Table 1.
Future directions.
| Methodology | Research question | Population | Relevance |
|---|---|---|---|
| Experimental paradigms | Do patients generalize their pain-related avoidance more compared with pain-free controls? • Along perceptual and conceptual dimensions? • Along contexts (ie, reduced context modulation)? |
Patients with chronic pain vs. pain free controls | Diagnostic validity paradigm |
| Is more generalization of pain-related avoidance in experimental paradigms associated with reduced functioning in daily life? • At same time point (avoidance generalization as a maintaining factor)? • In future (avoidance generalization as an instigating factor)? |
Patients with chronic pain | Predictive validity paradigm | |
| Does manipulation of hypothesized intervention targets lead to less generalization of pain-related avoidance? • Before avoidance conditioning (modelling prevention)? • Before/between generalization test(s) (modelling intervention)? |
Pain free/subclinical* & patients with chronic pain |
Proof-of-concept/predictive validity paradigm Proof-of-concept/predictive validity paradigm |
|
| Single-case experiments/randomized controlled trials | Improved functioning in daily life after interventions directed at the hypothesized intervention target? • Using prevention or intervention strategies informed by/translated from experimental manipulations (potentially as add-ons to treatments); eg, proprioceptive accuracy training could be implemented in a virtual reality task performed in the home environment; • When matching interventions to specific risk factors (“what works for whom”)? eg, low levels of positive affect may be an indication for positive psychology interventions. |
Patients with chronic pain | Proof of concept |
*
For example, selecting participants (without chronic pain) on specific traits, such as (high) pain-related fear and (low) positive affect. Diagnostic validity refers to the extent that behavior in the paradigm differs between patients and pain-free controls; predictive validity refers to the extent that behavior in the paradigm predicts behavior in daily life—eg, if a manipulation models a therapeutic intervention known to affect behavior in daily life, evidence for a significant effect on behavior in the experimental paradigm contributes to the predictive validity of the paradigm.