Skip to main content
SpringerLink
Log in

Expositionstherapie bei chronischen Rückenschmerzen

Exposure therapy for chronic back pain

  • Schwerpunkt
  • Published:
Der Schmerz Aims and scope Submit manuscript

Zusammenfassung

Die Expositionstherapie ist eine ökonomische und vielversprechende psychologische Methode zur Behandlung chronischer Rückenschmerzen, die allerdings noch wenig erforscht ist und deren Evidenz weiter geklärt werden muss. Expositionstherapie findet bisher wenig Anwendung in der Praxis, was einerseits an den wenigen veröffentlichten Studien zu diesem Thema und andererseits an der Unsicherheit der Behandler, ob Expositionen gefahrenlos durchgeführt werden können, liegt. Expositionstherapie ist den Tailored-treatment-Ansätzen zuzuordnen, bei denen Patienten mit bestimmten Profilen (hier: erhöhte Angst vor Bewegung) spezifische Behandlungen bekommen. In dem Übersichtsartikel werden die theoretischen Grundlagen der Expositionstherapie vorgestellt. Anschließend werden Möglichkeiten zur Identifikation der für die Expositionsbehandlung geeigneten Patienten erläutert. Das praktische Vorgehen wird anhand eines Fallbeispiels vorgestellt. Die vier bisher vorliegenden randomisierten, kontrollierten Studien werden ausführlich beschrieben und zusammenfassend diskutiert.

Abstract

Exposure therapy is an economical and promising psychological method for the treatment of chronic back pain, although little research has been done and its evidence needs further clarification. Exposure therapy has so far been little used in practice, which is partly due to the few published studies on this topic and partly to the uncertainty of the practitioners as to whether exposure therapy can be carried out without risk. Exposure therapy can be classified as a “tailored treatment” approach, in which patients with certain profiles (here: increased fear of movement) receive specific treatments. In this review article, the theoretical principles of exposure therapy are presented. Subsequently, possibilities for the identification of those patients suitable for exposure treatment are explained. The practical procedure is presented using a case study. The four randomized controlled trials available to date are described in detail and discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Notes

  1. Ursprünglich wurden die Expositionen entwickelt, um Angst vor Bewegung und deren Folgen, nicht Angst vor Schmerzen zu messen. Allerdings formulieren manche Patienten eher Angst vor dem Nicht-aushalten-Können der Schmerzen. Expositionen können auch dann durchgeführt werden, indem diese Befürchtung überprüft wird.

Literatur

  1. Barke A, Baudewig J, Schmidt-Samoa C, Dechent P, Kroner-Herwig B (2012) Neural correlates of fear of movement in high and low fear-avoidant chronic low back pain patients: an event-related fMRI study. Pain 153(3):540–552. https://doi.org/10.1016/j.pain.2011.11.012

    Article  PubMed  Google Scholar 

  2. Barke A, Preis MA, Schmidt-Samoa C, Baudewig J, Kroner-Herwig B, Dechent P (2016) Neural correlates differ in high and low fear-avoidant chronic low back pain patients when imagining back-straining movements. J Pain 17(8):930–943. https://doi.org/10.1016/j.jpain.2016.05.005

    Article  PubMed  Google Scholar 

  3. Boersma K, Linton S, Overmeer T, Jansson M, Vlaeyen J, de Jong J (2004) Lowering fear-avoidance and enhancing function through exposure in vivo—A multiple baseline study across six patients with back pain. Pain 108(1–2):8–16. https://doi.org/10.1016/j.pain.2003.03.001

    Article  PubMed  Google Scholar 

  4. Chenot J‑F, Greitemann B, Kladny B, Petzke F, Pfingsten M, Schorr SG (2017) Non-specific low back pain. Dtsch Arztebl Int 114(51–52):883–890. https://doi.org/10.3238/arztebl.2017.0883

    Article  PubMed  PubMed Central  Google Scholar 

  5. Claes N, Crombez G, Franssen M, Vlaeyen J (2016) The impact of pavlovian cues on pain avoidance: a behavioral study. Learn Motiv 56:73–83. https://doi.org/10.1016/j.lmot.2016.10.001

    Article  Google Scholar 

  6. Cook AJ, Brawer PA, Vowles KE (2006) The fear-avoidance model of chronic pain: validation and age analysis using structural equation modeling. Pain 121(3):195–206. https://doi.org/10.1016/j.pain.2005.11.018

