A Cognitive-Behavioural Approach to the Secondary Prophylaxis of Work-Related Back Pain

Abstract

A clear call has been made for the prevention of the development of chronic back pain. Indeed, chronic back pain is quite prevalent, causes great suffering, and is extremely costly. Although several attempts have been made in clinical settings to prevent the development of chronic pain, there are few reports on the techniques involved. Consequently, this paper aims to summarize some current initiatives in secondary prevention which are relevant for health care professionals. After reviewing some background principles, a guide to prevention is provided. This is based on a four-stage approach that includes screening, assessment, preventive intervention, and recycling of the program. Although research to date suggests that these methods are promising, there is a real need to conduct further research to determine the effectiveness of such programs as well as to develop the techniques further.     

Psychosocial and Behavioural Assessment of Chronic Pain: Recommendations for Clinicians and Researchers

Abstract

A variety of methods have been developed for the assessment of chronic benign pain. In research or in clinical practise, choosing an adequate measurement technique can be a laborious task. This article has two main purposes: to report on some basic features to consider when selecting assessment instruments, and to present a review of some psychosocial and behavioural measurement methods for the assessment of chronic benign pain. The selected methods have, with one exception, been evaluated on Swedish chronic pain populations and are used in international pain research. In conclusion, we recommend the use of psychometrically sound instruments, and that the purposes for use of a measure have to be thoroughly considered in advance. We also emphasize that in clinical practise, each separate measure must be interpreted in a wider context, where clinical findings and judgements are considered as a whole. In addition, none of the single reviewed assessment techniques can replace the communication between the patient and the clinician.     

Anxiety sensitivity, body vigilance and fear of pain

The aim of the present study was to investigate the role of anxiety sensitivity (AS) as a factor relevant to pain and pain persistence. Two studies were conducted to examine the relationship between AS, body vigilance and the experience of pain in non-clinical samples. Study 1 investigated the relationship between AS and body vigilance that was operationalized by the detection latency for innocuous electrical stimuli; trait anxiety and neuroticism were also included as covariates. Results indicated that the high AS group (N=69) presented shorter detection latency than the low AS group (N=70); neuroticism and trait anxiety did not have significant effects on detection latency. Using another sample, Study 2 investigated the relationship between AS, body vigilance, pain tolerance, catastrophizing, and self-reported distress and pain during a cold pressor task. Neuroticism, trait anxiety and fear of pain were included as covariates. Results showed significant differences between high- (N=66) and low- (N=69) AS groups in body vigilance, catastrophizing and tolerance. The covariates neuroticism, trait anxiety and fear of pain did not have any significant effects. No significant differences were found in pain and distress ratings. Results from both studies support the importance of AS in body vigilance and the experience of pain. The theoretical, preventive and clinical implications of these findings are discussed.     

The Effectiveness of Mindfulness Training on the Grieving Process and Emotional Well-Being of Chronic Pain Patients

Losses in relationships, work, and other areas of life often accompany the physical discomfort of chronic pain. Often the depth and intensity of the grief associated with chronic pain are overlooked or possibly misdiagnosed and treated as depression. We used an 8-week mindfulness meditation program to determine its effectiveness in addressing the grieving process among 39 patients diagnosed with chronic pain. Eighteen patients volunteered to be in a comparison group. The study was conducted in a regional hospital's pain clinic and patients completed the Response to Loss Scale (measuring grief), the Beck Depression Inventory, and the State Trait Anxiety Inventory. Results indicated that the treatment group advanced significantly more quickly through the initial stages of grieving than the comparison group. In addition, the treatment group demonstrated significant reductions in depression and state anxiety, but no significant differences emerged when comparing groups on the final stages of grieving or trait anxiety.     

