How do fear and avoidance of back pain cause chronic back pain?

Fear and avoidance of back pain is a learned behavior. While many patients suffering from back pain continue seeking cures and temporary relief wherever they can find them, most will stop the search and learn to live with pain. Their pain, their fearful expectations, and their avoidance form a psychological chronic pain cycle.

Pain evokes fearful expectations. Fearful expectations promote avoidance. Avoidance causes additional tightness and pain in joints and muscles.

Additional tightness and pain evokes more fearful expectations. The next thing you know, around and around you go.

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