Abstract：
Pain-related fear (PRF) can be a significant factor contributing to the development and maintenance of pain-related disability in individuals with persistent pain. One treatment approach to target PRF and related avoidance behavior is exposure in vivo (EXP). EXP has a long history in the field of anxiety, a field that is constantly evolving. This Perspective outlines recent theoretical advancements and how they apply to EXP for PRF, including suggestions for how to optimize inhibitory learning during EXP; reviews mechanistic work from neuroimaging supporting the targeting of PRF in people with chronic pain; and focuses on clinical applications of EXP for PRF, as EXP is moving into new directions regarding who is receiving EXP (eg, EXP in chronic secondary pain) and how treatment is provided (EXP in primary care with a crucial role for physical therapists). Considerations are provided regarding challenges, remaining questions, and promising future perspectives.
For patients with chronic pain who have elevated pain-related fear (PRF), exposure is the treatment of choice. This Perspective highlights the inhibitory learning approach, summarizes mechanistic work from experimental psychology and neuroimaging regarding PRF in chronic pain, and describes possible clinical applications of EXP in chronic secondary pain as well as in primary care.
For patients with chronic pain who have elevated pain-related fear (PRF), exposure is the treatment of choice. This Perspective highlights the inhibitory learning approach, summarizes mechanistic work from experimental psychology and neuroimaging regarding PRF in chronic pain, and describes possible clinical applications of EXP in chronic secondary pain as well as in primary care.
摘要：
疼痛相关的恐惧（PRF）可能是导致持续疼痛个体疼痛相关残疾发展和维持的重要因素。靶向PRF和相关回避行为的一种治疗方法是体内暴露(EXP)。EXP在焦虑领域有着悠久的历史，一个不断发展的领域。本观点概述了最近的理论进展以及它们如何应用于PRF的EXP，包括如何在EXP期间优化抑制性学习的建议;回顾神经影像学支持PRF在慢性疼痛患者中靶向的机制工作;并侧重于EXP在PRF中的临床应用,随着EXP进入关于谁接受EXP的新方向(例如，慢性继发性疼痛的EXP）以及如何提供治疗（初级保健中的EXP对物理治疗师至关重要）。提供了关于挑战的考虑，剩下的问题,和有前途的未来前景。
对于疼痛相关恐惧（PRF）升高的慢性疼痛患者，暴露是治疗的选择。这种观点强调了抑制性学习方法，总结了实验心理学和神经影像学关于慢性疼痛中PRF的机械工作，并描述了EXP在慢性继发性疼痛以及初级保健中的可能临床应用。
对于疼痛相关恐惧（PRF）升高的慢性疼痛患者，暴露是治疗的选择。这种观点强调了抑制性学习方法，总结了实验心理学和神经影像学关于慢性疼痛中PRF的机械工作，并描述了EXP在慢性继发性疼痛以及初级保健中的可能临床应用。