    Article  PubMed  Google Scholar 

  7. Cross B, Dean S, Hay-Smith J, Weatherall M (2014) Fear avoidance beliefs, held by occupational therapists, are associated with treatment recommendations. Br J Occup Ther 77(6):304–312. https://doi.org/10.4276/030802214x14018723138075

    Article  Google Scholar 

  8. de Jong JR, Vlaeyen J, Onghena P, Cuypers C, den Hollander M, Ruijgrok J (2005) Reduction of pain-related fear in complex regional pain syndrome type I: the application of graded exposure in vivo. Pain 116(3):264–275. https://doi.org/10.1016/j.pain.2005.04.019

    Article  PubMed  Google Scholar 

  9. Dworkin RH, Turk DC, Wyrwich KW, Beaton D, Cleeland CS, Farrar JT, Zavislc S et al (2008) Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations. J Pain 9(2):105–121. https://doi.org/10.1016/j.jpain.2007.09.005

    Article  PubMed  Google Scholar 

  10. Fersum KV, O’Sullivan P, Skouen JS, Smith A, Kvale A (2013) Efficacy of classification-based cognitive functional therapy in patients with non-specific chronic low back pain: a randomized controlled trial. Eur J Pain 17(6):916–928. https://doi.org/10.1002/j.1532-2149.2012.00252.x

    Article  Google Scholar 

  11. Glombiewski JA, Holzapfel S, Riecke J, Vlaeyen JWS, de Jong J, Lemmer G, Rief W (2018) Exposure and CBT for chronic back pain: an RCT on differential efficacy and optimal length of treatment. J Consult Clin Psychol 86(6):533–545. https://doi.org/10.1037/ccp0000298

    Article  PubMed  Google Scholar 

  12. Glombiewski JA, Riecke J, Holzapfel S, Rief W, Konig S, Lachnit H, Seifart U (2015) Do patients with chronic pain show autonomic arousal when confronted with feared movements? An experimental investigation of the fear-avoidance model. Pain 156(3):547–554. https://doi.org/10.1097/01.j.pain.0000460329.48633.ce

    Article  PubMed  Google Scholar 

  13. Hasenbring MI, Hallner D, Rusu AC (2009) Fear-avoidance- and endurance-related responses to pain: development and validation of the avoidance-endurance questionnaire (AEQ). Eur J Pain 13(6):620–628. https://doi.org/10.1016/j.ejpain.2008.11.001

    Article  PubMed  Google Scholar 

  14. Hasenbring MI, Verbunt JA (2010) Fear-avoidance and endurance-related responses to pain: new models of behavior and their consequences for clinical practice. Clin J Pain 26(9):747–753. https://doi.org/10.1097/AJP.0b013e3181e104

    Article  PubMed  Google Scholar 

  15. Helsen K, Goubert L, Vlaeyen J (2013) Observational learning and pain-related fear: exploring contingency learning in an experimental study using colored warm water immersions. J Pain 14(7):676–688. https://doi.org/10.1016/j.jpain.2013.01.771

    Article  PubMed  Google Scholar 

  16. Hoffman BM, Papas RK, Chatkoff DK, Kerns RD (2007) Meta-analysis of psychological interventions for chronic low back pain. Health Psychol 26(1):1–9. https://doi.org/10.1037/0278-6133.26.1.1

    Article  PubMed  Google Scholar 

  17. Holzapfel S, Riecke J, Rief W, Schneider J, Glombiewski JA (2016) Development and validation of the behavioral avoidance testback pain (BAT-back) for patients with chronic low back pain. Clin J Pain 32(11):940–947. https://doi.org/10.1097/ajp.0000000000000349

    Article  PubMed  Google Scholar 

  18. Houben RMA, Leeuw M, Vlaeyen J, Goubert L, Picavet HSJ (2005) Fear of movement/injury in the general population: Factor structure and psychometric properties of an adapted version of the Tampa Scale for Kinesiophobia. J Behav Med 28(5):415–424. https://doi.org/10.1007/s10865-005-9011-x

    Article  PubMed  CAS  Google Scholar 

  19. Klinger R, Soost S, Flor H, Worm M (2007) Classical conditioning and expectancy in placebo hypoalgesia: a randomized controlled study in patients with atopic dermatitis and persons with healthy skin. Pain 128(1–2):31–39. https://doi.org/10.1016/j.pain.2006.08.025

