The Open Pain Journal

2013, 6 : 165-175
Published online 2013 May 30. DOI: 10.2174/1876386301306010165
Publisher ID: TOPAINJ-6-165

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 and Monika Ilona Hasenbring, *,1
1 Department of Medical Psychology and Medical Sociology, Ruhr-University, Bochum, Germany
2 Department of Pal-liative Care, University of Bonn, Germany and Department of Neurology, University Medical Center, Johannes Guten-berg-University, Mainz, Germany
3 Neurophysiology, Center for Biomedicine and Medical Technology, Mannheim,Germany
4 Clinic of Neurosurgery, Knappschaftskrankenhaus, Bochum, Germany

* Address correspondence to this author at the Department of Medical Psychology and Medical Sociology, Ruhr-University of Bochum, Universitätsstraße 150, 44780 Bochum, Germany; Tel: ++49 234 32 25439;Fax: ++49 234 32 14203; E-mail: monika.hasenbring@rub.de

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.

Keywords:

Low Back Pain, Endurance Responses, Fear-Avoidance Responses, Quantitative Sensory Testing, Sensory Sensitivity.