TY - JOUR A1 - Wernicke, Sarah A1 - de Witt Huberts, Jessie A1 - Wippert, Pia-Maria T1 - The pain of being misunderstood BT - Invalidation of pain complaints in chronic low back pain patients JF - Journal of Health Psychology N2 - A particular form of social pain is invalidation. Therefore, this study (a) investigates whether patients with chronic low back pain experience invalidation, (b) if it has an influence on their pain, and (c) explores whether various social sources (e.g. partner and work) influence physical pain differentially. A total of 92 patients completed questionnaires, and for analysis, Pearson’s correlation coefficients and hierarchical linear regression analyses were conducted. They indicated a significant association between discounting and disability due to pain (respective β = .29, p > .05). Especially, discounting by partner was linked to higher disability (β = .28, p > .05). KW - chronic low back pain KW - disability KW - invalidation KW - social pain KW - social rejection Y1 - 2017 U6 - https://doi.org/10.1177/1359105315596371 SN - 1359-1053 SN - 1461-7277 VL - 22 SP - 135 EP - 147 PB - Sage Publ. CY - London ER - TY - GEN A1 - De Witt Huberts, Jessie A1 - Niederer, Daniel A1 - Wippert, Pia-Maria A1 - Mayer, Frank T1 - The effects of a new practical and synergetic multimodal treatment for chronic back pain on pain-related cognitions and wellbeing T2 - Psychosomatic medicine Y1 - 2017 SN - 0033-3174 SN - 1534-7796 VL - 79 IS - 4 SP - A22 EP - A23 PB - Lippincott Williams & Wilkins CY - Philadelphia ER - TY - JOUR A1 - Fliesser, Michael A1 - De Witt Huberts, Jessie A1 - Wippert, Pia-Maria T1 - The choice that matters: the relative influence of socioeconomic status indicators on chronic back pain- a longitudinal study JF - BMC health services research N2 - Background: In health research, indicators of socioeconomic status (SES) are often used interchangeably and often lack theoretical foundation. This makes it difficult to compare results from different studies and to explore the relationship between SES and health outcomes. To aid researchers in choosing appropriate indicators of SES, this article proposes and tests a theory-based selection of SES indicators using chronic back pain as a health outcome. Results: Chronic back pain intensity was best predicted by the multidimensional index (beta = 0.31, p < 0.05), followed by job position (beta = 0.29, p < 0.05) and education (beta = -0.29, p < 0.05); whereas, income exerted no significant influence. Back pain disability was predicted strongest by education (beta = -0.30, p < 0.05) and job position (beta = 0. 29, p < 0.05). Here, multidimensional index and income had no significant influence. Conclusions: The choice of SES indicators influences predictive power on both back pain dimensions, suggesting SES predictors cannot be used interchangeably. Therefore, researchers should carefully consider prior to each study which SES indicator to use. The introduced framework can be valuable in supporting this decision because it allows for a stable prediction of SES indicator influence and their hierarchy on a specific health outcomes. KW - socioeconomic status KW - Indicators of socioeconomic status KW - health inequality KW - education KW - job position KW - income KW - chronic back pain Y1 - 2017 U6 - https://doi.org/10.1186/s12913-017-2735-9 SN - 1472-6963 VL - 17 PB - BioMed Central CY - London ER - TY - JOUR A1 - Fliesser, Michael A1 - De Witt Huberts, Jessie A1 - Wippert, Pia-Maria T1 - The choice that matters: the relative influence of socioeconomic status indicators on chronic back pain BT - a longitudinal study JF - BMC health services research N2 - Background In health research, indicators of socioeconomic status (SES) are often used interchangeably and often lack theoretical foundation. This makes it difficult to compare results from different studies and to explore the relationship between SES and health outcomes. To aid researchers in choosing appropriate indicators of SES, this article proposes and tests a theory-based selection of SES indicators using chronic back pain as a health outcome. Methods Strength of relationship predictions were made using Brunner & Marmot’s model of ‘social determinants of health’. Subsequently, a longitudinal study was conducted with 66 patients receiving in-patient treatment for chronic back pain. Sociodemographic variables, four SES indicators (education, job position, income, multidimensional index) and back pain intensity and disability were obtained at baseline. Both pain dimensions were assessed again 6 months later. Using linear regression, the predictive strength