    Article  PubMed  Google Scholar 

  20. Kreddig N, Rusu AC, Burkhardt K, Hasenbring MI (2015) The German PASS-20 in patients with low back pain: new aspects of convergent, divergent, and criterion-related validity. Int J Behav Med 22(2):197–205. https://doi.org/10.1007/s12529-014-9426-2

    Article  PubMed  Google Scholar 

  21. Leeuw M, Goossens M, van Breukelen GJP, de Jong JR, Heuts P, Smeets R, Vlaeyen J et al (2008) Exposure in vivo versus operant graded activity in chronic low back pain patients: Results of a randomized controlled trial. Pain 138(1):192–207. https://doi.org/10.1016/j.pain.2007.12.009

    Article  PubMed  Google Scholar 

  22. Leonhardt C, Kuss K, Becker A, Basler HD, de Jong J, Flatau B, Quint S et al (2017) Graded exposure for chronic low back pain in older adults: a pilot study. J Geriatr Phys Ther 40(1):51–59. https://doi.org/10.1519/jpt.0000000000000083

    Article  PubMed  Google Scholar 

  23. Linton SJ (2000) A review of psychological risk factors in back and neck pain. Spine 25(9):1148–1156. https://doi.org/10.1097/00007632-200005010-00017

    Article  PubMed  CAS  Google Scholar 

  24. Linton SJ, Boersma K, Jansson M, Overmeer T, Lindblom K, Vlaeyen J (2008) A randomized controlled trial of exposure in vivo for patients with spinal pain reporting fear of work-related activities. Eur J Pain 12(6):722–730. https://doi.org/10.1016/j.ejpain.2007.11.001

    Article  PubMed  Google Scholar 

  25. Macedo LG, Smeets R, Maher CG, Latimer J, McAuley JH (2010) Graded activity and graded exposure for persistent nonspecific low back pain: a systematic review. Phys Ther 90(6):860–879. https://doi.org/10.2522/ptj.20090303

    Article  PubMed  Google Scholar 

  26. Norton PJ, Asmundson GJG (2003) Amending the fear-avoidance model of chronic pain: what is the role of physiological arousal? Behav Ther 34(1):17–30. https://doi.org/10.1016/s0005-7894(03)80019-9

    Article  Google Scholar 

  27. O’Sullivan PB, Caneiro JP, O’Keeffe M, Smith A, Dankaerts W, Fersum K, O’Sullivan K (2018) Cognitive functional therapy: an integrated behavioral approach for the targeted management of disabling low back pain. Phys Ther 98(5):408–423. https://doi.org/10.1093/ptj/pzy022

    Article  PubMed  PubMed Central  Google Scholar 

  28. Pfingsten M, Kroner-Herwig B, Leibing E, Kronshage U, Hildebrandt J (2000) Validation of the German version of the Fear-Avoidance Beliefs Questionnaire (FABQ). Eur J Pain 4(3):259–266. https://doi.org/10.1053/eujp.2000.0178

    Article  PubMed  CAS  Google Scholar 

  29. Riecke J, Holzapfel S, Rief W, Glombiewski JA (2013) Evaluation and implementation of graded in vivo exposure for chronic low back pain in a German outpatient setting: a study protocol of a randomized controlled trial. Trials. https://doi.org/10.1186/1745-6215-14-203

    Article  PubMed  PubMed Central  Google Scholar 

  30. Riecke J, Holzapfel S, Rief W, Lachnit H, Glombiewski JA (2016) Cross-cultural adaption of the German Quebec Back Pain Disability Scale: an exposure-specific measurement for back pain patients. J Pain Res 9:9–15. https://doi.org/10.2147/jpr.s92615

    Article  PubMed  PubMed Central  Google Scholar 

  31. Roelofs J, van Breukelen G, Sluiter J, Frings-Dresen MH, Goossens M, Thibault P, Vlaeyen JW et al (2011) Norming of the Tampa Scale for Kinesiophobia across pain diagnoses and various countries. Pain 152(5):1090–1095. https://doi.org/10.1016/j.pain.2011.01.028

    Article  PubMed  Google Scholar 

  32. Rusu AC, Kreddig N, Hallner D, Hulsebusch J, Hasenbring MI (2014) Fear of movement/(Re)injury in low back pain: confirmatory validation of a German version of the Tampa Scale for Kinesiophobia. BMC Musculoskelet Disord 15:280. https://doi.org/10.1186/1471-2474-15-280

