I have a picture that portrays my view of fear-avoidance:My perspective is that, in a good many of cases, everything is controlled by pain intensity. Some articles try to avoid the issue by saying “they just thought they were in a lot of pain” and that in itself was a psychological problem (oh brother).
Now it appears controlling the pain with opioids can facilitate exercise rehab without having to tell the patient to suck it up and say “It’s just pain”.
Analysis of rehab problems seem to boil down to level of pain and “fear avoidance”. I always felt the latter was no where near as large as pain level despite psychologically biased articles that attempt to shirt that issue. Now a German article has shown that exercise rehab is improved by the addition of opioids without having to deal with fear avoidance at all!
Orthopade. 2008 Sep 21. [Epub ahead of print]
Effective pain relief facilitates exercise therapy : Results of a multicenter study with controlled-release oxycodone in patients with movement pain. Teske W, Anastasiadis A, Krämer J, Theodoridis T.
“Physical [exercise] therapy was practicable in many patients only after implementation of a therapy regime with controlled-release oxycodone. Quality of life improved significantly under therapy with oxycodone, and the impairment of different aspects of life decreased by 50%….Pain intensity fell by an average of 65% within the first 4 weeks.”