Part II: Fear Avoidance

We know that 2 types of thinking can make your pain worse and cause greater disability: 1) catastrophizing and 2) fear avoidance. Fear avoidance is a tendency to:

• Be fearful of physical activity or work
• Avoid doing things that may increase your pain
• Fear that physical activity or work may cause more damage
• Believe that physical activity or work causes your pain

With fear avoidance, these questions and thoughts may run through your mind:

• I shouldn’t / can’t do things that might make my pain worse.
• Doing this might cause more damage in my body.
• Physical activity or work makes my pain worse.
• I shouldn’t / can’t do any physical activity or work with my present pain.
• I can’t do any physical activity or work until my pain is treated.
• I don’t think I’ll ever be able to go back to work.

It’s important to recognize that many people with chronic pain do have physician-prescribed physical limitations. Or, you might have limitations from your physical therapist or rehabilitation doctor. And it’s imperative that you follow those guidelines! What we’re addressing here is a fear or an avoidance of activity that’s physically ok for you to do. (If that difference between what you can and can’t do isn’t clear for you, please talk with your doctor about what is ok for you to do. And if you haven’t been doing activities, please discuss how to safely increase your activity level with your doctor.)

For many people with chronic pain, (unfortunately) you’ll have pain whether or not you do activities or work. So not doing anything won’t prevent discomfort. But, by not doing anything, you’ll miss out on all the positive aspects of activities, hobbies, work, and physical exercise. The important concept is balance. It’s very important that you do as much as you can, while also keeping your pain under control.

How do you minimize this “fear avoidance” type of thinking?

1. From your doctor, learn which activities are ok and which ones you shouldn’t do. With this information, you can then do as much as possible. Use Activity Logs. These chart how much you can do, rather than how bad your symptoms are.

2. Emphasize the positive aspects of activity.

While activity may indeed increase your pain, it may be worth it for the wonderful, positive things that come with activities, hobbies, work, and physical exercise.

3. Modify activities as needed.

Be creative in modifying your activities, so you can do them, while at the same time minimizing any increases in pain. Can you walk for several shorter periods instead of one long walk? Can you garden in containers on your front porch instead of doing the whole yard? Can you use voice recognition on your computer, instead of a keyboard?

Likewise, you may choose to do a longer walk one day when friends from out-of-town visit, recognizing that you may need to rest more for the next 2 days. Overall balance is what you’re trying to achieve.

4. Chronic pain often doesn’t mean body damage.

Acute pain often means you’re hurting your body. For example, touching that hot stove is causing a burn, so pain signals you that you’re hurting your body and makes you to pull your hand away. Chronic pain, on the other hand, often doesn’t mean that you’re hurting your body. So by limiting activities, you’re not avoiding damage.

5. Don’t let your pain get out of control.

You certainly don’t want to do activities to the point that your pain is getting worse and worse, or doesn’t subside when you rest. Be mindful of this balance between activities and pain levels, and don’t let either side completely dictate what you do.

6. Gradually add activities.

If you’re adding activities you haven’t done in a while, or doing more of an activity, do so gradually and under the supervision of your health provider.

7. Emphasize your ability to manage your pain.

Practice your skills to lower your pain levels. Practice your skills to cope with your pain. This will let you do more of what you enjoy and what’s important to you.

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The emphasis here is on a balance in your life. Don’t let your pain dictate your life. Live your life as fully as possible, despite having chronic pain.