    Article  PubMed  PubMed Central  Google Scholar 

  33. Tait RC, Chibnall JT (2005) Factor structure of the pain disability index in workers’ compensation claimants with low back injuries. Arch Phys Med Rehabil 86(6):1141–1146. https://doi.org/10.1016/j.apmr.2004.11.030

    Article  PubMed  Google Scholar 

  34. Thieme K, Gromnica-Ihle E, Flor H (2003) Operant behavioral treatment of fibromyalgia: a controlled study. Arthritis Rheum 49(3):314–320. https://doi.org/10.1002/art.11124

    Article  PubMed  Google Scholar 

  35. Trost Z, France CR, Thomas JS (2009) Examination of the photograph series of daily activities (PHODA) scale in chronic low back pain patients with high and low kinesiophobia. Pain 141(3):276–282. https://doi.org/10.1016/j.pain.2008.11.016

    Article  PubMed  Google Scholar 

  36. Turk DC (2003) Cognitive-behavioral approach to the treatment of chronic pain patients. Reg Anesth Pain Med 28(6):573–579. https://doi.org/10.1016/s1098-7339(03)00392-4

    Article  PubMed  Google Scholar 

  37. Underwood M, Buchbinder R (2013) Red flags for back pain. BMJ 347:f7432. https://doi.org/10.1136/bmj.f7432

    Article  PubMed  Google Scholar 

  38. van der Giessen RN, Speksnijder CM, Helders PJM (2012) The effectiveness of graded activity in patients with non-specific low-back pain: a systematic review. Disabil Rehabil 34(13):1070–1076. https://doi.org/10.3109/09638288.2011.631682

    Article  PubMed  Google Scholar 

  39. Vlaeyen J, Crombez G, Linton SJ (2016) The fear-avoidance model of pain. Pain 157(8):1588–1589. https://doi.org/10.1097/j.pain.0000000000000574

    Article  PubMed  Google Scholar 

  40. Vlaeyen J, de Jong J, Geilen M, Heuts P, van Breukelen G (2001) Graded exposure in vivo in the treatment of pain-related fear: a replicated single-case experimental design in four patients with chronic low back pain. Behav Res Ther 39(2):151–166. https://doi.org/10.1016/s0005-7967(99)00174-6

    Article  PubMed  CAS  Google Scholar 

  41. Wertli MM, Rasmussen-Barr E, Held U, Weiser S, Bachmann LM, Brunner F (2014) Fear-avoidance beliefs-a moderator of treatment efficacy in patients with low back pain: a systematic review. Spine J 14(11):2658–2678. https://doi.org/10.1016/j.spinee.2014.02.033

    Article  PubMed  Google Scholar 

  42. Wideman TH, Asmundson GGJ, Smeets R, Zautra AJ, Simmonds MJ, Sullivan MJL, Edwards RR et al (2013) Rethinking the fear avoidance model: Toward a multidimensional framework of pain-related disability. Pain 154(11):2262–2265. https://doi.org/10.1016/j.pain.2013.06.005

    Article  PubMed  PubMed Central  Google Scholar 

  43. Williams ACD, Eccleston C, Morley S (2012) Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD007407.pub3

    Article  PubMed Central  PubMed  Google Scholar 

  44. Woods MP, Asmundson GJG (2008) Evaluating the efficacy of graded in vivo exposure for the treatment of fear in patients with chronic back pain: A randomized controlled clinical trial. Pain 136(3):271–280. https://doi.org/10.1016/j.pain.2007.06.037

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinische Psychologie und Psychotherapie, Fachbereich Psychologie, Universität Koblenz-Landau, Ostbahnstr. 10, 76829, Landau, Deutschland

    J. A. Glombiewski

Authors
  1. J. A. Glombiewski
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. A. Glombiewski.

Ethics declarations

Interessenkonflikt

J.A. Glombiewski gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren. Für Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts, über die Patienten zu identifizieren sind, liegt von ihnen und/oder ihren gesetzlichen Vertretern eine schriftliche Einwilligung vor.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Glombiewski, J.A. Expositionstherapie bei chronischen Rückenschmerzen. Schmerz 32, 274–282 (2018). https://doi.org/10.1007/s00482-018-0311-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00482-018-0311-9

Schlüsselwörter

Keywords

Search

Navigation