Excessive Generalization Of Fear Avoidance

The Chiropractic Forward Podcast: Evidence-based Chiropractic Advocacy

CF 301:

Excessive Generalization Of Fear Avoidance

Today we’re going to talk about Excessive Generalization Of Fear Avoidance But first, here’s that sweet sweet bumper music

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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. We’re the fun kind of research. Not the stuffy, high-brow, look down your nose at people kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. I’m so glad you’re spending your time with us learning together. Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, drive, smart, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at [e-mail] If you haven’t yet I have a few things you should do.

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You have found yourself smack dab in the middle of Episode #301 Now if you missed last week’s episode , we talked about disc resorptions and pickleball injuries. Make sure you don’t miss that info. Keep up with the class. On the personal end of things….. I just got back from Chicago. Long long long conference. It’s serious on the CEUs folks. 27 hours of classroom sitting. That’s rough. But, I will say, it’s one of the smartest groups of docs you’ll be in the same room with. This conference was put on by the ACCC which is the American College of Chiropractic Consultant in conjunction with the America Board Of Forensic Professionals. Or somethiing like that. It’s the consultants with the forensics So basically you have the coding and compliance specialists with the medicolegal expert witness folks and you have a nice mix of really detail-oriented, research knowledgeable, and super smart people. The presenters at this conference gotta be tough and on their games because these folks are smart and, for the most part, know what the heck they’re talking about. I wouldn’t present to them. Lol. Anyway, one of my buddies, David Graber, presented and did a great job. He was from 8-10 on a Saturday afterr we all stayed out a little too late but he was full of energy and did a great job keeping eveyrone engaged. On Friday a new connection made out there presented. I did not know Dr. Steven Brown from Gilbert, AZ before this conference but we got to spend some quality time getting to know each other this weekend. It was funny how we met. I was in the elevator speaking to someone, I don’t remember who….and this voice from behind be goes….”Hey, aren’t you that chiropractor with the podcast?” Not thinking anyone ever listens to my podcast, I was surprised and just said, “Yeah….I have a podcast!” He said, “I recognized your voice!” So, that was Dr. Steven Brown. Lol. Turns our Steven was a presenter at the conference and was talking about when it is actually possible for chiros to cause strokes from SMT and how we can potentially avoid the pitfall. Great talk, plenty of discussion and interaction and he knows his stuff. No doubt. I got the opportunity to hang out with a friend and quasi-mentor of mine, Dr. James Lehman of the University of Bridgeport. I can’t say enough about Jim. He’s just a special guy and a great friend to me that I very much value. My buddy, Ben Fergus, who lives in Chicago, came down to visit me and meet Dr. Graber and Dr. Lehman. So, basically, a trip that I was not looking forward to at all turned into a great trip with lots of new connections made along the way. I don’t like classrooms filling up any of my weekends but this thing turned out A-OK. If you’ve ever throught about a Diplomate in Forensics, I have some advice. Get the Neuromusculoskeletal Medicine Diplomate at 300 hours through the University of Bridgeport like I did. Then, for only 100 extra hours, you can get the Forensics Diplomate. Then with both of those in your pocket, you’ll be well-positioned to be a medicolegal expert witness. If you had told me 5 years ago that I would have a Diplomate, I would have told you that you need to quick smoking the Devil’s lettuce. Now, sitting here in 2023, I am double board certified with two Diplomates. It’s weird how things change and interests change. I was in a hurry and I loved the Neuromusculoskeletal information so much that I burned through the course in 6 months and you can too. For the most part, none of you are any busier with business and life than I am. I promise. That forensics diplomate probably only took me roughly 3 months to complete. If you’d like any information on them, I’ll put the links in the show notes here. Just go to episode #301 at chiropracticforward.com and check it out. https://www.bridgeport.edu/academics/programs/hs-postgrad-programs/orthopedics-neuromusculoskeletal-medicine https://www.acatoday.org/aca-membership/aca-specialty-councils/council-on-forensic-sciences/ Since it’s a little long, we’re just going with one paper this week. It’s called, “Excessive generalization of pain-related avoidance behavior: mechanisms, targets for intervention, and future directions” by Vandael et. Al. and was published in Pain Journal for November 2023 and that’s so hot not a man can hold it! Vandael, Kristofa,b; Vervliet, Bramb; Peters, Madelona; Meulders, Anna,c,*. Excessive generalization of pain-related avoidance behavior: mechanisms, targets for intervention, and future directions. PAIN 164(11):p 2405-2410, November 2023. | DOI: 10.1097/j.pain.0000000000002990 When you have chronic pain, it is natural to want to avoid activities that you think will cause pain. However, if you avoid too many activities, it can make your pain worse and lead to disability. One reason why people with chronic pain avoid activities is because they fear that those activities will cause pain. This fear is often based on past experiences of pain. However, the fear can sometimes spread to activities that are unlikely to cause pain. This is known as overgeneralization of pain-related fear. Overgeneralization of pain-related fear is a key feature of chronic pain disability. There are a number of things that can be done to reduce overgeneralization of pain-related fear, including:

• Learning about pain and how it works
• Gradually exposing yourself to activities that you fear will cause pain
• Identifying and changing the negative thoughts and beliefs that contribute to your avoidance behavior
• Learning to accept your pain and focus on living a meaningful life despite your pain

There are a few potential intervention targets to reduce overgeneralization of pain-related avoidance:

• Competing goals: Encouraging people to pursue valued goals, even if it means experiencing some pain, can help to weaken the fear-avoidance relation.
• Perceptual accuracy: Training people to more accurately perceive their movements can help to reduce generalization, as people are less likely to avoid activities that they know are safe.
• Positive affect: Inducing positive affect can help to inhibit fear from spreading to novel safe stimuli and may also increase willingness to approach fear-evoking stimuli.

Other potential intervention targets include executive functions such as working memory and attentional control, and anxious traits such as anxiety, sensitivity, and intolerance of uncertainty. Future research on overgeneralization of pain-related avoidance should focus on:

• Establishing the diagnostic and predictive validity of paradigms developed to study generalization of avoidance behavior in pain research.
• Testing experimental interventions to reduce overgeneralization in both healthy subclinical and clinical samples.
• Investigating the role of social factors in generalization.
• Examining observational and instructed learning as mechanisms of generalization.
• Conducting preventive trials in the acute pain stage.
• Translating experimental interventions into practice to test for clinically relevant improvements.

This research is important to inform and strengthen evidence-based treatment for chronic pain. All of this is just building on what we’ve been learning in the last 5-10 years with regard to pain. Fear avoidance is huge. We must address it before de-conditioning sets in. Hurt doesn’t equal harm Movement at the joint and at the global level is healing, it improves proprioceptive input, it clears up a muddied and blurry neural map of our joints and our movements, it has an effect on neuroplasticity, and it increases our confidence in movement while lowering our overall pain levels. So let’s get our patients moving as quickly as we can responsibly and appropriately. Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. Store Remember the evidence-informed brochures and posters at chiropracticforward.com.

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms. We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference. Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website

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