Second, a reverse pattern was observed for trait PA; that is, low trait PA individuals show a release of fear inhibition
(ie, increased fear of movement-related pain reports) to the safe movement in the beginning of the extinction phase. This effect is not observed for people with ‘‘high’’ levels of PA. Again, the slopes during the course of extinction indicate a continued deficiency in fear inhibition to the safe movement for low TA individuals.
To our knowledge, this is the first study to demonstrate the effect of trait PA on safety learning during
fear extinction.
Third, and even more interestingly, we found that high PA could serve as a buffer for the detrimental effects of
high TA on safety learning during extinction
These findings have at least 3 important implications for clinical treatment of fear of movement-related pain and chronic pain disability. First, patients with high TA should be identified at the onset of the treatment process. Chronic pain patients with high fear of pain do not necessarily score high on TA. Closely related is the distinction between fear and anxiety.4 Whereas specific fear refers to a phasic response to an identifiable imminent threat as is typically observed in ‘‘kinesiophobia’’ (eg, specific movement that is feared because of its association with increased pain), anxiety is a more free-floating and general form of distress in the absence of impending danger (eg, constant fear of reinjuring oneself).4