The coper carries on as normal as possible.
  2. The coper deals with the pain by being positive, staying active and getting on with life.

Who suffers most?

  • Avoiders suffer the most; they have pain for longer, they have more time off work and they can become disabled.
  • Copers get better faster, enjoy life more and have less trouble in the long run.


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