From acute to chronic back pain : risk factors, mechanisms, and clinical implications

607 Pages·2012·2.38 MB·English

by  Monika I. Hasenbring

From Acute to Chronic
Back Pain
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From Acute to Chronic
Back Pain
Risk Factors, Mechanisms,
and Clinical Implications
Edited by
Monika I. Hasenbring
Department of Medical Psychology and Medical Sociology,
Faculty of Medicine,
Ruhr-University,
Bochum, Germany
Adina C. Rusu
Department of Medical Psychology and Medical Sociology,
Faculty of Medicine,
Ruhr-University,
Bochum, Germany,
Department of Psychology, Royal Holloway,
University of London,
London, UK
Dennis C. Turk
School of Medicine,
University of Washington,
Seattle, Washington, USA
1
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1

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Preface
Chronic back pain has been and continues to be a major cause of distress (both to people with
persistent pain and their significant others), disability, work loss, and costs to society. Moreover,
with the aging population, it is becoming even more prevalent and as a consequence is having an
escalating impact upon the healthcare systems and society as a whole worldwide. A significant
issue concerns understanding why, although the majority of people with acute back symptoms
recover in a reasonable time, a significant minority evolve into patients with chronic pain and
prolonged pain-related disability. Understanding the variables that contribute to chronicity could
serve as a basis for early intervention to prevent the downward spiral. A growing number of stud-
ies have been conducted designed to discover predictors of chronicity and clinical trials have been
initiated in an attempt to identify targets for intervention. To date there have been no volumes
that have attempted to compile this research in a single source or that integrate the results of
available studies in order to facilitate prevention and intervention in practice.
T he identification of clinically relevant risk factors in low back pain has broad practical impli-
cations for the healthcare system globally. During the past 15 years, psychosocial risk factors and
psychobiological mechanisms have been identified as important risk factors and have led to the
development of early screening methods (e.g. ‘yellow flag’ diagnostics) and new psychosocial
interventions by targeting treatment modalities to patients’ particular characteristics and needs
(risk factor-based interventions for pain and pain-related disability). Research is evolving from
asking ‘What treatments work?’ to a set of inter-related questions: ‘What treatments are most
effective to people with what set of characteristics, provided when, on what outcome measures,
compared to what alternatives, and at what costs?’. However, substantial aspects of the pathway
from acute to chronic pain still remain unexplained. Recent neurobiological paradigms investi-
gating genetic, neurophysiological, and biomechanical processes elucidate important mecha-
nisms of chronic back pain, which represent important pathways from acute to chronic pain.
We hope that these paradigms will lead to the development of new pharmacological and non-
pharmacological treatment approaches, which might establish evidence that supports a compre-
hensive approach to assessment and treatment of back pain spanning the entire spectrum
from acute through prevention and treatment of chronic pain and disability. Early and more
appropriate interventions are needed to prevent long-term, disabling back pain with accompany-
ing socioeconomic consequences.
T his book was conceived following a series of discussions at international conferences and
symposia about the future of evidence-based pain science and research between the three of us
several years ago. We felt that there was an absence of a single volume that integrated the large but
disparate body of knowledge of numerous specialties — medicine, psychology, and physiotherapy.
The major aim of the symposia that preceded the development of the current publication was to
present advances in basic pain research with a view to their relevance for the transition from acute
to chronic pain. Thus, the meetings presented an opportunity for some of the most prominent
pain scientists to present and critically discuss their current findings in an interdisciplinary set-
ting. These conferences proved to be extremely stimulating to all parties and it revealed that much
knowledge needs to be synthesized and transferred from research to the clinical practice. We hope
that this book will fill a void by translating basic pain research to clinical practice in back pain.
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vi PREFACE
The volume should be of equal interest to clinicians from multiple and diverse specialties who are
involved in the treatment of back pain patients, as well as to pain researchers. Clinicians working
with back pain patients and wanting to understand more about the basic mechanisms underlying
back pain as well as novel developments in the clinical science will find a wealth of information in
this book. To our knowledge, no other book has exactly this focus, and we hope that it may
c ontribute to further increase the collaboration and the exchange of information between back
pain experts and basic pain scientists.
We focused on three main themes in conceptualizing this text: (1) the mechanisms involved in
the transition from acute to persistent pain; (2) the concept of treatment-relevant subgroups; and
(3) how available research evidence can inform the prevention management of acute and chronic
back pain. The volume brings together an internationally renowned group of contributors who
are recognized as experts in their fields. It is organized in six inter-related sections. In Part 1, we
introduced current developments in pain epidemiology. We also included chapters on recent
neurobiological paradigms investigating genetic, neurophysiological (Part 2), biomechanical
processes (Part 3), and psychosocial mechanisms including fear-avoidance, endurance, cognitive
processing, and significant others/behavioral (Part 4) that may represent important pathways
from acute to chronic pain. Part 5 delineates important advances in the practitioner’s role in the
process of care. Parts 6 to 9 summarize important advances to diagnostics and treatment of acute,
subacute, and chronic back pain. In these final sections we extended the approach of treatment-
relevant subgroups further and provide ideas on how to relate those findings to the prevention
management of acute, sub-acute, and chronic back pain and disability.
M ulti-author books take some years from initial conceptualization to publication. Hopefully,
that wait will have been worthwhile, both for those readers who have been aware of impending
completion of the text and for the authors themselves. When drafting the first outline of the
c urrent edited volume, we intended to develop a book that would stimulate discussion and offers
avenues of future investigation and collaboration. Publication of this volume should be viewed as
a status report and serve as a stimulus for additional research as there remains much that is not
understood and much needs to be learned to prevent chronic pain and pain-related disability.
Clinicians should find the materials as a useful guide for approach patients with acute, subacute,
and chronic pain but they need to continue to follow research developments to enhance their
approaches as evidence becomes available.
Monika I. Hasenbring
Adina C. Rusu
Dennis C. Turk
Bochum, Germany and S eattle, Washington, USA March 2011

