The fear avoidance model disentangled: Improving the clinical utility of the fear avoidance model

Tamar Pincus, Rob J.E.M. Smeets, Maureen J. Simmonds, Michael J.L. Sullivan

Research output: Contribution to journalReview articlepeer-review

119 Scopus citations


Background: The model of fear avoidance proposes that fear of movement in back pain patients is an obstacle to recovery and leads over time to increased disability. Therefore, fear of movement should be targeted explicitly by interventions. Aims: To review the evidence (1) for the causal components proposed by the model, and (2) about interventions that attempt to reduce fear of movement. In addition, we aim to propose alternatives and extensions to the current model in order to increase the clinical utility of the model. Methods: A collaborative narrative review. Results: The fear avoidance model needs to be conceptually expanded and further tested to provide adequate and appropriate clinical utility. Currently, although there is experimental support for the model, observational studies in patients show contradictory results. Interventions based on the model have not delivered convincing results, only partly due to methodological shortcomings. Some assumptions inherent in the current model need adjusting, and other factors should be incorporated to indicate subgroupings within patients high in avoidance behavior. In addition, both theoretical and methodological limitations were identified in measurements of fear and avoidance. Conclusions: Future research should elucidate whether the proposed subgrouping of patients with avoidance behavior is helpful. Further research should focus on developing more accurate and psychometrically sound assessment tools as well as targeted interventions to improve activities and participation of patients with chronic disabling musculoskeletal pain disorders.

Original languageEnglish (US)
Pages (from-to)739-746
Number of pages8
JournalClinical Journal of Pain
Issue number9
StatePublished - 2010


  • fear avoidance
  • pain
  • subgrouping

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine


Dive into the research topics of 'The fear avoidance model disentangled: Improving the clinical utility of the fear avoidance model'. Together they form a unique fingerprint.

Cite this