RESEARCH ARTICLE
Pain-Related Endurance, Fear-Avoidance and Somatosensory Sensitivity as Correlates of Clinical Status after Lumbar Disc Surgery
Sabine Melanie Held1, Roman Rolke2, Rolf-Detlef Treede3, Kirsten Schmieder4, Zohra Karimi1, Sigrid Christa Sudhaus1, Monika Ilona Hasenbring*, 1
Article Information
Identifiers and Pagination:
Year: 2013Volume: 6
First Page: 165
Last Page: 175
Publisher ID: TOPAINJ-6-165
DOI: 10.2174/1876386301306010165
Article History:
Received Date: 04/03/2013Revision Received Date: 19/04/2013
Acceptance Date: 29/04/2013
Electronic publication date: 30/5/2013
Collection year: 2013
open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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.
