Ten weeks of physical-cognitive-mindfulness training reduces fear avoidant beliefs about work related activity

People with chronic musculoskeletal pain often experience pain related fear of movement and avoidance behaviour. The fear avoidance model proposes a possible mechanism at least partly explaining the development and maintenance of chronic pain. It is possible that people who interpret pain during movement as being potentially harmful may initiate a behavioural cycle by generating pain related fear of movement accompanied by avoidance behaviour.


Chronic pain has been defined by the International Association for the Study of Pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in such terms of damage.


It is well known that that occupationally derived musculoskeletal pain is often present in job tasks involving low force, static or quasi static repetitive and monotonous movements.


The recent study carried out by Jay et al (2016) looks at chronic pain of the neck, shoulder, upper and lower back, elbow and wrist in women working as laboratory assistants. The study is addressing both the physical and psychological interactions of chronic pain in the work place.


The study group was divided into 2- Reference group- maintaining current workplace activity initiatives vs Physical- cognitive – mindfulness training group.


The treatment group received a multifactorial intervention comprising of:
• slow joint mobility exercises focussing on precise motor control for the pain affected area
• 4 different strength training exercises with elastic bands
• Cognitive behavioural therapy involving education and counselling about the fear of movement, the positive effects of movement and de-catastrophising pain
• Mindfulness group training over 10 weeks.


Results of the 10 week targeted physical- cognitive- mindfulness intervention indicated significant effects on work related fear avoidance behaviour (FAB) with a reduction of 52% in pain intensity experienced across 6 body regions compared to the reference group.



There was a large correlation most painful body region and work related fear avoidance behaviour (FAB). This suggests that work related FAB are body region specific to the degree of experienced pain, and that by exercising that region with guidance in terms of movement and strength training in addition to pain education and reduced catastrophizing can result in a reduction in threat caused by moving that body part at work.


Mindfulness was not found to significantly reduce stress and pain fear avoidance behaviour in this study.


Kenneth Jay MSc, Mikkel Brandt, Markus Due Jakobsen, Emil Sundstrup, Kasper Gymoese Berthelsen, mc schraefel, Gisela Sjogaard, Lars L Anderson, ten weeks of physical- cognitive- mindfulness training reduces fear-avoidance beliefs about work-related activity- Medicine 2016 95:43


The comments above are the implicit advice of Workplace Physiotherapy. The views expressed are based on current evidence-based research and accepted best practice approaches. Unless otherwise stated, these comments are not the view of WorkCover NSW or any other professional body. No reproduction or forwarding of this advice is permitted without the consent of the author.


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