Physical activity, fear avoidance, and chronic non-specific pain: A narrative review

Background: Chronic non-specific pain (CNSP) and physical inactivity have become increasingly prevalent in the United States; however, the associations between the two remain unclear. The lack of clarity may be due to the presence of a third variable, the individual's pain coping strategy. Objectives: We had three specific aims. 1) To review the associations between fear-avoidance beliefs and behaviors, and levels of physical activity and disability. 2) To review the theoretical mechanisms behind chronic non-specific pain and the potential mediating role of physical activity. 3) Finally, to report the most commonly recommended interventions for fear-avoidant individuals suffering with chronic pain. Conclusions: Further investigation is needed to fully understand the associations between physical activity, chronic non-specific pain, and fear avoidant beliefs and behaviors. Precise relationships notwithstanding, there is strong evidence to suggest that physical activity is an integral piece to the chronic non-specific pain puzzle. For this reason, it is incumbent upon clinicians to strongly recommend participation in regular, yet properly progressed, physical activity to chronic non-specific pain sufferers.