Fear Avoidance and Chronic Pain: How Avoiding Pain Can Make It Worse

The Secret to Living Longer Might Be Simpler Than We Think

15/10/2026

Six Months Post-Op: I’ve Stopped Thinking About My Back

Published by Maria Polymeneas on 06/09/2026

Back Surgery Recovery at Six Months - Life Gets Bigger

Why I Stopped Thinking About My Back

This is the eighth and last in a series of "Surgery, Function, and the Brain" blogs on Maria's recent surgical experience. Her previous blogs are:

Back surgery recovery is not always marked by a zero pain score or the complete disappearance of every neurological symptom. Six months after surgery, the biggest change for me is simpler—and probably more important: I have completely stopped organising my life around my back.

I know. I said my Week 6 post was going to be my last back-surgery blog until the 12-month mark.

Apparently, I lied.

It is now six months since my back surgery at the end of February 2026, and I thought this was worth an update because something quite significant has happened.

I’ve stopped thinking about my back

And, for me, that may be one of the most important markers of recovery.

At six weeks post-op, I was back at work full time with no restrictions. I was already planning kayaking, skiing and white-water rafting, while unsuccessfully trying to convince my surgeon and my partner that my recovery absolutely required the purchase of a leg press.

Six months later, things have progressed.

Including, I am delighted to report, THE HOME GYM.

The Home Gym Campaign Has Been Won

Persistence pays off. I have finally convinced my partner that the bottom room of the house needs to become a proper home gym.

Yay!!!

I have picked out the equipment and am already mentally redesigning the room.

There is probably a rehabilitation lesson here about persistence, goal setting and behavioural activation.

But mostly, I am just pleased that I won.

More importantly, over the past month I have been moving furniture, reorganising things and generally doing normal physical tasks without stopping beforehand to think:

“Should I do this?” That is a huge change.

That change also connects with what psychologists call fear avoidance—when concern about pain or re-injury gradually begins determining which movements or activities we are prepared to attempt.

Earlier in recovery, movement was something I consciously considered (at least most if the time). How much should I lift? Should I pace myself? Am I doing too much? Now I generally just get on with it.

That is what returning to function eventually needs to look like.

The Neurological Symptoms Haven’t Completely Gone

I still have neurological symptoms. At six weeks, my surgeon had explained that nerve recovery can continue over a much longer period, potentially across the following 12 months.

At six months, symptoms remain. Perhaps they will improve further. Perhaps some will remain. Increasingly, however, I am accepting that I may need to live with residual neurological sensation.

And strangely, that has become much less important than it once seemed.

One of the most interesting things I have noticed is this: When I am busy or distracted, I often don't notice the symptoms at all.

Why Stress and Attention Can Turn Up the Volume

When I am stressed, I notice them much more.

That doesn't mean the symptoms aren't real.

It illustrates something we talk about constantly in pain psychology: what we notice in our body is influenced by attention, context, stress and nervous-system arousal.

When the brain is busy engaging with work, conversation, cooking, exercise or something enjoyable, bodily sensations can move into the background.

When we are stressed, tired, worried or monitoring our body, those same sensations can suddenly become much more prominent.

The sensation hasn't necessarily changed as dramatically as our experience of it has. Attention can act a little like a volume control.

I have written previously about the way an overprotective nervous system can become highly responsive to stress, context and perceived threat. See my blog When Your Brain is Basically a Bengal Cat.

Maria sitting at an outdoor table feeding ice cream to our meerkats Arnie and Essie

Symptoms Don't Have to Be Zero Before Life Restarts

This is probably the biggest lesson from the past six months.

Recovery does not necessarily mean:

Pain = 0

Neurological symptoms = 0

Everything feels exactly as it did 10 years ago!

Sometimes recovery means: The symptoms are still there, but they are no longer making the decisions. That distinction is incredibly important.

If I waited until every strange sensation disappeared before returning fully to life, I could potentially spend years monitoring my legs and feet, wondering whether today feels different from yesterday.

Instead, my attention has increasingly shifted outward. Work, Home, Exercise, Cooking, Friends, planning adventures, and buying gym equipment.

Life has become bigger again, while the symptoms have become smaller within it.

An Eight-Hour Cooking Experiment

I have continued to need no pain medication because I've had very little back pain. Last weekend was an exception.

We had a party, and apparently, I decided the appropriate way to prepare was to start cooking at around 7 am and remain on my feet until approximately 10 pm.

I cooked for about eight hours in total and barely sat down all day. By the end of it, my back was understandably uncomfortable.

Was my immediate thought: "Oh no, I've damaged my back!"

No.

My thought was essentially: "Well, that was a ridiculous amount of standing when I haven't done that for ages."

There is an important difference between those interpretations.

I hadn't suddenly become injured again. I had simply asked my body to do considerably more than it had recently been accustomed to doing.

I was sore. And a day later, I had bounced back. That is exactly the type of experience that helps rebuild confidence in the body.

Do something demanding - Notice some discomfort – Recover - Move on.

