Bernhard Klasen

Pain-related avoidance versus endurance in primary care patients with subacute back pain: psychological characteristics and outcome at a 6-month follow-up.

Summary Data are presented on the concurrent and prospective validity of 4 psychosocial subgroups in subacute low back pain patients, as suggested by the avoidance‐endurance model. ABSTRACT Recent research has found individual differences in back pain patients due to behavioral avoidance vs persistence. However, there is a lack of prospective studies of nonspecific low back pain patients. The avoidance‐endurance model (AEM) suggests at least 3 pathways leading to chronic pain: fear‐avoidance response, distress‐endurance response, and eustress‐endurance response. We sought to compare these 3 maladaptive subgroups with an adaptive group using a classification tool that included the following scales: the thought suppression and behavioral endurance subscale of the Avoidance‐Endurance Questionnaire and the Beck Depression Inventory. The psychological characteristics, and pain and disability of the AEM subgroups were investigated. We report results from 177 patients with subacute nonspecific low back pain at the start of outpatient treatment and at follow‐up after 6 months. At baseline, a multivariate analysis of variance found that the fear‐avoidance patients scored higher in pain catastrophizing than the other groups. The distress‐endurance patients displayed elevated anxiety/depression and helplessness/hopelessness accompanied with the highest scores in the classification variables thought suppression and persistence behavior. The eustress‐endurance patients had the highest humor/distraction scores, pain persistence, and positive mood despite pain. All 3 maladaptive groups revealed a higher pain intensity than the adaptive patients at follow‐up after 6 months; however, disability at follow‐up was elevated only in the fear‐avoidance and distress‐endurance patients. The study provides preliminary evidence for the construct and prospective validity of AEM‐based subgroups of subacute, nonspecific back pain patients. The results suggest the need for individually targeted cognitive behavioral treatments in the maladaptive groups.

Biopsychosoziale Mechanismen der Chronifizierung von Rückenschmerzen

Dauert ein akuter Schmerz trotz jeweils indizierter medizinischer Behandlungsmasnahmen langer als sechs Monate an, sprechen wir gemas einer internationalen Konvention von einem chronischen Schmerz. Zu den haufigsten chronischen Schmerzsyndromen zahlen verschiedene Kopfschmerzformen einschlieslich Migrane sowie chronische Ruk-kenschmerzen bei rheumatischen und degenerativen Erkrankungen. Chronische wirbelsaulenbedingte Ruckenschmerzen stellen nach einem meist langjahrigen Krankheitsverlauf mit 25 % den haufigsten Grund fur Fruhberentungsmasnahmen bei Frauen, mit 32 % den zweithaufigsten bei mannlichen Arbeitnehmern (Hagen et al. 1997). Die Entwicklung effektiver Behandlungsmasnahmen setzt Kenntnisse daruber voraus, bei wie vielen Menschen ein einmalig auftretender, akuter Schmerz in ein chronisches Schmerzleiden ubergeht und welche Faktoren zu einer lang dauernden Chronifizierung beitragen. Ein empirisch gesichertes Wissen zu diesen Fragen existiert gegenwartig vor allem im Bereich chronischer, wirbelsaulenbedingter Ruckenschmerzen.