Early maladaptive schemas in Finnish adult chronic pain patients and a control sample

Engel (1959) suggested that negative physical or emotional experiences in childhood predispose to the development of chronic pain. Studies have shown that physical and sexual abuse in early life is connected with chronic pain. Emotional adversities are much less studied causes contributing to the development of chronic pain and disability. Early emotional abuse, neglect, maltreatment and other adversities are deleterious childhood experiences which, according to Young's schema theory (1990), produce early maladaptive schemas (EMSs). The primary goal of this study was to examine whether early adversities were more common in chronic pain patients than in a control group. A total of 271 (53% women) first-visit chronic pain patients and 331 (86% women) control participants took part in the study. Their socio-demographic data, pain variables and pain disability were measured. To estimate EMSs the Young Schema Questionnaire was used. Chronic pain patients scored higher EMSs reflecting incapacity to perform independently, catastrophic beliefs and pessimism. The most severely disabled chronic pain patients showed an increase in all the EMSs in the Disconnection and Rejection schema domain, namely Abandonment/Instability, Mistrust/Abuse, Emotional Deprivation, Defectiveness/Shame and Social Isolation/Alienation EMSs. The results of the study suggested that chronic pain patients had suffered early emotional maltreatment.     

The Accuracy of the DSM-IV Pain Disorder and the ICD-10 Persistent Somatoform Pain Disorder in Chronic Pain Patients

Objectives. In this investigation we studied the relationships between different psychological relevant subgroups and the presence of different psychosomatic symptoms in a sample of chronic pain patients, testing the accuracy of the DSM- and ICD classification systems.Results. We found no evidence for a “pure” pain syndrome according to the DSM- and ICD systems. On the contrary, we found highly significant evidence of a mixed psychosomatic condition.Conclusion. The results suggest a broad somatoform classification, with subgroups based on personality characteristics taking a stress—coping model into account, including interpersonal attachment behaviour. An alternative model of a diagnostic approach is presented.     

Hermeneutics and Experiences of the Body. The Case of Low Back Pain

The purpose of this paper is to elaborate on the notion of clinical medicine as a hermeneutical enterprise and to bridge the gap between the general perspectives of hermeneutics and the particularities of medical practice. The case of a patient with low back pain is analyzed. The discussion centers around the metaphor of the patient as a text and a model of five social discourses about low back pain. The problems addressed are: (1) the nature of a moral experience, (2) the variety of available texts, (3) the difference between the doctor's and patient's narratives, and (4) the patient's and doctor's responsibility regarding the existential, biographical meaning of an illness. Although many problems are left unsolved, it is argued that from a philosophical point of view the notion of medicine as a hermeneutical enterprise opens up the possibility of gaining insight in the foundations of the clinical encounter.     

后基因时代神经源性疼痛研究的焦点：蛋白质网络

后基因时代到来后蛋白质组学技术得到了迅猛发展,系统化和网络化研究神经源性疼痛模型中,神经系统蛋白质结构和功能必将是未来疼痛相关研究的重要组成部分。蛋白质组学方法的广泛应用,将为我们提供一个用于判断疼痛的新工具,更有利于疼痛机理的揭示。     

Sexual-Assault History and Long-Term Physical Health Problems: Evidence From Clinical and Population Epidemiology

Having a history of sexual assault is associated with both poor general health and limitations in physical functioning, as well as with specific health problems such as chronic pelvic pain, premenstrual disturbance, other gynecologic symptoms, fibromyalgia, headache, other pain syndromes, and gastrointestinal disorders. In studies evaluating the possible role of depression in these associations, depression among sexually assaulted persons did not account for their poorer health. Although there are unanswered questions in the literature on the associations between sexual assault and health, existing findings are consistent with standard criteria for inferring causal relationships from observational data. For example, many assault-health associations are supported by multiple, independent studies, and many demonstrate dose-response relationships (i.e., more incidents of sexual assault, or more severe assaults, are associated with more adverse health outcomes).     

Exposure to physical movement in chronic back pain patients: no evidence for generalization across different movements

This study investigated whether the effects of exposure to one movement generalize towards another dissimilar movement in patients with low back pain. Thirty-nine patients (11 male, 28 female; mean age=43.49 yrs) were requested to perform two movements twice, i.e. bending forward and straight leg raising. During each of the four trials, baseline pain, expected pain and experienced pain were recorded. Analyses revealed that patients initially overpredicted pain, but after exposure the overprediction was readily corrected. This exposure effect did not generalize towards another dissimilar movement. The above pattern of results was only characteristic for patients reporting a high frequency of catastrophic thinking about pain. Low pain catastrophizers did not overpredict pain. The results are discussed in terms of the view that exposure may be better conceived of as the learning of exceptions to a general rule.