Herbert Rusche

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.

Stand der hausärztlichen Palliativversorgung in Deutschland

To investigate the role of general practitioners among the increasing specialization in outpatient palliative care, meaningful research topics, developments of new collaborations and structures in the outpatient sector of palliative care, 52 articles were reviewed. Results have shown that general practitioners are still involved in outpatient palliative care research and show a distinct participation in quality development. Typical research topics in outpatient palliative care research are quality of care and structures. However, cooperative structures between general practitioners and palliative specialists are rare in the field of outpatient palliative care research.

Avoidance-endurance fast screening (AE-FS): Content and predictive validity of a 9-item screening instrument for patients with unspecific subacute low back pain

Schmerz 2020 · 34 (Suppl 1):S1–S7 https://doi.org/10.1007/s00482-018-0323-5 Published online: 17 September 2018

Correction to: Mild Depression in Low Back Pain: the Interaction of Thought Suppression and Stress Plays a Role, Especially in Female Patients

This article was updated to correct the author names. Family and given names are in the correct order.

Strategien gegen den Schmerz

ZusammenfassungTumorschmerz bei Pflegeheimbewohnern ist ein häufiges und bei steigender Lebenserwartung wachsendes Problem. Viele Besonderheiten sind zu beachten, allen voran die häufige Kombination demenzieller Entwicklungen, unzureichender Kommunikationsfähigkeiten und unzureichender Wahrnehmung der Problematik. Hier haben sich in letzter Zeit einfache Screeninginstrumente durchgesetzt, wie z.B. die Schmerzmessung mit eindimensionalen Skalen und die Beurteilung von Schmerz bei Demenz (BESD). Wenige Zusammenhänge zu Ätiologie und Pathophysiologie sind zu verstehen, um eine gezielte Schmerztherapie einzuleiten. Beachtet werden sollten Besonderheiten wie Durchbruchschmerzen, neuropathische Schmerzen, Schmerztherapie bei Demenz und die Finalphase. Dabei steht das Ziel, Menschen die letzte Lebensphase in der von ihnen gewünschten Umgebung zu ermöglichen und somit Klinikeinweisungen zu vermeiden, im Vordergrund. Besonderes Augenmerk ist auch auf Therapieziele, Methodenauswahl, Medikation und Dosierung bei zumeist schwer pflegebedürftigen Menschen zu legen.

Wissen Sie, was im Notfall zu tun ist?

ZusammenfassungLebensbedrohliche Notfälle kommen in einer allgemeinmedizinischen Praxis nur ein- bis dreimal pro Jahr vor. Dennoch sollte jeder Hausarzt kompetente Hilfe leisten können. Lesen Sie im folgenden Beitrag, welche Maßnahmen Sie bei Patienten mit akutem Thoraxschmerz, akuter Luftnot, neurologischen Ausfällen oder Bewusstlosigkeit ergreifen müssen.