S V Wolff1, R Willburger2, D Hallner3, A C Rusu3, H Rusche4, T Schulte2, M I Hasenbring3. 1. Abteilung für Medizinische Psychologie und Medizinische Soziologie, Fakultät für Medizin, Ruhr-Universität Bochum, Universitätsstr. 150, Bochum, Deutschland. sonja.wolff-w5u@ruhr-uni-bochum.de. 2. Universitätsklinik für Orthopädie und Unfallchirurgie, St. Josef Hospital, Ruhr-Universität Bochum, Bochum, Deutschland. 3. Abteilung für Medizinische Psychologie und Medizinische Soziologie, Fakultät für Medizin, Ruhr-Universität Bochum, Universitätsstr. 150, Bochum, Deutschland. 4. Abt. für Allgemeinmedizin, Medizinische Fakultät, Ruhr-Universität Bochum, Bochum, Deutschland.
Abstract
BACKGROUND: Among screening measures to assess psychosocial risk factors (yellow flags) for chronic low back pain (LBP) economic tools which address dysfunctional endurance pain responses besides emotional distress and fear-avoidance pain processing are rare. Targeting contrasting types of pain processing might improve stratified patient counselling. OBJECTIVE: The aim of the study was to develop a short screening method, based on the avoidance-endurance model of pain and to investigate the prognostic validity for pain intensity, disability and physical function. MATERIAL AND METHODS: A prospective observational study was carried out on 144 patients with subacute LBP (<3 months) from 7 general practitioners and 5 orthopedic practices. The 9‑item avoidance-endurance fast screening (AE-FS) was derived from a previous 37-item screening using correlational and receiver operating curve (ROC) analyses and the agreement of subgrouping was calculated using Cohen's kappa. Primary outcomes were assessed after 6 months by mail in 124 patients (86%). Endpoints were pain intensity and disability. RESULTS: The classification of subgroups as high and low risk by both measures had considerable agreement with a value of 0.71 (Cohen's Kappa). The sensitivity to predict pain intensity >2 was high (82%) as was the positive predictive value (80%) but the negative predictive value was moderate (61%). The ROC (AUC) characteristics (95% confidence interval CI) were 0.70 (0.60-0.80) for pain intensity and for limitations in the pain disability index (PDI) 0.70 (0.55-0.87). DISCUSSION: The 9‑item AE-FS displayed sufficient prognostic validity for all three outcomes in a sample of primary care patients with subacute LBP. The differentiation of the high-risk patients into fear-avoidance and endurance-related pain processing enables the physician to provide an individualized counselling with the aim of a healthy balance between stress and relaxation.
BACKGROUND: Among screening measures to assess psychosocial risk factors (yellow flags) for chronic low back pain (LBP) economic tools which address dysfunctional endurance pain responses besides emotional distress and fear-avoidance pain processing are rare. Targeting contrasting types of pain processing might improve stratified patient counselling. OBJECTIVE: The aim of the study was to develop a short screening method, based on the avoidance-endurance model of pain and to investigate the prognostic validity for pain intensity, disability and physical function. MATERIAL AND METHODS: A prospective observational study was carried out on 144 patients with subacute LBP (<3 months) from 7 general practitioners and 5 orthopedic practices. The 9‑item avoidance-endurance fast screening (AE-FS) was derived from a previous 37-item screening using correlational and receiver operating curve (ROC) analyses and the agreement of subgrouping was calculated using Cohen's kappa. Primary outcomes were assessed after 6 months by mail in 124 patients (86%). Endpoints were pain intensity and disability. RESULTS: The classification of subgroups as high and low risk by both measures had considerable agreement with a value of 0.71 (Cohen's Kappa). The sensitivity to predict pain intensity >2 was high (82%) as was the positive predictive value (80%) but the negative predictive value was moderate (61%). The ROC (AUC) characteristics (95% confidence interval CI) were 0.70 (0.60-0.80) for pain intensity and for limitations in the pain disability index (PDI) 0.70 (0.55-0.87). DISCUSSION: The 9‑item AE-FS displayed sufficient prognostic validity for all three outcomes in a sample of primary care patients with subacute LBP. The differentiation of the high-risk patients into fear-avoidance and endurance-related pain processing enables the physician to provide an individualized counselling with the aim of a healthy balance between stress and relaxation.
Entities:
Keywords:
Avoidance-endurance; Prognosis; Psychosocial; Screening; Subacute low back pain
Authors: Alessandro Chiarotto; Maarten Boers; Richard A Deyo; Rachelle Buchbinder; Terry P Corbin; Leonardo O P Costa; Nadine E Foster; Margreth Grotle; Bart W Koes; Francisco M Kovacs; C-W Christine Lin; Chris G Maher; Adam M Pearson; Wilco C Peul; Mark L Schoene; Dennis C Turk; Maurits W van Tulder; Caroline B Terwee; Raymond W Ostelo Journal: Pain Date: 2018-03 Impact factor: 6.961
Authors: M I Hasenbring; C Levenig; D Hallner; A-K Puschmann; A Weiffen; J Kleinert; J Belz; M Schiltenwolf; A-C Pfeifer; J Heidari; M Kellmann; P-M Wippert Journal: Schmerz Date: 2018-08 Impact factor: 1.107