of each SES indicator on pain intensity and disability was estimated and compared to the theory based prediction. Results Chronic back pain intensity was best predicted by the multidimensional index (beta = 0.31, p < 0.05), followed by job position (beta = 0.29, p < 0.05) and education (beta = −0.29, p < 0.05); whereas, income exerted no significant influence. Back pain disability was predicted strongest by education (beta = −0.30, p < 0.05) and job position (beta = 0.29, p < 0.05). Here, multidimensional index and income had no significant influence. Conclusions The choice of SES indicators influences predictive power on both back pain dimensions, suggesting SES predictors cannot be used interchangeably. Therefore, researchers should carefully consider prior to each study which SES indicator to use. The introduced framework can be valuable in supporting this decision because it allows for a stable prediction of SES indicator influence and their hierarchy on a specific health outcomes. KW - Socioeconomic status KW - Indicators of socioeconomic status, Health inequality KW - Education KW - Job position KW - Income KW - Chronic back pain Y1 - 2017 U6 - https://doi.org/10.1186/s12913-017-2735-9 SN - 1472-6963 VL - 17 PB - BioMed Central CY - London ER - TY - JOUR A1 - Wippert, Pia-Maria A1 - Rector, Michael V. A1 - Kuhn, Gisela A1 - Wuertz-Kozak, Karin T1 - Stress and Alterations in Bones BT - An Interdisciplinary Perspective JF - Frontiers in endocrinology N2 - Decades of research have demonstrated that physical stress (PS) stimulates bone remodeling and affects bone structure and function through complex mechanotransduction mechanisms. Recent research has laid ground to the hypothesis that mental stress (MS) also influences bone biology, eventually leading to osteoporosis and increased bone fracture risk. These effects are likely exerted by modulation of hypothalamic–pituitary–adrenal axis activity, resulting in an altered release of growth hormones, glucocorticoids and cytokines, as demonstrated in human and animal studies. Furthermore, molecular cross talk between mental and PS is thought to exist, with either synergistic or preventative effects on bone disease progression depending on the characteristics of the applied stressor. This mini review will explain the emerging concept of MS as an important player in bone adaptation and its potential cross talk with PS by summarizing the current state of knowledge, highlighting newly evolving notions (such as intergenerational transmission of stress and its epigenetic modifications affecting bone) and proposing new research directions. KW - biomechanics KW - bone–brain–nervous system interactions KW - endocrine pathways KW - osteoporosis KW - exercise Y1 - 2017 U6 - https://doi.org/10.3389/fendo.2017.00096 SN - 1664-2392 VL - 8 PB - Frontiers Research Foundation CY - Lausanne ER - TY - JOUR A1 - Wippert, Pia-Maria A1 - Fliesser, Michael A1 - Krause, Matthias T1 - Risk and protective factors in the clinical rehabilitation of chronic back pain JF - Journal of pain research N2 - Objectives: Chronic back pain (CBP) can lead to disability and burden. In addition to its medical causes, its development is influenced by psychosocial risk factors, the so-called flag factors, which are categorized and integrated into many treatment guidelines. Currently, most studies investigate single flag factors, which limit the estimation of individual factor significance in the development of chronic pain. Furthermore, factors concerning patients’ lifestyle, biography and treatment history are often neglected. Therefore, the objectives of the present study are to identify commonly neglected factors of CBP and integrate them into an analysis model comparing their significance with established flag factors. Methods: A total of 24 patients and therapists were cross-sectionally interviewed to identify commonly neglected factors of CBP. Subsequently, the impact of these factors was surveyed in a longitudinal study. In two rehabilitation clinics, CBP patients (n = 145) were examined before and 6 months after a 3-week inpatient rehabilitation. Outcome variables, chronification factor pain experience (CF-PE) and chronification factor disability (CF-D), were ascertained with confirmatory factor analysis (CFA) of standardized questionnaires. Predictors were evaluated using stepwise calculations of simple and multiple regression models. Results: Through interviews, medical history, iatrogenic factors, poor compliance, critical life events (LEs), social support (SS) type and effort–reward were identified as commonly neglected factors. However, only the final