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Contents
List of Contributors xi
List of Abbreviations xv
Part 1 Current Developments in Epidemiology
1 Epidemiology of Back Pain, from the Laboratory to the Bus Stop:
Psychosocial Risk Factors, Biological Mechanisms, and Interventions in Population-
Based Research 3
Blair H. Smith, Nicola Torrance, and Gary J. Macfarlane
2 Defining Chronic Pain by Prognosis 21
Kate M. Dunn, Michael Von Korff, and Peter R. Croft
Part 2 Risk Factors of Chronic Back Pain and Disability:
Biological Mechanisms
3 Genetic Factors Modulating Chronic Back Pain 43
Julia Metzner and Irmgard Tegeder
4 Peripheral and Central Sensitization as Risk Factors of Low Back Pain 55
Hermann O. Handwerker
5 Dysfunction of the Hypothalamic–Pituitary–Adrenal Axis and Associated Stress
Axes in the Development of Chronic Low Back Pain 69
John McBeth and Andrea Power
6 Central Imaging of Pain and the Process of Chronicity 89
Sandra Kamping and Herta Flor
7 Structural Brain Changes in Patients with Chronic Back Pain 105
Arne May and A. Vania Apkarian
8 The Psychophysiology of Chronic Back Pain Patients 115
Kati Thieme and Richard H. Gracely
Part 3 Risk Factors of Chronic Back Pain and Disability:
Biomechanical Mechanisms
9 Electromyographically-Determined Muscular Fatigue in Low Back Pain 155
Anne F. Mannion and David O’Riordan
10 Unmasking the Deconditioning Paradigm for Chronic Low Back Pain
Patients 185
Jeanine Verbunt, Rob J.E.M. Smeets, and Harriet Wittink
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viii CONTENTS
Part 4 Risk Factors of Chronic Back Pain and Disability:
Sociodemographic and Psychosocial Mechanisms
1 1 Screening of Psychosocial Risk Factors (Yellow Flags) for Chronic Back Pain
and Disability 203
Chris J. Main, Nicholas A.S. Kendall, and Monika I. Hasenbring
12 Dispositional Fear, Anxiety Sensitivity, and Hypervigilance 231
R. Nicholas Carleton and Gordon J.G. Asmundson
1 3 Processes Underlying the Relation between Catastrophizing and
Chronic Pain: Implications for Intervention 251
Michael J.L. Sullivan and Marc O. Martel
14 Fear-Avoidance as a Risk Factor for the Development of Chronic Back
Pain and Disability 269
Linda Vancleef, Ida Flink, Steven J. Linton, and Johan Vlaeyen
1 5 Endurance-Related Pain Responses in the Development of
Chronic Back Pain 295
Monika I. Hasenbring, Dirk Hallner, and Adina C. Rusu
16 Cognitive Processing and Self-Pain Enmeshment in Chronic Back Pain 315
Adina C. Rusu and Tamar Pincus
1 7 Significant Others in the Chronicity of Pain and Disability 339
Annmarie Cano and Laura Leong
18 Effects of Workers’ Compensation Systems on Recovery from
Disabling Injuries 355
James P. Robinson and John D. Loeser
1 9 Work-Related Risk Factors for Transition to Chronic Back Pain
and Disability 377
William S. Shaw, Glenn S. Pransky, and Chris J. Main
Part 5 Practitioner’s Role in the Process of Care
2 0 The Physician as Disability Advisor for Back Pain Patients 391
James Rainville, Glenn S. Pransky, Sarah Gibson, and Pradeep Suri
2 1 The Attitudes and Beliefs of Clinicians Treating Back Pain: Do They
Affect Patients’ Outcome? 405
Tamar Pincus, Rita Santos, and Steven Vogel
Part 6 Clinical Implications: New Approaches to
Diagnostics and Treatment
2 2 International Guidelines for the Diagnostics and Treatment of Acute,
Subacute, and Chronic Back Pain 419
Maurits van Tulder and Bart Koes
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CONTENTS ix
Part 7 Clinical Approaches for Patients with Acute
and Subacute Low Back Pain
2 3 Engaging Patients in their Own Care for Back Care: The Role of Education
and Advice in the Prevention of Chronic Pain and Disability 433
Chris J. Main and Kim Burton
2 4 Motivational Issues in Pain Management 453
Robert D. Kerns, Mark P. Jensen, and Warren R. Nielson
25 Pharmacotherapy of Low Back Pain 471
Kay Brune and Bertold Renner
Part 8 Subgroup-Specific Approaches for Patients at
Risk For or With Chronic Pain
2 6 Reviewing the Concept of Subgroups in Subacute and Chronic Pain and
the Potential of Customizing Treatments 485
Adina C. Rusu, Katja Boersma, and Dennis C. Turk
2 7 Risk Factor-Based Cognitive-Behavioural Therapy for Acute and Subacute
Back Pain 513
Monika I. Hasenbring, Bernhard W. Klasen, and Adina C. Rusu
Part 9 Clinical Approaches for Patients with Established
Pain and Disability
2 8 Physical Exercise Interventions and Low Back Pain 531
J. Bart Staal, Chris G. Maher, and William S. Shaw
29 Contextual Cognitive-Behavioural Therapy for Chronic Pain (Including
Back Pain) 547
Lance M. McCracken
3 0 Rehabilitation Programmes to Prevent Severely Disabling Chronic
Back Pain 565
Michael K. Nicholas and Rob J.E.M. Smeets
Index 581
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