Kinesiophobia and Chronic Pain
It is only natural to avoid activities that cause us pain, but it is important to endure some kinds of discomfort if they help us achieve a more pain-free life in the long run. One of the key examples of this is rehabilitation after an injury or illness that may be painful during the sessions but promise to lessen overall pain and improve quality of life.
There are many potential obstacles to completing pain treatment, including overwhelming pain and immobility, but there is also another factor that often gets less attention—fear. Many people with chronic pain issues avoid activities that may produce pain, and eventually this psychological avoidance may evolve into a complex known as kinesiophobia.
Kinesiophobia is technically defined as a fear of movement. Many chronic pain sufferers who are also subject to kinesiophobia may experience more intense pain from their condition because their joints and musculature stiffen or from cognitive accentuation of pain.
What Is Kinesiophobia?
It is fairly common for people in pain to avoid rehabilitative exercises out of a reluctance to endure the discomfort that it entails, but when this avoidance becomes pathological, it is labeled as kinesiophobia. Many people with chronic pain conditions develop this kind of avoidance behavior in an effort to minimize exposure to additional pain or re-injury.
Kinesiophobia is most commonly found among patients with long-term pain conditions like lower back pain in which movement can produce potent pain symptoms or even re-aggravate an injury. In most circumstances, although there is a reasonable chance of pain, there is only minimal risk of worsening an existing injury or condition. That is why kinesiophobia is defined as an excessive or irrational fear of movement.
One of the most common tools for diagnosing and evaluating the level of kinesiophobia is the Tampa Scale of Kinesiophobia or TSK. The TSK consists of 17 self-reporting questions that assess levels of fear, pain catastrophizing and disability. Your physician or physical therapist will compile the answers and determine the severity of your kinesiophobia.
The Effects of Kinesiophobia
Kinesiophobia may produce a wide variety of physical and psychological effects. The nature and severity of these conditions may depend on a variety of factor including intensity of pain symptoms, duration of pain condition, and access to effective physical therapy.
Among the possible outcomes of untreated kinesiophobia are the following
- Limited range of motion—because kinesiophobia sufferers are unwilling to engage in stretching and strengthening exercises, they often exhibit less range of motion than comparable chronic pain sufferers.
- Distorted motor coordination—many people who fear certain kinds of movement may compensate by adopting an altered motion. This may produce unconventional strain on joint tissue and muscles which can lead to secondary pain or health conditions.
- Pain catastrophizing—one of the greatest challenges in treating kinesiophobia is mitigating symptom intensification. Because the neural pathways that govern fear and pain overlap, fear of pain can make even modest stimuli feel much worse than they actually are.
- Diminished quality of life—due to an almost paralyzing fear of movement, many kinesiophobia sufferers are greatly limited in their ability to perform even the simplest of activities. Limited functionality often leads to diminished independence and even disability which can severely impact quality of life.
- Greater pain—despite trying to avoid more pain by limiting movement, kinesiophobia sufferers often experience more pain due to disuse and disability. Joints and muscles may atrophy and stiffen, making even everyday movements more difficult and painful. This disuse may lead to painful secondary health issues or even re-injury.
How to Treat Kinesiophobia
Treating kinesiophobia can be a complex task. Kinesiophobia is most commonly diagnosed during physical therapy, but it may require a multi-disciplinary approach. Although there may be some physical impediments to performing rehabilitation like swelling, scar tissue or intense discomfort, the primary issue for most kinesiophobia sufferers is the overwhelming fear of impending pain.
There are techniques that a physical therapist may employ to allay this fear, but in certain cases where the kinesiophobia is debilitating, it may be necessary to include a psychotherapist in the treatment. Once the patient is able to manage the pain, then physical therapy can proceed without hindrance.
Some common therapeutic techniques for kinesiophobia include:
- Unentangling pain and injury—one of the core reasons that many patients want to avoid pain is to prevent another injury, but many kinesiophobia sufferers mistakenly associate all kinds of pain with bodily harm. These patients must be educated about how pain is sometimes beneficial; in some cases, it may be necessary to use a therapist to counsel the patient.
- Associate movement with enjoyment—one important way of overcoming fear of movement is to link it with pleasure. This may not actually involve any physical activity; instead, you may work with a health care professional to imagine enjoyable motions like walking on a beach or playing a favorite musical instrument. You should try to imagine every detail of such an activity including joint and muscle movements, so that you can look forward to the actual motion.
- Limited motion—once your therapist thinks you are ready, you can try limited movements. Initially, these should help identify your tolerances for pain. Over weeks or months, this should gradually improve, allowing you to engage in more movement.
- Analgesics—in some cases, it may be appropriate to use pain medications to limit pain symptoms during physical therapy. This drug regime should initially be limited to over-the-counter anti-inflammatory pain medications, but some physicians may resort to prescription opioids if necessary.
- Massage therapy—manual manipulation may prove quite effective for certain kinesiophobia patients. Not only can manual manipulation help resolve scar tissue and tense muscles, but there is a definite euphoria associated with this therapy that can help mitigate any lingering pain and fear.
- Anti-anxiety medications—some patients that suffer from kinesiophobia may improve by taking certain anti-anxiety drugs. The most commonly prescribed include selective serotonin reuptake inhibitors like Paxil or Zoloft, however some physicians may resort to benzodiazepines like Valium which carry greater risks.
Article written by: Dr. Robert Moghim – CEO/Founder Colorado Pain Care
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