[Endurance strategies-a neglected phenomenon in the research and therapy of chronic pain?].

Within a prospective longitudinal study of 111 patients with acute radicular pain and lumbar disc prolapse who underwent conservative or surgical treatment, we examined the importance of specific pain coping strategies, which have received little attention in psychological pain research: appeals to "stick it out" on the cognitive level and endurance strategies on the behavioural level. Prior to treatment we conducted a psychological and neurological examination. The psychological tests included the Kiel Pain Inventory (KPI) and the Beck Depression Inventory (BDI). Based on these scales we allocated patients to three groups: A (endurance strategies and positive mood;n=16), B (appeals to stick it out and depressive mood;n=20) and C (no psychological risk factors;n=40). The outcome variable was the intensity of pain (8-point self-rating scale), which was assessed prior to treatment, at the time of discharge, 1 week later and 6 months later. Additionally, 6 months later we assessed the ability to work and the attitude to application for early retirement. Results showed that patients in groups A and B had significantly more pain at the 6-month follow up than the patients in group C, who were painfree. Patients in group A were a specially high risk group: at the time of discharge they had no pain, but from the first week after discharge up to the 6-month follow up they had increasing pain. Additionally at the 6 month follow up they seemed less likely to return to work and 8 times more of them had applied for early retirement than in the groups of patients without psychological risk factors. The results suggested several suggestions for modification of medical and psychological therapy for chronic pain patients.