De angst voor bewegen: geleidelijke exposure in vivo bij chronische lagerugpijn

Jong, Jeroen de; Vlaeyen, Johan W. S.; Geilen, Mario; Heuts, P.H.T.G.

doi:10.1007/bf03060233

Cited by 5 publications

(7 citation statements)

References 25 publications

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“…Much more dramatic changes are seen when a systematic exposure in vivo with behavioural experiments is applied. In line with previous studies (37,47), decreases in pain-related fear also concurred with decreases in pain catastrophizing, pain disability and pain vigilance. In addition, current pain intensity levels were also affected by the exposure in vivo treatment, although these changes occurred at a slower pace.…”

Section: Discussionsupporting

confidence: 91%

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Can Pain‐Related Fear Be Reduced? The Application of Cognitive‐Behavioural Exposure in Vivo

Vlaeyen

Jong

Onghena

et al. 2002

Pain Research and Management

134

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Although cognitive-behavioural treatments of patients with chronic pain generally are reported to be effective, customization might increase their effectiveness. One possible way to customize treatment is to focus the intervention on the supposed mechanism underlying the transition from acute to chronic pain disability. Evidence is accumulating in support of the conjecture that pain-related fear and associated avoidance behaviours are crucial in the development and maintenance of chronic pain disability. It seems timely to apply this knowledge to the cognitive-behavioural management of chronic pain. Two studies are presented here. Study 1 concerns a secondary analysis of data gathered in a clinical trial that was aimed at the examination of the supplementary value of coping skills training when added to an operant-behavioural treatment in patients with chronic back pain. The results show that, compared with a waiting list control, an operant-behavioural treatment with or without pain-coping skills training produced very modest and clinically negligible decreases in pain-related fear. Study 2 presents the effects of more systematic exposure in vivo treatment with behavioural experiments in two single patients reporting substantial pain-related fear. Randomization tests for AB designs revealed dramatic changes in pain-related fear and pain catastrophizing. In both cases, pain intensity also decreased significantly, but at a slower pace. Differences before and after treatment revealed clinically significant improvements in pain vigilance and pain disability.

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Section: Discussionsupporting

confidence: 91%

“…It consisted of 15 sessions each of 90 min duration. In contrast to previous studies (37,46,47), there were no other treatment components included in the rehabilitation program.…”

Section: Designmentioning

confidence: 91%

Can Pain‐Related Fear Be Reduced? The Application of Cognitive‐Behavioural Exposure in Vivo

Vlaeyen

Jong

Onghena

et al. 2002

Pain Research and Management

134

View full text Add to dashboard Cite

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“…21 The actual applications were reported more recently. 22,23 Although EXP may appear quite similar to the usual graded activity (GA) programs, 24,25 in that it gradually increases activity levels despite pain, they are both conceptually and practically quite different.…”

mentioning

confidence: 99%

“…In sum, it is quite plausible that, in analogy with the treatment of phobias, exposure to backstressing movements may indeed be a successful treatment approach for patients with back pain patients reporting substantial fear of movement/(re)injury. Indeed, using a replicated single-case experimental design, Vlaeyen et al 23,28 and de Jong et al 22 provided preliminary evidence that, for patients reporting fear of movement/(re)injury, a tailored EXP is superior to a nontreatment baseline period and a GA. Because the results were based on self-report only, the authors suggested to validate the assumption that the confrontation of feareliciting activities in the rehabilitation center is an analog for how patients respond in daily life situations by using ambulatory activity monitors in everyday life, outside the clinic.…”

mentioning

confidence: 99%

The Treatment of Fear of Movement/(Re)injury in Chronic Low Back Pain: Further Evidence on the Effectiveness of Exposure In Vivo

Vlaeyen¹,

Jong²,

Geilen³

et al. 2002

The Clinical Journal of Pain

Self Cite

447

238

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Abstract:Background and objective: Several cognitive-behavioral factors contribute to the persistence of pain disability in patients with chronic back pain. Fear-avoidance beliefs and fear of movement/(re)injury in particular have been shown to be strong predictors of physical performance and pain disability. Patients reporting substantial pain-related fear might benefit from exposure in vivo to a set of individually tailored, fear-eliciting, and hierarchically ordered physical movements rather than more general graded activity.Patients and interventions: Six consecutive patients with chronic low back pain who reported substantial fear of movement/(re)injury were included in the study. After a no-treatment baseline measurement period, the patients were randomly assigned to one of two interventions. In the first intervention, patients received exposure in vivo first, followed by graded activity. In the second intervention, the sequence of treatment modules was reversed. Before each treatment module, treatment credibility was assessed. Daily measures of pain-related fear, pain catastrophizing, and pain intensity were completed using visual analog scales. In addition, standardized measures of pain disability, pain-related fear, and pain vigilance were taken before and after each treatment module and at the 1-year follow-up. To obtain more objective data on actual activity levels, an ambulatory activity monitor was carried by the patients during 1 week before and after each treatment module.Results: Time series analysis of the daily measures showed that improvements in pain-related fear and pain catastrophizing occurred only during the exposure in vivo and not during the graded activity, irrespective of the treatment order. Analysis of the pretreatment to post-treatment differences also revealed that decreases in pain-related fear also concurred with decreases in pain disability and pain vigilance and an increase in physical activity levels. All improvements remained at the 1-year follow-up.Key Words: Anxiety-Cognitive-behavioral treatment-Exposure in vivo-Fearavoidance beliefs-Low back pain.The early notion that, in chronic patients, the lowered ability to accomplish tasks of daily living is merely the consequence of pain severity has now been reconsidered. Indeed, a steadily increasing number of studies are showing that observable physical performance and selfreported disability levels in subacute and chronic pain are associated with cognitive and behavioral aspects of

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“…De graduele exposure in vivo-behandeling wordt uitgevoerd in drie stappen: cognitief gedragsmatige analyse, educatie en graduele exposure in vivo met gedragsexperimenten (De Jong, Vlaeyen, Geilen & Heuts, 2000;Vlaeyen, De Jong & Crombez, 2000).…”

Section: Exposure In Vivounclassified