Next Stop: The Ocean

The next test will be considerably more fun.

Now that Adelaide is heading into warmer weather, I am planning to get back out ocean kayaking within the next few weeks. Six months ago, my world involved surgery, restrictions, wound healing, neurological symptoms and figuring out when I could return to work (1 week).

Now I am deciding which gym equipment to buy and when I can get the kayak back into the ocean. That feels like a much better use of my brain.

Maria paddling a red kayak on calm water at Torrens Island as she returns to valued activities after back surgery.

Recovery Becomes Successful When It Becomes Boring

We often look for dramatic evidence that someone has recovered.

A scan - A pain score - A medical clearance - A major physical achievement.

But sometimes one of the strongest signs of recovery is much less dramatic.

You stop thinking about the injury. You bend down without analysing it. You move furniture because the furniture needs moving. You stand cooking all day, get sore, recover and don't catastrophise it. You notice neurological symptoms occasionally but don't spend the day checking whether they're still there. You make plans based on what you want to do rather than what your back might allow you to do.

The injury gradually stops being the main character.

Key Takeaways

Recovery does not necessarily mean zero symptoms. Function, confidence and participation can improve even while some symptoms remain.
Attention matters. Bodily sensations can become more noticeable when we are stressed, worried, tired or closely monitoring them.
Symptoms are always real even when their intensity changes with context. Stress and attention influencing an experience does not make the experience imaginary.
Discomfort after doing more than usual does not automatically mean re-injury. Sometimes the body has simply been asked to do something it is no longer accustomed to doing.
Confidence is rebuilt through experience. Doing something, tolerating the response, recovering and moving on can gradually restore trust in the body.
Meaningful activity matters. Work, exercise, cooking, relationships, recreation and future plans can become part of rehabilitation rather than something postponed until every symptom disappears.
The goal is bigger than pain reduction. Ultimately, successful rehabilitation is about restoring participation in a meaningful life.

The underlying principles are consistent with contemporary pain literature: the Australian Pain Society specifically discusses pain education, fear, avoidance and the importance of function, while IASP describes avoidance, activity and psychological processes as important influences on disability and recovery.

The goal is not simply to reduce pain, but to increase participation in a meaningful life.

Summary

Back surgery recovery has taught me that successful recovery does not necessarily mean having no symptoms at all. Six months after surgery, I still experience some neurological sensations, and they become more noticeable when I am stressed or paying close attention to them.

The important change is that they are no longer determining what I do.

I am working, moving furniture, cooking for hours, setting up a home gym and planning to return to ocean kayaking. My attention has increasingly shifted away from monitoring my body and back towards living my life.

Recovery, for me, has become less about asking “Have all my symptoms disappeared?” and more about asking “Am I doing the things that matter to me again?”

And increasingly, the answer is yes.

Want to Learn More?

Recovery after injury or surgery is not only about what is happening in the tissues. Confidence, expectations, stress, attention, fear of re-injury and the way we respond to symptoms can all influence how quickly life begins to expand again.

At Paragon PsychConnect, our psychologists work with people experiencing persistent pain, post-injury difficulties and reduced confidence in movement to help them:

understand the relationship between pain, stress, attention and the nervous system;
distinguish between protecting an injury and becoming unnecessarily restricted by it;
reduce fear and catastrophic interpretations of pain or physical sensations;
rebuild confidence through gradual return to meaningful activity;
develop realistic approaches to pacing and flare-ups; and
shift the focus of rehabilitation from simply reducing symptoms to increasing function and participation.

If pain, fear or uncertainty has started determining what you do, psychological pain management can form one part of a broader multidisciplinary rehabilitation approach.

Our Persistent Pain Program uses an integrated psychological, neuroscience and rehabilitation approach to improve confidence, function and participation. Individual psychological support is also available. The program page currently outlines assessment, pain education, practical skill development, graded re-engagement and coordination with the person’s wider treatment team.

Take the Next Step

If pain, persistent symptoms or fear of re-injury are making your life smaller, our psychologists can help you rebuild confidence, function and participation. Register your interest in our Persistent Pain Group Program, or give Angela a call on (08) 7095 3484, or send us a message. You can also come and see a psychologist one on one.

Explore More Paragon PsychConnect Blogs about Pain

Read more of our mental health blogs about pain.

If you haven't read Maria's series of "Surgery, Function, and the Brain" blogs you start from the beginning with Starting This Journey .

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Disclaimer

This blog provides general information only and is not a substitute for individual psychological or medical advice.

Treatment should be individualised and coordinated with relevant medical and allied health professionals. New, unexplained or substantially worsening pain should be medically assessed before beginning a new activity program.

Maria Polymeneas

Maria works with adolescents and adults in managing a variety of health conditions. She has over 3 decades of experience as a psychologist with her key areas of interest within the pain management, anxiety and capacity building arenas. She is one of the few expert psychologists in Australia in pain management. Maria is collaborative and practical in her approach to therapy and enjoys complex problems.

Back Surgery Recovery at Six Months - Life Gets Bigger