TY  - JOUR
A1  - Puschmann, Anne-Katrin
A1  - Drießlein, David
A1  - Beck, Heidrun
A1  - Arampatzis, Adamantios
A1  - Moreno Catalá, Maria
A1  - Schiltenwolf, Marcus
A1  - Mayer, Frank
A1  - Wippert, Pia-Maria
T1  - Stress and Self-Efficacy as Long-Term Predictors for Chronic Low Back Pain
BT  - A Prospective Longitudinal Study
JF  - Journal of Pain Research
N2  - Purpose: Psychosocial variables are known risk factors for the development and chronification of low back pain (LBP). Psychosocial stress is one of these risk factors. Therefore, this study aims to identify the most important types of stress predicting LBP. Self-efficacy was included as a potential protective factor related to both, stress and pain.

Participants and Methods: This prospective observational study assessed n = 1071 subjects with low back pain over 2 years. Psychosocial stress was evaluated in a broad manner using instruments assessing perceived stress, stress experiences in work and social contexts, vital exhaustion and life-event stress. Further, self-efficacy and pain (characteristic pain intensity and disability) were assessed. Using least absolute shrinkage selection operator regression, important predictors of characteristic pain intensity and pain-related disability at 1-year and 2-years follow-up were analyzed.

Results: The final sample for the statistic procedure consisted of 588 subjects (age: 39.2 (± 13.4) years; baseline pain intensity: 27.8 (± 18.4); disability: 14.3 (± 17.9)). In the 1-year follow-up, the stress types “tendency to worry”, “social isolation”, “work discontent” as well as vital exhaustion and negative life events were identified as risk factors for both pain intensity and pain-related disability. Within the 2-years follow-up, Lasso models identified the stress types “tendency to worry”, “social isolation”, “social conflicts”, and “perceived long-term stress” as potential risk factors for both pain intensity and disability. Furthermore, “self-efficacy” (“internality”, “self-concept”) and “social externality” play a role in reducing pain-related disability.

Conclusion: Stress experiences in social and work-related contexts were identified as important risk factors for LBP 1 or 2 years in the future, even in subjects with low initial pain levels. Self-efficacy turned out to be a protective factor for pain development, especially in the long-term follow-up. Results suggest a differentiation of stress types in addressing psychosocial factors in research, prevention and therapy approaches.
KW  - low back pain
KW  - psychosocial risk factors
KW  - stress
KW  - self-efficacy
KW  - MiSpEx
Y1  - 2019
U6  - https://doi.org/10.2147/JPR.S223893
SN  - 1178-7090
VL  - 13
SP  - 613
EP  - 621
PB  - Dove Medical Press
CY  - Albany, Auckland
ER  - 
TY  - JOUR
A1  - Wippert, Pia-Maria
A1  - Wiebking, Christine
T1  - Stress and Alterations in the Pain Matrix
BT  - A Biopsychosocial Perspective on Back Pain and Its Prevention and Treatment
JF  - International Journal of Environmental Research and Public Health
N2  - The genesis of chronic pain is explained by a biopsychosocial model. It hypothesizes an interdependency between environmental and genetic factors provoking aberrant long-term changes in biological and psychological regulatory systems. Physiological effects of psychological and physical stressors may play a crucial role in these maladaptive processes. Specifically, long-term demands on the stress response system may moderate central pain processing and influence descending serotonergic and noradrenergic signals from the brainstem, regulating nociceptive processing at the spinal level. However, the underlying mechanisms of this pathophysiological interplay still remain unclear. This paper aims to shed light on possible pathways between physical (exercise) and psychological stress and the potential neurobiological consequences in the genesis and treatment of chronic pain, highlighting evolving concepts and promising research directions in the treatment of chronic pain. Two treatment forms (exercise and mindfulness-based stress reduction as exemplary therapies), their interaction, and the dose-response will be discussed in more detail, which might pave the way to a better understanding of alterations in the pain matrix and help to develop future prevention and therapeutic concepts
KW  - stress
KW  - allostatic load
KW  - relaxation
KW  - back pain
KW  - chronic pain
KW  - physical activity
KW  - exercise
KW  - neuroplasticity
KW  - pain matrix
Y1  - 2018
U6  - https://doi.org/10.3390/ijerph15040785
SN  - 1660-4601
SN  - 1661-7827
VL  - 15
IS  - 4
SP  - 1
EP  - 11
PB  - MDPI AG
CY  - Basel
ER  -