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. Author manuscript; available in PMC: 2020 Dec 1.
Published in final edited form as: Neurosci Biobehav Rev. 2019 Oct 14;107:641–655. doi: 10.1016/j.neubiorev.2019.10.007

Figure 2: Proposed key points of contact for stress, overlaid on an adapted version of the fear avoidance model of chronic pain.

Figure 2:

The four points of contact where the HPA axis stress response is argued to interact with threat learning and pain are: [1] Stress may bias our system into perceiving a stimulus or situation with actual or potential tissue damage as highly threatening by increasing attention to the threat and optimizing threat-processing. [2] Pain-related distress (e.g., catastrophizing, fears) may facilitate the activation of the HPA axis stress response, while an HPA axis stress response may also affect aspects of the pain experience. [3] Stress may bias towards inflexible, rule-governed behavior by compromising value-based, flexible goal-directed behavior. [4] Stress may further modulate threat learning. Fear avoidance model adapted from Vlaeyen and colleagues (2016)