November 2013

SIG Officers
Mari Lundberg (Sweden): Chair
Rob Smeets (Netherlands): Past Chair
Romy Parker (South Africa): Secretary
Anne Söderlund (Sweden): Treasurer
Monika Hasenbring (Germany): Chair, Scientific Committee
Beverly Bolton (South Africa): Member

IASP Council Liaison
Michael Nicholas

Timely topics in pain research and treatment have been selected for publication, but the information provided and opinions expressed have not involved any verification of the findings, conclusions, and opinions by the International Association for the Study of Pain (IASP)® or the SIG on Pain and Movement. Thus, the opinions expressed in this newsletter do not necessarily reflect those of the Association, the SIG, or the Officers and Councilors of either IASP or the SIG. No responsibility is assumed by the Association or the SIG for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Because of the rapid advances of medical science, the publisher recommends independent verification of diagnoses and drug dosage.

Message From the Chair

Dear Friends,

On my way back from the EFIC conference in Florence the other day, I sat next to an old woman at the airport. She saw the book I was reading "Pain in the humanities" (edited by Lisa Folkmarson Käll) and we started to talk. One of the most fascinating things about pain is that everbody has a relation to pain and it touches something very existential in all of us. The same can be said for movement. After three hours I had learned more from the old woman about pain than any book or course could ever teach me. There is so much wisdom in every story told to us, the challenge is to bring that wisdom into clinical practice and to research questions in order to bring the pain into motion.

According to our mission statement we, as a SIG, are constantly working to bring the benefits of moving while in pain into action. With that aim as our goal, we work through an education committee and a research committee.

"Embrained, embodied and embedded" is the theme for the proposal submitted for the Pain, Mind, Movement V Official Satellite Symposium of the 15th World Congress on Pain, to be held in Argentina in October, 2014. International keynote speakers have already accepted invitations to speak should the proposal be accepted. The rationale behind the theme is that the close relation with movement will be covered from various perspectives.

Our future plans for 2015 include arranging a pain conference in South Africa with the aim to learn from one of the developmental countries what the issues are about pain in relation to mind and movement.

We are constantly looking for ways to keep an active dialogue. With this in mind we have created a twitter account.

Follow us on twitter: twitter.com/Pain_Mind_Movem (@Pain_Mind_Movem) – remember to # us if you tweet something pain related! Many members were tweeting during EFIC 2013 – a great way to keep track of breaking news!

In 2014 we will be holding our biannual elections. Are you interested in getting more involved or contributing in some way? Or do you have some interesting news to share for the newsletter? Please do not hesitate to contact us to keep us all moving forward.

Warm Regards,
Mari Lundberg
PhD, Associate Professor


News from our Research Corner

In this edition of the newsletter we present an article from Jo Nijs and colleagues. Jo is one of our active members from Belgium. He works as a clinician and researcher in physiotherapy and holds a PhD in rehabilitation science. Here Jo writes on the clinical implications of fear of movement in chronic fatigue syndrome (ME) and fibromyalgia.

The fear of exacerbating pain and fatigue following physical activity in chronic fatigue syndrome and fibromyalgia: State of the art and implications for clinical practice

The fear-avoidance model of pain-related fear of movement and its role in contributing to and sustaining chronic pain disorders has attracted the long-term interest of researchers and clinicians in the field of pain, mind and movement. This includes researchers and clinicians working with patients fulfilling the diagnostic criteria for chronic fatigue syndrome and fibromyalgia (CFS & FM).

CFS and FM are severely disabling and largely overlapping disorders, both characterized by chronic fatigue, chronic widespread pain, concentration difficulties and physical inactivity. Both disorders are characterized by the same underlying mechanism: signs and symptoms result from the hyperexcitability of the central nervous system (or central sensitization) [1-3]. Severe exacerbation of symptoms following physical activity (including exercise therapy) is characteristic for CFS and FM. These exacerbations make it understandable for people with CFS and FM to develop fear of performing body movement or physical activity, and consequently avoidance behavior towards physical activity.

