Exposure to movement in chronic back pain: evidence of successful generalization across a reaching task

According to the fear-avoidance model, kinesiophobia (pain-related fear) is an important factor in the development of chronic pain and disability through the maintenance of maladaptive avoidance behaviors. Using a paradigm that required repeated exposure to a reaching task, the current study investigated generalization of pain and harm expectancy corrections (i.e., the tendency to bring expectations in line with experience) in chronic low back pain sufferers with high versus low levels of kinesiophobia. Sixty participants were asked to consecutively perform four adaptations of a reaching task, each introducing an element of increased intensity. Expected and experienced pain and harm ratings were collected during the two trials comprising each movement. Individuals with high levels of kinesiophobia reported greater pain and harm ratings during the movements. Further, highly kinesiophobic female, but not male, participants demonstrated greater overprediction of harm relative to low kinesiophobic counterparts during the first reaching trial. Finally, in contrast to previous investigations, highly kinesiophobic participants showed successful generalization of pain expectancy corrections across movement tasks. Possible clinical implications of the findings are noted.