Overcome the Fear Avoidance Cycle in Chronic Pain

Overcoming the Fear Avoidance Cycle

As people, we do all we can to avoid unnecessary pain. But this can quickly go too far when we fall into the fear avoidance cycle. While this is a normal response from the brain, it is also a stumbling block to solving and overcoming chronic pain.

What Does it Look Like?

Say you were to bend forward and try to pick something heavy up, and it set off a terrible pain in your back. If you then start to avoid the cause of that pain, it sets up a fear avoidance cycle.

The next time you go to bend, the threat of that terrible pain turns on a fear reaction inside you. In your brain, the amygdala sets of a fight or flight response. Fear grips you and as you start to bend, your stomach lurches, your mouth dries, your heart beats faster, and everything inside you screams, “Don’t do this! It’s too dangerous.”

So then, you don’t. You stop bending forward.

This powerful cycle continues and every time you start to move forward, the fear response turns on. This is a form of self-preservation coming from deep in your brain. The problem is, it becomes an overreaction that has far-reaching consequences for your life.

Progression of Fear-Avoidance Cycle

Because you fear to bend forward, you’re now in a hyper-vigilant mode. You may go to bend forward a little, and the survival part of your brain says, “No, you can’t do that.” This is because fear is coursing through your body and everything’s hyped up. You find you can only bend 20 degrees before the fight or flight reflex kicks in.

This restricted movement starts to interfere with a vast number of things in your life. It means you can’t put your shoes on, you can’t bend down to pick things up, you can’t dress easily. Very quickly, your pain starts to trim the edges of your life.

Now you find that you’ve become quite disabled. The one episode when you had an awful pain now turns on this overwhelming fear which stops you from doing a whole range of things in your life. And a lot of those things are activities that you enjoy or things you have to do in your normal life.

What Does This Mean for Me?

When researchers started to look at the tie between fear and pain, they found that it was probably the most powerful predictor in turning an acute pain into a persistent chronic pain. Fear avoidance turns to hyper-vigilance and then catastrophizing completes the cycle.

Catastrophising means that every time you go to make a movement, you’re imagining the worst. This makes the pain become more and more generalized. Instead of not being able to move forward, now you can’t move back, you can’t twist, you can’t drive your car–and the list goes on.

The thing to takeaway here is that the one episode of very significant pain evokes fear, which then powers down the thinking part of your brain. In this way, fear of pain will intrude until it takes over your life–that’s powerful.

Once you recognize how powerful fear is, you will also recognize the power of Reactive pain, where the expectation of pain amplifies it.

For example, one lady who hurt her back bending forward thought “I just know that because this pain has happened, it’s going to happen again. Because it happened now in the middle of winter when it’s freezing and there’s snow on the ground, it will happen again in the summer. And so I can’t go on my summer holiday.”

That’s actually not correct. The summer is going to be six months away. In six months, you can work on and sort out a lot of your chronic pain issues.


We are self-healing and self-regenerating organisms. We may have some pain, but disability is what stops you from doing things. When you’re able to confront the fear that’s become paired with the pain, the pain loses its power to control your life.

Once you can down-regulate your pain system and turn down amplified pain, you can find the true limits of what your body is capable of. Then you can gradually increase what you do until you’re able to live your life normally again. The pain may not go away 100%, but you’ll be able to move on with your life, and you’ll no longer be afraid.

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