|3.||What impact does fear of pain have on AS and which, if either, is the more basic fear? Related to this, it is vital to confirm whether high AS precedes persistent pain conditions or if it develops as a consequence of painful experiences.|
|4.||Are high levels of AS associated with analgesic abuse and dependency, guarding (i.e., a defensive posture or motion) or inactivity, and overreliance on others? How can we assess the impact of AS on physical impairment?|
|5.||How do the findings obtained from samples of patients with chronic musculoskeletal pain generalize to those with other pain syndromes (e.g., headache, gastrointestinal pain, temporomandibular joint dysfunction)?|
These are but a few salient questions that remain unaddressed at present. As a final point, it is important to consider how the studies reviewed in this chapter impact on the generally accepted conceptualization of AS. The literature indicates that the experience of pain sensations, when accompanied by negative expectancies and persistent avoidance behaviors, can lead to a vicious cycle that mires an individual into a chronic course of pain and suffering (Figure 12.1). The experience of pain, in addition to its influence on affect and behavior, often provokes considerable activity in the autonomic, visceral, and musculoskeletal systems. In other words, pain can provoke somatic arousal akin to anxiety. Consequently, it may be that people come to initially fear pain because they fear the consequences of the affective and somatic arousal that it produces ( Asmundson & Taylor, 1996). Alternatively, AS may denote a fear of somatic sensations and perturbations that may not necessarily be identified with anxiety (also see Cox, Kuch, Parker, Schulman, & Evans, 1994). That is, the ASI may be tapping fear of anxiety symptoms as well as fears of other atypical, unpredictable, or aversive somatic sensations and associated emotional reactions. Therefore, the AS construct may reflect a set of fears that is more basic than fear of anxiety. This is an important theoretical question that warrants further attention. Indeed, Taylor ( 1995) previously noted that further research is needed to determine whether AS can be logically reduced to more basic fears. One likely candidate is the fear that is associated with a sensory and emotional experience that many humans spend a considerable amount of time trying to avoid -- pain.
The author acknowledges the helpful comments of Heather D. Hadjistavropoulos, PhD, G. Ron Norton, PhD, and Peter J. Norton, MSc.