Parameters of low back pain chronicity among athletes: associations with physical and mental stress

Objective: In the general population, physical and mental stress factors are linked to chronic low back pain (LBP). The aim of the present study was to examine this association among athletes

Exploring cognitive factors in pain persistence behavior: some methodological and theoretical considerations — a commentary on a study by Andrews et al.

This paper is a commentary on a study by Andrews et al. It makes some methodological points pertinent to qualitative methods and discusses cognitive factors in pain persistence behaviour

Effective Reassurance in Primary Care of Low Back Pain: What Messages From Clinicians are Most Beneficial at Early Stages of LBP?

OBJECTIVES:: Effective reassurance of patients suffering from complaints for which no clear aetiological origin is available, is one of the most important challenges in the early phases of non-specific back pain. However, there is a lack of empirical studies on the effects of reassurance and, effects shown, were small. Improvements are needed with respect to the process of physician-patient interaction and to the methods used by the physician.METHODS:: We provide a short narrative review of the literature with special reference to affective and cognitive communication, based on a systematic review of 16 studies. We further consider recent evidence in the prognosis of low back pain, the role of physical activity and sub-groups-based individual differences in pain coping, questioning the information basis of reassurance.RESULTS:: A two-process model of affective and cognitive reassurance, was supported. Recovery improved in a combination of communication of empathy with cognitive reassurance, giving concrete information and instructions. In terms of information, recent research indicate that a substantial rate of patients do not recover within the first year after onset of back pain. Further, very low and high levels of physical activity are associated with pain and disability, associated with cognitive/behavioural pain coping.DISCUSSION:: Reassurance of patients in early phases of persistent back pain might improve from affective and cognitive parts of communication and individually tailored information. Subgroup differences with respect to different prognosis, associated patterns of adaptive or maladaptive pain coping and levels of health-promoting versus harmful physical activity should be considered more carefully

Avoidance and endurance in chronic pain:A self- regulation perspective

This chapter focuses on two vexing aspects of coping with daily activities while experiencing pain-the tendency to avoid actions that are perceived as exacerbating the pain (avoidance), and the tendency to endure pain by persistent engagement in ongoing activities (endurance). Based on theoretical approaches such as the fear-avoidance and the avoidance-endurance models of pain, the chapter provides insights into the wide variety of cognitive, emotional, and behavioral pain responses that are related to an avoidant or endurance pain response style and aspects of dysfunctionality. Several specific response patterns are identified that mirror dysfunctional avoidance or endurance in addition to an adaptive pattern. The chapter provides preliminary evidence from both clinical and experimental research and is based on selected models of goal striving as conceptualized within a broad self-regulation perspective

Stress-related psychological factors for back pain among athletes: important topic with scarce evidence

Health issues represent a frequent problem for athletes, as this particular demographic is repeatedly confronted with physically and psychologically stressful situations. Back pain (BP) materialises as comparatively common health problem being regarded as functionally limiting and psychologically straining burden for athletes. According to research conducted on athletes with BP, biomechanical and physiological mechanisms emerge as influential, whereas stress-related psychological factors appear to be neglected. For athletic injuries, the essential impact of psychological processes on injury occurrence and return from injury has already been corroborated. Hence, the aim of this literature review is to: (1) introduce a conceptual differentiation between injuries and BP; (2) summarise the results obtained regarding stress-related psychological aspects for injuries; and (3) connect the injury research to the state-of-the-art evidence regarding stress-related factors for BP among athletes. A distinction between injuries and BP could be established based on previous definitions, despite the fact that a considerable overlap between both concepts prevails. Injuries can be attributed to a physical origin, whereas BP frequently lacks this physical criterion. For BP, our enquiry yielded four studies including psychological measures of stress – with two studies specifically examining the association between BP and psychological stress among athletes longitudinally. Abundant findings from the general population support the importance of considering psychological and specifically stress-related factors in BP prevention and rehabilitation, but evidence related to the athletic field remains elusive. Further scientific investigations with a wider methodological approach are needed to deepen the knowledge about the crucial relationship between psychological stress, BP, and athletes

Pain Unstuck: The Role of Action and Motivation

Background: What is it that motivates our actions? As human beings, existing as part of complex societies, the actions we take are subject to multiple, often competing motives. Spanning nonconscious reflexes, cognitively derived choice as well as long- and short-term goals, our actions allow us to make sense of our environment. Pain disrupts action and hijacks our intentions. Whilst considered adaptive when temporary, pain that persists continues to interrupt and can threaten our ability to actively investigate a changing world. Objective: This work is a narrative review. Results: Drawing upon three complementary theoretical approaches to pain: an embodied framework, a motivational approach and the avoidance-endurance model, this review places the relationship between pain, motivation and action at its core, unpicking a dynamic process that can become stuck. Conclusions: In taking a wide view of pain and action, we expose the nuances within drive to goal behaviour in the presence of pain. This has implications for the clinic, specifically in relation to assessing the multifactorial influences that shape action in pain. But it also seeks to go further, considering the broader environment in which we make decisions and the influence that other professionals, outside of typical healthcare roles, may play a part in the maintenance and resolution of pain. Key Words: pain unstuck, embodied pain, motivation, cognitive bias, avoidance vs. enduranc