• Monika I Hasenbring, Dirk Hallner, and Adina C Rusu.
• Dept. of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr-University of Bochum, Bochum, Germany. Monika.Hasenbring@ruhr-uni-bochum.de
• Eur J Pain. 2009 Jul 1; 13 (6): 620-8.

Aim Of InvestigationRecent research indicated wide variability regarding pain-related cognitive/affective and behavioral responses to pain, showing that fear-avoidance responses (FAR) and endurance-responses (ER) play a prominent role in the maintenance of low back pain (LBP). Until now, there is a lack of reliable and valid instruments covering FAR and ER.MethodsA pool of 60 items, derived from the Kiel Pain Inventory was answered by 191 LBP patients. Principle components analyses (PCA) was used to explore the factor structure creating the Avoidance-Endurance Questionnaire (AEQ). Validity was calculated using the criteria variables pain intensity, disability, chronic pain grades (CPG) and number of sick days, further self-report measures (Fear-Avoidance Beliefs Questionnaire FABQ, Pain Anxiety Symptoms Scale PASS, Tampa Scale of Kinesiophobia TSK and Beck Depression Inventory BDI) evaluating construct validity.ResultsPCA revealed five AEQ-FAR scales with anxiety/depression, catastrophizing, help-/hopelessness, avoidance of social activities, avoidance of physical activities, and four AEQ-ER scales with positive mood, thought suppression, pain persistence behavior and humor/distraction. All scales revealed high internal consistency. As expected, FAR scales showed positive associations with pain, disability and other FAR variables (correlations between r=.26 and r=.58), whereas ER scales showed negative associations (between r=-.19 and -.48). The only exception referred to positive correlations between both, FAR and ER and pain intensity.ConclusionsThe AEQ has shown as a reliable and valid measure to assess pattern of fear-avoidance and endurance-related responses to pain. Both aspects seem to play a role in the maintenance of LBP.

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