full day workshop

REDUCTION OF PAIN-RELATED FEAR IN CHRONIC PAIN: EXPOSURE IN VIVO WITH BEHAVIORAL EXPERIMENTS

Johan W.S. Vlaeyen, University of Leuven, Belgium and University of Maastricht, The Netherlands  and  Stephen Morley, Academic Unit for Psychiatry and Behavioural Sciences, University of Leeds, UK

AC Hotel Room: Sants

Whom the workshop is aimed at: Experience in cognitive-behavioral treatment of patients with somatoform disorders is desirable in order to follow this workshop.   Background: There is accumulating evidence that the lowered ability to accomplish tasks of daily living in chronic pain patients is not so much the consequence of pain severity. Instead, catastrophic misinterpretations of pain and associated fear of pain can be more disabling than pain itself. Pain-related fear (fear of movement, physical activity and fear of re-injury) has shown to be associated with impaired physical performance and self-reported disability, and to predict future disability in individuals with acute pain. Inversely, the reduction of pain-related fear (by means of exposure in vivo and behavioral experiments) has shown to increase functional abilities and sometimes to reduce pain severity. The current workshop will briefly summarize the most recent research findings on the role of pain-related fear in chronic pain, and subsequently focus on exposure in vivo as a novel treatment for patients with chronic musculoskeletal pain who report substantial pain-related fear.  The exposure in vivo treatment that is outlined in the present workshop consists of four components: Identification of treatment goals, establishment of a fear hierarchy, education about the paradoxical and detrimental effects of safety behaviors, and graded exposure to fearful stimuli following the fear hierarchy. During exposure in vivo sessions, behavioral experiments can be applied, in which the patient gets the opportunity to correct dysfunctional beliefs about the association between physical activity, pain and re-injury.

Johan W.S. Vlaeyen is professor in behavioral medicine whose main interests are the cognitive and behavioral mechanisms that may be responsible for the transition from acute pain to chronic pain disability, and the development and evaluation of tailored CBT interventions for chronic pain. He currently directs a research program on the role of pain-related fear, mood, and stop rules in the maintenance of chronic musculoskeletal pain. Stephen Morley is professor in clinical psychology whose major research interest is the effectiveness and development of psychological methods for treating chronic pain, and the cognitive, interpersonal, and identity processes in adjusting to chronic pain.

Key References:
Leeuw M, Goossens MEJB, Linton SJ, Crombez G, Boersma K, Vlaeyen JWS. The fear-avoidance model of musculoskeletal pain: current state of scientific evidence. Journal of Behavioural Medicine; 2007, in press. 
Vlaeyen JWS, de Jong JR, Sieben JM, Crombez G. Graded exposure in vivo for pain-related fear. In: Turk DC, Gatchel RJ, editors. Psychological Approaches to Pain Management A practitioner's handbook. Second edition ed. New York: Guilford; 2002. p. 210-33. 
de Jong JR, Vlaeyen JW, Onghena P, Goossens ME, Geilen M, Mulder H. Fear of Movement/(Re)injury in Chronic Low Back Pain: Education or Exposure In Vivo as Mediator to Fear Reduction? Clin J Pain. 2005 Jan;21(1):9-17. 
de Jong JR, Vlaeyen JW, Onghena P, Cuypers C, Hollander MD, Ruijgrok J. Reduction of pain-related fear in complex regional pain syndrome type I: The application of graded exposure in vivo. Pain. 2005 Aug;116(3):264-75. 
Asmundson GJG, Vlaeyen JWS, Crombez G. Understanding and treating fear of pain. Oxford: Oxford University Press; 2004.