Yet in despite of our empathy for the patients' avoidance behavior, a number of studies have now examined whether such avoidance behavior is maladaptive for patients with FM and CFS. Recently, the research examining the fear-avoidance model in CFS and FM has been reviewed by researchers from the Pain in Motion research group (www.paininmotion.be) [4]. As the Pain in Motion team has published several studies on the topic themselves, they collaborated with Mari Lundberg on this review. Mari provided her unbiased expert opinion on the fear avoidance model in chronic pain to allow for a more balanced presentation of the available research findings, and to guarantee presentation in line with the most up-to-date developments of the fear avoidance model.

The specific aims of the literature review were to review what measures are available for measuring fear of movement and avoidance behavior; the prevalence fear of movement and avoidance behavior towards physical activity; and the therapeutic options when fear of movement and avoidance behavior towards physical activity is present in patients with CFS and FM. The review revealed that fear of movement and avoidance behavior towards physical activity is highly prevalent in both the CFS and FM populations. The fear of movement and avoidance behavior towards physical activity is related to various clinical characteristics of CFS and FM, including symptom severity and self-reported quality of life and disability [4]. It appears to be crucial for treatment (success) to identify CFS and FM patients displaying fear of movement and avoidance behavior towards physical activity to delivery targeted treatment.

For the clinician, the critical question is: "Which treatments are able to decrease avoidance behavior towards physical activity in FM and CFS?" Individually-tailored cognitive behavioral therapy plus exercise training, depending on the patient's classification as avoiding or persisting, appears to be the most promising strategy for treating fear of movement and avoidance behavior towards physical activity in patients with CFS and FM [4]. Indeed, not all patients with CFS or FM have fear of movement and avoidance behavior towards physical activity; many patients with CFS and FM display persistence behavior. Compared to fear avoidant CFS or FM patients, persisting CFS and FM patients require cognitive restructuring, pacing activity self-management and acceptance-based approaches rather than operant behavioral interventions like graded exposure or graded exercise therapy. Using these tailored approaches of combining exercise with cognitive restructuring appears to be the most effective method to rehabilitate patients with CFS and FM.

Jo Nijs
Departments of Human Physiology and Physiotherapy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel

E-mail: Jo.Nijs@vub.ac.be
Website: www.paininmotion.be


"Fear of movement and avoidance behavior towards physical activity in chronic fatigue syndrome and fibromyalgia: State of the art and implications for clinical practice" Nijs J, Roussel N, Van Oosterwijck J, De Kooning M, Ickmans K, Struyf F, Meeus M, and Lundberg M. Clinical Rheumatology 2013; 32:1121-1129.


1. Staud, R., Evidence of involvement of central neural mechanisms in generating fibromyalgia pain. Curr Rheumatol Rep, 2002. 4(4): p. 299-305.
2. Vierck, C.J., Jr., Mechanisms underlying development of spatially distributed chronic pain (fibromyalgia). Pain, 2006. 124(3): p. 242-63.
3. Nijs, J., et al., In the mind or in the brain? Scientific evidence for central sensitisation in chronic fatigue syndrome. Eur J Clin Invest, 2012. 42(2): p. 203-212.
4. Nijs, J., et al., Fear of movement and avoidance behaviour toward physical activity in chronic-fatigue syndrome and fibromyalgia: state of the art and implications for clinical practice. Clin Rheumatol, 2013. 32(8): p. 1121-9.


15th World Congress on Pain

See you in Buenos Aires 2014!

We would love to hear from our members! Please submit your contributions, ideas, and comments for the newsletter to the SIG secretary: romy.parker@uct.ac.za


International Association for the Study of Pain, 1510 H Street NW, Suite 600, Washington DC 20005–1020 USA
Tel +1.202.524.5300 - Fax +1.202.524.5301 - Email IASPdesk@iasp-pain.org