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Updated: Jul 10, 2026

Investigating Pain-Related Avoidance Behavior using a Robotic Arm-Reaching Paradigm
Published on: October 3, 2020
The role of fear-avoidance and helplessness in explaining functional disability in chronic pain: a prospective study
Han J A Samwel1, Floris W Kraaimaat, Ben J P Crul
1Department of Medical Psychology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. h.samwel@mps.umcn.nl
Objective:
Based on the fear-avoidance and helplessness models, the relative contribution of fear of pain, avoidance behavior, worrying, and helplessness were examined in relation to fluctuations in functional disability in chronic-pain patients.
Methods:
A cohort of 181 chronic-pain patients first completed various questionnaires and kept a 7-day pain journal during a standard 3-month waiting-list period prior to their scheduled treatment at an Interdisciplinary Pain Centre and did so again immediately preceding the intervention.
Results:
At baseline, fear of pain, avoidance behavior, and helplessness all predicted functional disability after 3 months. Stepwise regression analyses showed avoidance behavior to be the strongest predictor of change in functional disability followed by helplessness, thus both ahead of fear of pain.
Conclusion:
The current findings support the roles of both fear-avoidance factors and helplessness in the functional disability in chronic-pain patients awaiting treatment but revealed a central role for avoidance behavior.
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