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

Gajsar, Hannah; Titze, Christina; Levenig, Claudia; Kellmann, Michael; Heidari, Jahan; Kleinert, Jens; Rusu, Adina C.; Hasenbring, Monika

doi:10.1002/ejp.1442

Cited by 20 publications

(21 citation statements)

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“…The development of endurance-related pain responses might therefore be particularly important to maintain or increase their level of performance [33,34]. Indeed, "playing through" pain [35,36] or "playing hurt" [37,38] appear to be common characteristics among athletes, and some studies demonstrated more endurance-related strategies in athletes compared to non-athletes [39,40], although others reported no such differences [41][42][43]. One disadvantage of these studies is, however, that they do not distinguish between more complex patterns of pain responses.…”

Section: Introductionmentioning

confidence: 99%

Psychosocial subgroups in high-performance athletes with low back pain: eustress-endurance is most frequent, distress-endurance most problematic!

Titze

Fett

Trompeter

et al. 2020

Scandinavian Journal of Pain

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ObjectivesIn non-athletes, fear-avoidance and endurance-related pain responses appear to influence the development and maintenance of low back pain (LBP). The avoidance-endurance model (AEM) postulates three dysfunctional pain response patterns that are associated with poorer pain outcomes. Whether comparable relationships are present in athletes is currently unclear. This cross-sectional case-control study explored frequencies and behavioral validity of the AEM-based patterns in athletes with and without LBP, as well as their outcome-based validity in athletes with LBP.MethodsBased on the Avoidance-Endurance Fast-Screen, 438 (57.1% female) young adult high-performance athletes with and 335 (45.4% female) without LBP were categorized as showing a “distress-endurance” (DER), “eustress-endurance” (EER), “fear-avoidance” (FAR) or “adaptive” (AR) pattern.ResultsOf the athletes with LBP, 9.8% were categorized as FAR, 20.1% as DER, 47.0% as EER, and 23.1% as AR; of the athletes without LBP, 10.4% were categorized as FAR, 14.3% as DER, 47.2% as EER, and 28.1% as AR. DER and EER reported more pronounced endurance- and less pronounced avoidance-related pain responses than FAR, and vice versa. DER further reported the highest training frequency. In athletes with LBP, all dysfunctional groups reported higher LBP intensity, with FAR and DER displaying higher disability scores than AR.ConclusionsThe results indicate that also in athletes, patterns of endurance- and fear-avoidance-related pain responses appear dysfunctional with respect to LBP. While EER occurred most often, DER seems most problematic.ImplicationsEndurance-related pain responses that might be necessary during painful exercise should therefore be inspected carefully when shown in response to clinical pain.

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Section: Introductionmentioning

confidence: 99%

Psychosocial subgroups in high-performance athletes with low back pain: eustress-endurance is most frequent, distress-endurance most problematic!

Titze

Fett

Trompeter

et al. 2020

Scandinavian Journal of Pain

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“…This pressure is evoked by trainers, media, and audience who expect top performance independent from injury or pain. 12 Preliminary research indicates that endurance-related pain responses apart from FAR are also associated with higher pain and disability in athletes with LBP 13 ; however, little is known about the role of psychosocial subgroups in athletes.…”

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confidence: 99%

Body Image in Athletes and Nonathletes With Low Back Pain: Avoidance–Endurance-Related Subgroups and Sports Status Play a Role

Levenig¹,

Kellmann²,

Kleinert³

et al. 2021

Journal of Sport Rehabilitation

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Context: Low back pain (LBP) is a serious health problem, both in the general population as well as in athletes. Research has shown that psychosocial aspects, such as dysfunctional pain responses, play a significant role in the chronification of LBP. Recent research supports the relevance of the multidisciplinary concept of body image in the interpretation of LBP. Objective: To examine the differences in 2 psychosocial aspects, body image and pain responses, between athletes and nonathletes with LBP. Design: Cross-sectional design. Setting: The questionnaires were distributed in the course of LBP treatment. Participants: Data from 163 athletes (mean age = 28.69 [9.6] y) and 75 nonathletes (mean age = 39.34 [12.63] y) were collected. Interventions: Data were collected by questionnaires assessing body image, pain behavior, training activity, and LBP. Main Outcome Measures: To examine group differences between athletes and nonathletes regarding body image and pain behavior, the authors performed 2-way analyses of variance with Bonferroni post hoc tests. Results: The results showed (1) a significant main effect regarding pain responses and body image, showing that participants with eustress endurance or adaptive pain behavior revealed a more positive body image in both groups compared with participants with distress endurance or fear-avoidance behavior, and (2) a significant main effect for the factor group in the body image dimension of physical efficacy, indicating a more positive body image for athletes. Conclusion: These results suggest that considering multiple risk factors for LBP, such as body image and dysfunctional pain behavior, as well as subgrouping, might be valuable for research and for broadening therapy options.

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“…[2][3][4] Chronic NS-LBP can have a long and tedious treatment that often is not a straightforward process. Psychosocial factors have been well established to have an association with chronic LBP [5][6][7] as has the advocation for including strategies to address these factors during treatment, even in athletes. 8 The lack of structural deformity or tissue damage associated with chronic NS-LBP can leave both the patients and the clinicians frustrated with the slow rehabilitation process.…”

Section: Clinical Scenariomentioning

confidence: 99%

Pain Education With Therapeutic Exercise in Chronic Nonspecific Low Back Pain Rehabilitation: A Critically Appraised Topic

Jones¹,

Tocco²,

Marshall³

et al. 2020

Journal of Sport Rehabilitation

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Clinical Scenario: Low back pain is widely prevalent in the general population as well as in athletes. Therapeutic exercise is a low-risk and effective treatment option for chronic pain that can be utilized by all rehabilitation clinicians. However, therapeutic exercise alone does not address the psychosocial aspects that are associated with chronic low back pain. Pain education is the umbrella term utilized to encompass any type of education to the patient about their chronic pain. Therapeutic exercise in combination with pain education may allow for more well-rounded and effective treatment for patients with chronic nonspecific low back pain (NS-LBP). Clinical Question: Does pain education combined with therapeutic exercise, compared with therapeutic exercise alone, improve patient pain in adults with chronic NS-LBP over a 2- to 3-month treatment period? Summary of Key Findings: A thorough literature review yielded 8 studies potentially relevant to the clinical question, and 3 studies that met the inclusion criteria were included. The 3 studies included reports that exercise therapy reduced symptoms. Two of the 3 included studies support the claim that exercise therapy reduces the symptoms of chronic NS-LBP when combined with pain education, whereas one study found no difference between pain education with therapeutic exercise. Clinical Bottom Line: There is moderate evidence to support the use of pain education along with therapeutic exercise when attempting to reduce symptoms of pain and disability in patients with chronic NS-LBP. Educational interventions should be created to educate patients about the foundation of pain, and pain education should be implemented as a part of the clinician’s strategy for the rehabilitation of patients with chronic NS-LBP. Strength of Recommendation: Grade B evidence exists to support the use of patient education with therapeutic exercise for decreasing pain in patients with chronic NS-LBP.

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

Cited by 20 publications

References 75 publications

Psychosocial subgroups in high-performance athletes with low back pain: eustress-endurance is most frequent, distress-endurance most problematic!

Psychosocial subgroups in high-performance athletes with low back pain: eustress-endurance is most frequent, distress-endurance most problematic!

Body Image in Athletes and Nonathletes With Low Back Pain: Avoidance–Endurance-Related Subgroups and Sports Status Play a Role

Pain Education With Therapeutic Exercise in Chronic Nonspecific Low Back Pain Rehabilitation: A Critically Appraised Topic

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