Pain Anxiety und Fear Avoidance Beliefs bei chronischem Rückenschmerz im Alter

Abstract Chronic low back pain (CLBP) is one of the most frequent pain disorders in the elderly. Nonetheless, there is a lack of research about CLBP in this age group. Many studies with younger individuals demonstrate that Fear Avoidance Beliefs (FAB) and pain anxiety impact the process of chronicity. Moreover, treatment studies show the effectiveness of confrontation therapy to overcome FAB and pain anxiety. At old age, however, the significance of the FAB construct remains unclear. There is not only a scarcity of assessment instruments tailored specifically to this age group, but also a disregard of the elderly in treatment studies that cover this topic. The objective of the present studies is to examine the relevance of the FAB and the pain anxiety model for elderly individuals with CLBP and, in addition, to develop assessment instruments for their measurement. The first study shows the relevance of the FAB construct regarding the functional outcome of a physiotherapy treatment. The second study addresses the pain anxiety model and shows that, other than in younger persons, pain anxiety and physiological parameters seem to be less important to explain determinants of avoidant behaviour. The third study finally refers to the well-known significance of a hierarchy of stimuli utilized in certain confrontation treatments. We developed an assessment instrument called AMIKA that is based on photographs of possible aversive behaviours that might provoke anxiety. This instrument showed good psychometric properties and may be used to develop an FAB oriented treatment tailored to the individual. Its usefulness will be tested in a future study about confrontation treatment in elderly patients with CLBP.