three held significance in comparison to established factors such as depression and pain-related cognitions. Longitudinally, lifestyle factors found to influence future pain were initial pain, physically demanding work, nicotine consumption, gender and rehabilitation clinic. LEs were unexpectedly found to be a strong predictor of future pain, as were the protective factors, reward at work and perceived SS. Discussion: These findings shed insight regarding often overlooked factors in the development of CBP, suggesting that more detailed operationalization and superordinate frameworks would be beneficial to further research. Conclusion: In particular, LEs should be taken into account in future research. Protective factors should be integrated in therapeutic settings. KW - yellow flags KW - life events KW - clinical pain research Y1 - 2017 U6 - https://doi.org/10.2147/JPR.S134976 SN - 1178-7090 VL - 10 SP - 1569 EP - 1579 PB - Dove Medical Press CY - Albany, Auckland ER - TY - JOUR A1 - Linden, Michael A1 - Bernert, Sebastian A1 - Funke, Ariane A1 - Dreinhöfer, Karsten E. A1 - Jöbges, Michael A1 - von Kardorff, Ernst A1 - Riedel-Heller, Steffi G. A1 - Spyra, Karla A1 - Völler, Heinz A1 - Warschburger, Petra A1 - Wippert, Pia-Maria T1 - Medizinische Rehabilitation unter einer Lifespan-Perspektive T1 - Medical rehabilitation from a lifespan perspective JF - Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz N2 - Die Lifespan-Forschung untersucht die Entwicklung von Individuen über den gesamten Lebenslauf. Die medizinische Rehabilitation hat nach geltendem Sozialrecht die Aufgabe, chronische Krankheiten abzuwenden, zu beseitigen, zu mindern, auszugleichen, eine Verschlimmerung zu verhüten und Negativfolgen für die Lebensführung zu reduzieren. Dies erfordert in wissenschaftlicher wie in praxisbezogener Hinsicht die Entwicklung einer Lebensspannenperspektive als Voraussetzung für die Klassifikation und Diagnostik chronischer Erkrankungen, die Beschreibung von verlaufsbeeinflussenden Faktoren, kritischen Lebensphasen und Critical Incidents (kritische Verlaufszeitpunkte), die Durchführung von prophylaktischen Maßnahmen, die Entwicklung von Assessmentverfahren zur Erfassung und Bewertung von Verläufen oder Vorbehandlungen, die Auswahl und Priorisierung von Interventionen, eine Behandlungs- und Behandlerkoordination auf der Zeitachse, die Präzisierung der Aufgabenstellung für spezialisierte Rehabilitationsmaßnahmen, wie beispielsweise Rehabilitationskliniken, und als Grundlage für die Sozialmedizin. Aufgrund der Vielfalt der individuellen Risikokonstellationen, Krankheitsverläufe und Behandlungssituationen über die Lebensspanne hinweg, bedarf es in der medizinischen Rehabilitation in besonderer Weise einer personalisierten Medizin, die zugleich rehabilitationsförderliche und -behindernde Umweltfaktoren im Rehabilitationsverlauf berücksichtigt. N2 - Lifespan research investigates the development of individuals over the course of life. As medical rehabilitation deals with primary and secondary prophylaxis, treatment, and compensation of chronic illnesses, a lifespan perspective is needed for the classification and diagnosis of chronic disorders, the assessment of course modifying factors, the identification of vulnerable life periods and critical incidents, the implementation of preventive measures, the development of methods for the evaluation of prior treatments, the selection and prioritization of interventions, including specialized inpatient rehabilitation, the coordination of therapies and therapists, and for evaluations in social and forensic medicine. Due to the variety of individual risk constellations, illness courses and treatment situations across the lifespan, personalized medicine is especially important in the context of medical rehabilitation, which takes into consideration hindering and fostering factors alike. KW - Medical rehabilitation KW - Lifespan KW - Chronic illness KW - Personalized medicine KW - Prevention KW - Medizinische Rehabilitation KW - Lebensspanne KW - Chronische Krankheit KW - Personalisierte Medizin KW - Prävention Y1 - 2017 U6 - https://doi.org/10.1007/s00103-017-2520-2 SN - 1436-9990 SN - 1437-1588 VL - 60 SP - 445 EP - 452 PB - Springer CY - New York ER - TY - GEN A1 - Puschmann, Anne-Kathrin A1 - Beck, Heidrun A1 - Schiltenwolf, Marcus A1 - Wippert, Pia-Maria A1 - Mayer, Frank T1 - Distress in a longitudinal study of a population with nonspecific low back pain T2 - Psychosomatic medicine Y1 - 2017 SN - 0033-3174 SN - 1534-7796 VL - 79 SP - A20 EP - A21 PB - Lippincott Williams & Wilkins CY - Philadelphia ER - TY - JOUR A1 - Wippert, Pia-Maria