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MSK Pain – Musculoskeletal Pain – Positive/Negative Cycle

Pain cycle in MSK Pain

The avoidance model in hip and knee osteoarthritis explains the association between the expectation of pain during activities and the subsequent avoidance of activities, development of muscle weakness and activity limitations [1]. The model also incorporates psychological distress, determining that it’s presence further strengthens the avoidance of activities. Subsequent research has identified strong associations between the components of the model, illustrating the potential for a cycle of decline [2].


1         Dekker J, Boot B, van der Woude LHV, et al.Pain and disability in osteoarthritis: A review of biobehavioral mechanisms. J Behav Med1992;15:189–214. doi:10.1007/BF00848325

2         Holla JFM, Sanchez-Ramirez DC, van der Leeden M, et al.The avoidance model in knee and hip osteoarthritis: a systematic review of the evidence. J Behav Med2014;37:1226–41. doi:10.1007/s10865-014-9571-8