Der Schmerz
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Review Observational Study
[Avoidance-endurance fast screening (AE-FS) : Content and predictive validity of a 9‑item screening instrument for patients with unspecific subacute low back pain].
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. ⋯ 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.
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Exposure therapy is an economical and promising psychological method for the treatment of chronic back pain, although little research has been done and its evidence needs further clarification. Exposure therapy has so far been little used in practice, which is partly due to the few published studies on this topic and partly to the uncertainty of the practitioners as to whether exposure therapy can be carried out without risk. Exposure therapy can be classified as a "tailored treatment" approach, in which patients with certain profiles (here: increased fear of movement) receive specific treatments. ⋯ Subsequently, possibilities for the identification of those patients suitable for exposure treatment are explained. The practical procedure is presented using a case study. The four randomized controlled trials available to date are described in detail and discussed.
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Adult pain perception is influenced substantially by interactions between mind, body, and social environment during early life. Early stress exposure and traumatic life events induce powerful psychophysical stress reactions that exert multiple neurofunctional processes. ⋯ Based on selected studies, psychophysiological findings are presented and possible underlying mechanisms are discussed. The article concludes with a discussion of potential implications for treatment.
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Progressive muscle relaxation (PMR) after Jacobson has been used for migraine prophylaxis since the early 1970s. Migraine patients are assumed to have an enhanced autonomic arousal which can be counterbalanced by systematic relaxation. Relaxation techniques are thought to reduce the activation level, to alter cortical pain processing and to enhance activation in pain-reducing cortical structures in the periaqueductal grey matter. ⋯ The initially increased CNV amplitude became normalized after regular PMR training in migraine patients. With the review of PMR studies on migraine prophylaxis and the results of our own study it could be shown that PMR is an efficacious non-pharmacological treatment option for migraine prophylaxis. In addition to its clinical effects, alterations in cortical stimulation processing in terms of a normalization of the CNV could be documented.
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Chronic back pain is of enormous health and economic relevance for industrialized countries because a small group of patients with chronic disease is responsible for a large proportion of medical costs. The prevention of chronic disease is therefore a primary goal in the treatment of patients with acute low back pain. Psychological factors are the central risk factors for later chronification. ⋯ It remains unclear which exact cognitive mechanisms are involved in the maintenance and reinforcement of depression and pain-related disability. In this review, the current results of cognitive bias research and theoretical models are presented and summarized regarding the relationship between chronic pain and depression. Finally, the clinical implications and recommendations for clinical research will be presented.