Catastrophic interpretations of pain as a signal of impending threat usually elicits fear, and escape or avoidance behavior. According to the fear-avoidance (FA) model [8] these behaviors may initially be adaptive, but they paradoxically worsen the situation when engaged in later on. Avoidance behavior may fuel pain, disability and depression. A particular strength of the FA model is that it generates testable hypotheses about the association amongst its constituent elements. Although correlational studies have accumulated, yet few studies have used prospective designs. Wideman et al.[9] are to be complimented with their elegant study testing the above mentioned ‘‘pain catastrophizing–fear and avoidance–disability–depression” sequence, in a sample of high risk individuals with work-related musculoskeletal pain receiving a cognitive-behavioral treatment aimed at return to work. Not only are their findings important, we also appreciate their thoughtful reflections as well as those expressed by Nicholas in the associated editorial [4]. Given that aversive stimuli may activate a network of fear processes simultaneously, and the bi-directional relationship between safety behaviors and threat appraisals, do we need a different methodology such as path analytic analyses [1]? We think that these are pertinent questions that need to be scrutinized.

Indeed, we are not there yet. The FA model was never meant to be a final model to be unconditionally embraced or falsified. Rather, the FA model is a theory-based heuristic in search for a better understanding of the dynamics of pain disability. Sophisticated studies, such as the one by Wideman et al., call for refinements and extensions of the FA model. We are pleased to see that the model is evolving, and steadily growing out of its infancy. We would like to take the opportunity to broaden the horizon, and call for an expanded affective-motivational perspective of pain-related fear, with a prominent focus on behavior in context. Pain-related fear may elicit different behaviors depending on current goal context, and vice versa, outwardly similar behaviors may be driven by different motivational strategies [5, 7]. Such an affective-motivational perspective will initiate a next generation of studies addressing new questions including the following (1) can higher order goals inhibit the primary goal to protect the integrity of the body by hypervigilance, escape and avoidance behavior eg [3, 5]?(2) What is the effect of life goal interference and goal conflict on pain-related fear eg [2]?(3) Can cognitive-behavioral therapies aimed at the re-evaluation of major life goals help countering fear-driven and disabling avoidance behavior eg [6]? The search continues...