Vlaeyen & Linton (2000) · Chronic pain
Vlaeyen & Linton (2000)
Pain Experience
The experience of pain — an injury, a flare-up, or persistent pain. How it is interpreted, more than the pain itself, determines which way the cycle turns.
Catastrophising / Fear
Catastrophic interpretation of the pain — 'this means serious damage', 'movement will harm me', 'it will only get worse' — leading to pain-related fear and hypervigilance to bodily sensations. (Where pain is appraised as non-threatening, people tend to stay active and recover — the alternative pathway.)
Avoidance / Guarding
Avoidance and escape — of movement, activity, work and social life — together with guarding, bracing and over-resting. Protective in the short term, but applied long after it is helpful.
Deconditioning / Disability
The longer-term costs of avoidance — physical deconditioning (weakness, stiffness, lost fitness), disability and withdrawal from valued activities, and low mood and frustration.
Increased Pain Sensitivity
Increased pain and sensitivity — deconditioning, guarding and hypervigilance lower the pain threshold and amplify pain signals, so there is more pain to interpret and the cycle turns again.
The published model, shown for reference. Switch to “Blank” to see the empty template you complete with a client.
When pain carries on long after an injury has healed, or has no clear cause, it can be confusing and frightening. This model — the fear-avoidance model — explains how fear of pain can, with the best intentions, make life narrower and the pain harder to live with.
It starts with pain, and how we make sense of it matters a great deal. If pain is read as a sign of serious damage — 'something is badly wrong', 'moving will injure me more' — it becomes frightening.
Fear leads us to protect the area: to avoid movement, activities and work, and to brace or guard the body. In the short term that feels sensible. But over time, doing less leads to weaker, stiffer muscles, lost fitness, low mood, and a life shrunk down around the pain.
A less active, deconditioned body often becomes more sensitive to pain, not less, and being constantly on the lookout for it makes it louder. So the pain continues, the fear seems justified, and the cycle turns. The hopeful part is that the cycle also shows the way out: when pain feels less threatening, people can gradually move and do more, rebuild strength, and turn the cycle around.
How to introduce the model, guided-discovery questions, treatment targets and a behavioural experiment are available to signed-in therapists.
This diagram is a reconstruction of the published model for clinical and educational use, grounded in the sources above.
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