The Fear Avoidance Model of Chronic Pain: How to Overcome the Fear

An estimated 20% of U.S. adults have chronic pain, and 7.4% of those individuals have pain that is so severe, it limits their life and work activities. Overcoming chronic pain can be incredibly challenging and for some, and can feels like a lifelong battle. While there are many theories on what causes chronic pain and how to treat it, the fear-avoidance model of chronic pain may offer a solution for some individuals.

What is the Fear Avoidance Model of Chronic Pain?

the fear avoidance model of chronic pain woman laying on the couch in pain

The fear-avoidance (FA) model is the idea that people develop chronic musculoskeletal pain because of fear-avoidance behavior. 

Here’s a simplified version of the concept:

  • You have a negative experience with pain and the consequences of that pain. 
  • That negative experience causes fear and catastrophizing thoughts.
  • Out of fear of having another negative experience, you avoid anything that may trigger that pain.
  • Avoidance leads to disuse and disability, which only leads to prolonged pain.
  • The vicious cycle continues.

The FA model suggests that when someone experiences pain, like after an injury, they can take one of two paths. One path is the FA model of chronic pain. The other is to recognize that pain is a part of the healing process. Without that fear, these individuals can confront the pain and go through the recovery process.

Over time, those who follow the FA path may:

  • Overestimate future pain
  • Repeatedly avoid activities that cause pain
  • Suffer from physical deconditioning, disability, and depression

There is still some great debate about the FA model for chronic pain among researchers. Many believe that it’s an oversimplified model that can’t be applied to everyone. 

However, there is evidence that fear-avoidance is linked to more severe pain and disability. Research has also found that people who are afraid of pain are more likely to suffer from it.

There’s no question that pain, especially chronic pain, is complex. However, the FA model of chronic pain offers a different perspective and can help people approach treatment in a different way.

How to Overcome the Fear of Chronic Pain

Fear is a natural response to negative or dangerous encounters. However, when that fear response keeps you trapped in a cycle of avoidance behavior, it can lead to disability, depression, and other issues that prevent you from recovering.

So, how do you break the cycle and move out of that positive feedback loop that keeps you in pain?

First, it’s important to remember that fear is a natural response to pain. You did not choose to associate fear with pain, and it is not your fault that you are experiencing chronic pain.

Cognitive Behavioral Therapy (CBT)

CBT is a talking therapy that aims to help you understand the connection between your thoughts and behaviors. The goal is to replace negative thoughts with positive ones. In this case, the fear and avoidance behaviors would be replaced with positive thoughts and behaviors that encourage daily movement and exercises to restore function.

CBT has been shown to be effective for catastrophizing and disability. Reprogramming your thoughts and your mindset can help you break that cycle of fear of pain so that you can confront it and recover.

Observational Learning

Another way to address fear-avoidance is observational learning. For example, experimental studies have found that participants can develop a fear of pain by watching other people’s distressed expressions when performing certain tasks.

Observational learning may be used to create the opposite effect. This paper suggests using action observation to treat fear-avoidance behaviors. With action observation, you visualize other people performing tasks, behaviors, or movements in a positive way. This form of therapy is already used in stroke rehabilitation. 

When you see that other people are performing the tasks you fear and having a positive experience, it can change your own perception of that activity. 

Massage Therapy

the fear avoidance model of chronic pain man sitting in massage chair

Massage therapy can be used alongside other therapies to help break the cycle of fear. For example, one research paper suggests using massage to help combat the muscle tension caused by fear-avoidance and pain.

Massage can help reduce or eliminate muscle tension, pain, anxiety, and stress. Reducing the discomfort associated with chronic pain may also help ease that fear that’s contributing to the chronic pain cycle. 


Sometimes, just understanding how the FA model works and affects your body’s perception of pain can help break the cycle. In addition, education itself can alleviate anxiety and stress, which can help prevent overreaction to pain and may even reduce pain perception.

Gentle Stretching

Gentle stretching can help reduce the stiffness and tension caused by pain and anxiety. It can also help prevent your pain signals from firing rapidly.

Gentle, purposeful stretching and breathing may help reset pain receptors. It can also help combat the loss of range of motion caused by fear-avoidance behaviors.


Walking is a gentle, simple way to get your body moving and start increasing your daily activity level. Try taking it slow at first. Start with just a few minutes of walking, and work your way up to longer sessions as you feel more comfortable with the movement. 

Consider walking in a peaceful, natural setting if the weather permits. Research has shown that exposure to nature can help reduce anxiety and stress, which may help reduce your fear. 

Deep Breathing

When you’re feeling stressed and overwhelmed by your pain, deep breathing exercises may help. Deep breathing can help reduce stress and send a signal to your brain that it’s time to calm down.

Deep breathing may help:

  • Slow your heart rate
  • Slow your breathing
  • Reduce your blood pressure

With continued practice, deep breathing exercises can help you reach a deep state of relaxation. When your body is relaxed, it can help reduce pain and the fear that you’re feeling in the moment. 

Final Thoughts

The fear-avoidance model of chronic pain can help you understand why you’re experiencing pain and work towards breaking the fear cycle. There are several therapies that can help you along that path as well as natural pain relievers to help reduce your discomfort and fear.

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