Pain-Related Endurance, Fear-Avoidance and Somatosensory Sensitivity as Correlates of Clinical Status after Lumbar Disc Surgery

Abstract

Most pain and disability variance in patients with low back pain still remains unexplained. The aim of this study was to enhance the degree of explained variance by including measures of pain and tactile sensitivity as well as pain-related endurance and fear-avoidance responses. Thirty-six post lumbar disc surgery patients completed psychometric questionnaires (Avoidance-Endurance Questionnaire, Fear-Avoidance Beliefs Questionnaire, Beck Depression Inventory) and underwent quantitative sensory testing (QST) with measures of pain (pressure (PPT) and mechanical pain threshold) and tactile sensitivity (MDT). Bivariate correlations and hierarchical multiple regression analysis were computed. In addition to the contribution of fear-avoidance responses, pressure pain sensitivity and endurance behavior significantly contributed to explanations of pain variance, whereas disability was primarily predicted by fear-avoidance. While all psychological variables and MDT were positively related to pain or disability, PPT was negatively related to pain. The regression model accounted for 69 % of the variance in back pain intensity and 68 % of the variance in disability. Tactile hypaesthesia was related to increased clinical pain. Pain-related endurance responses and pressure pain hyperalgesia were significant additional predictors for pain, but not for disability. These findings are compatible with generalized disinhibition via descending pathways and a general inhibition of tactile acuity by ongoing pain.

Psychological pain responses in athletes and non‐athletes with low back pain: Avoidance and endurance matter

“…Regarding the functionality of ER in LBP, pain‐related thought suppression (PTS) was associated with higher disability, which is in accordance to previous studies in (sub)acute (Hasenbring, Hallner, Klasen, et al, ; Held et al, ) and chronic LBP (Pegram et al, ; Scholich et al, ). Experimental research suggests that pain‐related thought suppression results in thought intrusions and increases of the very painful sensations that were sought to be suppressed (Cioffi & Holloway, ; Sullivan et al, ).…”

“…To this end, pain‐related thought suppression may serve to enable pain persistence, also known as overactivity, eventually resulting in overuse (Andrews et al, ; Hasenbring & Verbunt, ) and depressive mood (Hülsebusch, Hasenbring, & Rusu, ; Konietzny et al, ) (Figure ). Thus, endurance‐related responses (ER) are, like FAR, associated with disability (Andrews et al, ; Hasenbring, Hallner, Klasen, et al, ; Held et al, ; Pegram, Lumley, Jasinski, & Burns, ; Scholich, Hallner, Wittenberg, Hasenbring, & Rusu, ) and pain intensity (Hasenbring, Marienfeld, Kuhlendahl, & Soyka, ; Held et al, ; Pegram et al, ; Scholich et al, ), (see Figure ).…”

Pain-related avoidance and endurance behaviour in migraine: an observational study

“…It is an interesting question if migraine patients show the same avoidance/endurance pattern as other chronic pain samples. When AEQ scores were exploratively compared with results from the low back pain literature, the present migraine sample had higher social and lower physical avoidance scores [2, 11] and similar or slightly lower endurance scores [2, 11, 12].…”

“…The AEQ was developed to assess emotional, cognitive and behavioural fear-avoidance and endurance responses to pain, and has been validated and repeatedly applied in different chronic pain populations [2, 11, 12]. In the present study, only the behavioural subscales were used.…”

Effective Reassurance in Primary Care of Low Back Pain

“…As there is convincing evidence from several systematic reviews that 10,11 psychosocial risk factors, such as emotional distress and maladaptive coping with pain, have a significant impact on the maintenance of acute/subacute nonspecific LBP, both eliciting and giving information should include known maladaptive pain responses. [20][21][22] On a behavioral level, there is evidence not only for the role of avoidance behavior leading to chronic pain and disability, probably mediated by physical disuse, but also for the role of marked endurance behavior, which is maintained despite severe pain. [12][13][14][15] For example, there is evidence that cognitive pain responses, such as catastrophizing and helplessness/hopelessness, ongoing with high pain anxiety and fear of (re)injury will increase the probability of future pain and pain-related disability.…”