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Endurance-Related Pain Responses in the Development of Chronic Back Pain 

Endurance-Related Pain Responses in the Development of Chronic Back Pain
Endurance-Related Pain Responses in the Development of Chronic Back Pain

Monika I. Hasenbring

, Dirk Hallner

, and Adina C. Rusu

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date: 28 July 2021

During the past two decades, a significant amount of evidence has supported the impact of pain-related cognitive, affective, and behavioural responses on the development and maintenance of chronic musculoskeletal pain (Turk and Rudy 1992; Waddel 2004; Gatchel et al. 2007). For example, catastrophizing and pain-related fear were identified as important mediators of pain and disability (Linton 2000; Sullivan et al. 2001; Turner and Aaron 2001). The fear-avoidance model (FAM; Vlaeyen and Linton 2000) is a stimulating approach, postulating a pathway between these pain responses, physical disuse and chronic pain (Verbunt et al. 2003, see detailed discussion of the FAM in Chapter 14). However, recently, there is growing evidence that a second, potentially opposite pathway will also lead to the development and maintenance of chronic pain. This alternative pathway is based upon endurance-related responses and includes physical overuse or overload instead of physical disuse as main mediators (Bousema et al. 2007; Hasenbring et al. 2006; Smeets et al. 2007). The avoidance-endurance model (AEM) proposes several pathways for chronicity of pain based on either endurance- or fear avoidance-related responses. The following review will at first focus on research concerning the frequency of self-reported endurance-related responses to pain, as a complement to the well-known fear-avoidance responses. Second, basic assumptions underlying the conceptualization of the AEM will be outlined. This will be followed by a review of existing empirical evidence supporting hypotheses related to the AEM and its consequences for the performance of daily activities will be presented. Finally, clinical implications, such as proposed modifications for behavioural interventions will be described.

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