Brazilian Journal of Pain
Brazilian Journal of Pain
Review Article

Therapeutic approach to pain-related fear and avoidance in adults with chronic musculoskeletal pain: an integrative review and a roadmap for clinicians

Abordagem terapêutica do medo relacionado à dor e da evitação em adultos com dor musculoesquelética crônica: revisão integrativa e roteiro para o clínico

Gisele Harumi Hotta; Anamaria Siriani de Oliveira; Rafael Krasic Alaiti; Felipe José Jandre dos Reis

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BACKGROUND AND OBJECTIVES: Cognitive-behavioral approaches have been applied in patients with chronic pain as a treatment strategy to reduce symptoms and disability, since fear related to pain, kinesiophobia and catastrophizing may be important psychosocial barriers for recovery. The relevance of fear and avoidance behaviors in the development and maintenance of processes of disabling chronic pain is already well established in the scientific literature.

CONTENTS: The cognitive-behavioral approach defines the relationship of pain with defense behaviors and the contribution to functional disability, assisting clinicians to recognize signs of these defensive behaviors during practice, as well as providing strategies for clinical practice, highlighting approaches that can be used, such as pain neuroscience education and exposure therapy. Therefore, it is possible to provide a guide to facilitate the implementation of these concepts in clinical practice for the management of chronic musculoskeletal pain, helping clinicians to ground the theories of fear learning and avoidance in the context of pain and to address the psychosocial factors of patients who present an association between pain and movement.

CONCLUSION: Pain-related fear and catastrophic thoughts influence pain intensity and functional disability. Recognizing pain within a multidimensional context assists in establishing targeted approaches. Cognitive-behavioral approaches based on exposure therapy focus on the view beyond body structures.


Adaptation psychological, Chronic pain, Exercise therapy, Fear, Musculoskeletal pain, Pain


JUSTIFICATIVA E OBJETIVOS: As abordagens cognitivo-comportamentais têm sido aplicadas em pacientes com dor crônica como estratégia de tratamento para redução de sintomas e incapacidade, uma vez que o medo relacionado a dor, a cinesiofobia e a catastrofização podem representar barreiras psicossociais importantes para a recuperação. A relevância do medo e de comportamentos de evitação no desenvolvimento e manutenção de processos de dor crônica incapacitante já é bem estabelecida na literatura científica.

CONTEÚDO: A abordagem cognitivo-comportamental fundamenta a relação da dor com comportamentos de defesa e a contribuição para a incapacidade funcional, auxiliando os clínicos a reconhecer sinais destes comportamentos defensivos na prática, além de fornecer estratégias para prática clínica, destacando as abordagens que podem ser utilizadas, como a educação em neurociência da dor e as terapias de exposição. Dessa maneira, é possível fornecer um guia para facilitar a implementação desses conceitos na prática clínica para a abordagem de pessoas com dor musculoesquelética crônica, ajudando os clínicos a fundamentar as teorias de aprendizado do medo e evitação no contexto da dor e a lidar com fatores psicossociais dos pacientes que apresentam associação entre dor e movimento.

CONCLUSÃO: O medo relacionado à dor e os pensamentos catastróficos influenciam na intensidade da dor e na incapacidade funcional. O reconhecimento da dor dentro do contexto multidimensional auxilia no estabelecimento de abordagens direcionadas. As abordagens cognitivo-comportamentais baseadas em terapia de exposição têm como enfoque o olhar para além das estruturas do corpo.


Adaptação psicológica, Dor, Dor crônica, Dor musculoesquelética, Medo, Terapia por exercício


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