A1 - Puschmann, Anne-Katrin A1 - Arampatzis, Adamantios A1 - Schiltenwolf, Marcus A1 - Mayer, Frank T1 - Diagnosis of psychosocial risk factors in prevention of low back pain in athletes (MiSpEx) JF - BMJ Open Sport & Exercise Medicine N2 - Background Low back pain (LBP) is a common pain syndrome in athletes, responsible for 28% of missed training days/year. Psychosocial factors contribute to chronic pain development. This study aims to investigate the transferability of psychosocial screening tools developed in the general population to athletes and to define athlete-specific thresholds. Methods Data from a prospective multicentre study on LBP were collected at baseline and 1-year follow-up (n=52 athletes, n=289 recreational athletes and n=246 non-athletes). Pain was assessed using the Chronic Pain Grade questionnaire. The psychosocial Risk Stratification Index (RSI) was used to obtain prognostic information regarding the risk of chronic LBP (CLBP). Individual psychosocial risk profile was gained with the Risk Prevention Index – Social (RPI-S). Differences between groups were calculated using general linear models and planned contrasts. Discrimination thresholds for athletes were defined with receiver operating characteristics (ROC) curves. Results Athletes and recreational athletes showed significantly lower psychosocial risk profiles and prognostic risk for CLBP than non-athletes. ROC curves suggested discrimination thresholds for athletes were different compared with non-athletes. Both screenings demonstrated very good sensitivity (RSI=100%; RPI-S: 75%–100%) and specificity (RSI: 76%–93%; RPI-S: 71%–93%). RSI revealed two risk classes for pain intensity (area under the curve (AUC) 0.92(95% CI 0.85 to 1.0)) and pain disability (AUC 0.88(95% CI 0.71 to 1.0)). Conclusions Both screening tools can be used for athletes. Athlete-specific thresholds will improve physicians’ decision making and allow stratified treatment and prevention. Y1 - 2017 U6 - https://doi.org/10.1136/bmjsem-2017-000295 SN - 2055-7647 VL - 3 IS - 1 ER - TY - JOUR A1 - Wippert, Pia-Maria A1 - Puschmann, Anne-Katrin A1 - Drießlein, David A1 - Arampatzis, Adamantios A1 - Banzer, Winfried A1 - Beck, Heidrun A1 - Schiltenwolf, Marcus A1 - Schmidt, Hendrik A1 - Schneider, Christian A1 - Mayer, Frank T1 - Development of a risk stratification and prevention index for stratified care in chronic low back pain. Focus: yellow flags (MiSpEx network) JF - Pain reports N2 - Introduction: Chronic low back pain (LBP) is a major cause of disability; early diagnosis and stratification of care remain challenges. Objectives: This article describes the development of a screening tool for the 1-year prognosis of patients with high chronic LBP risk (risk stratification index) and for treatment allocation according to treatment-modifiable yellow flag indicators (risk prevention indices, RPI-S). Methods: Screening tools were derived from a multicentre longitudinal study (n = 1071, age >18, intermittent LBP). The greatest prognostic predictors of 4 flag domains ("pain," "distress," "social-environment," "medical care-environment") were determined using least absolute shrinkage and selection operator regression analysis. Internal validity and prognosis error were evaluated after 1-year follow-up. Receiver operating characteristic curves for discrimination (area under the curve) and cutoff values were determined. Results: The risk stratification index identified persons with increased risk of chronic LBP and accurately estimated expected pain intensity and disability on the Pain Grade Questionnaire (0-100 points) up to 1 year later with an average prognosis error of 15 points. In addition, 3-risk classes were discerned with an accuracy of area under the curve = 0.74 (95% confidence interval 0.63-0.85). The RPI-S also distinguished persons with potentially modifiable prognostic indicators from 4 flag domains and stratified allocation to biopsychosocial treatments accordingly. Conclusion: The screening tools, developed in compliance with the PROGRESS and TRIPOD statements, revealed good validation and prognostic strength. These tools improve on existing screening tools because of their utility for secondary preventions, incorporation of exercise effect modifiers, exact pain estimations, and personalized allocation to multimodal treatments. KW - Back pain prognosis KW - Back pain diagnosis KW - Pain screening KW - PROGRESS/TRIPOD KW - Prediction of disability/intensity KW - Yellow flags KW - Exercise Y1 - 2017 U6 - https://doi.org/10.1097/PR9.0000000000000623 VL - 9 SP - 1 EP - 11 PB - Wolters Kluwer Health CY - Riverwoods, IL ER -