(PS6-C55) Role of Avoidance Behaviors in Pain

Pain is a crucial warning signal, but can be at levels of intensity so as to be unbearable, and can be chronic (i.e., defined as pain lasting 3+ months), thus defeating its purpose as a stimulus to prompt help-seeking or other attempts to ameliorate it. Pain, at various levels of intensity, is universal and affects significant amount numbers of people worldwide, negatively impacting daily activities, quality of life, and sleep. Research on pain clearly demonstrates that psychological factors play important roles in coping, catastrophizing, disability, and treatment effectiveness. The fear-avoidance model suggests how psychological factors (e.g., avoidance behaviors, fear of pain) affect pain experience, implying the potential of targeting them in pain management. According to the model, individuals with high levels of pain-related fear tend to be sedentary and to avoid behaviors (e.g., outdoor activities, movement). Avoidance behaviors lead to negative outcomes such as depression, which can worsen pain experience. The purpose of this study was to examine the Fear-Avoidance model of Chronic Pain (which has implications for acute pain and its possible transition into a more lasting problem) by testing the mediation role of avoidance behavior in the relationship between fear of pain and depression.

A total of 286 undergraduate students (69% female, M age = 20.5 years old) were recruited at Chungnam National University, South Korea. Participants completed the Fear of Pain Questionnaire-9 (FPQ-9), Center for Epidemiologic Studies-Depression Scale (CES-D), and the Avoidance-Endurance Questionnaire (AEQ), which focuses on one’s typical responses to pain (e.g., avoidance behavior).  

Overall, depression was positively related to avoidance behaviors and fear of pain. A mediation analysis was conducted using PROCESS, showing that avoidance behavior mediated the relationship between fear of pain and depression (B = .04, p < .05). The total effect of fear of pain on depression was significant (B = .33, p < .01), and the direct effect was also significant (B = .29, p < .05). The results suggest that individuals who report high levels of fear of pain may be more likely to engage in avoidance behaviors in the existence of pain than individuals with low levels of fear of pain, and increased avoidance behaviors may be associated with greater depression.

Results provide evidence supporting the Fear-Avoidance model, emphasizing the role of psychological factors (e.g., avoidance behavior, fear of pain) in pain experience. Given that depression and pain have a negative bidirectional effect on each other, it may be important to target avoidance in pain management.