[Psychosocial risk factors for chronic back pain in the general population and in competitive sports : From theory to clinical screening-a review from the MiSpEx network]. / Psychosoziale Risikofaktoren für chronischen Rückenschmerz in der Allgemeingesellschaft und im Leistungssport : Von der Modellbildung zum klinischen Screening ­ ein Review aus dem MiSpEx-Netzwerk.

BACKGROUND: Lumbar back pain and the high risk of chronic complaints is not only an important health concern in the general population but also in high performance athletes. In contrast to non-athletes, there is a lack of research into psychosocial risk factors in athletes. Moreover, the development of psychosocial screening questionnaires that would be qualified to detect athletes with a high risk of chronicity is in the early stages. The purpose of this review is to give an overview of research into psychosocial risk factors in both populations and to evaluate the performance of screening instruments in non-athletes. METHODS: The databases MEDLINE, PubMed, and PsycINFO were searched from March to June 2016 using the keywords "psychosocial screening", "low back pain", "sciatica" and "prognosis", "athletes". We included prospective studies conducted in patients with low back pain with and without radiation to the legs, aged ≥18 years and a follow-up of at least 3 months. RESULTS: We identified 16 eligible studies, all of them conducted in samples of non-athletes. Among the most frequently published screening questionnaires, the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) demonstrated a sufficient early prediction of return to work and the STarT Back Screening Tool (SBT) revealed acceptable performance predicting pain-related impairment. The prediction of future pain was sufficient with the Risk Analysis of Back Pain Chronification (RISC-BP) and the Heidelberg Short Questionnaire (HKF). CONCLUSION: Psychosocial risk factors of chronic back pain, such as chronic stress, depressive mood, and maladaptive pain processing are becoming increasingly more recognized in competitive sports. Screening instruments that have been shown to be predictive in the general population are currently being tested for suitability in the German MiSpEx research consortium.

[Adaptation to physical activity and mental stress in the context of pain : Psychobiological aspects]. / Adaptation an körperliche Aktivität und psychischen Stress im Kontext von Schmerz : Psychobiologische Aspekte.

The genesis of chronic pain is predominantly explained by a multidimensional pain model approach that is based on the dysfunctional influence of biological, psychological and social variables as key risk factors inducing aberrant long-term changes. Biological facets comprise adaptation processes on the neuronal, musculoskeletal and (psycho) biological level that can be influenced by physical training or psychosocial factors, such as stress. These factors can play a causative role in developing dysfunctional adaptation mechanisms, which in turn prepare the biological ground to facilitate negative long-term changes in the peripheral and central nervous systems. Hence, these processes can be assumed to be fundamentally involved in the transition from acute to chronic and persistent pain. The aim of this review article is to discuss hypotheses for the genesis of chronic pain and possible treatment strategies. Selected research results about maladaptive processes in chronic pain due to psychological stress and physical activity are presented in order to inspire discussions about the ideal dose-response relationship of physical activity and the combination of different therapeutic concepts.

[Development and content of the behavioral therapy module of the MiSpEx intervention: Randomized, controlled trial on chronic nonspecific low back pain]. / Beschreibung und empirische Fundierung des verhaltenstherapeutischen Moduls der MiSpEx-Intervention: Randomisierte, kontrollierte Studie zu chronischem unspezifischem Rückenschmerz.

Back pain is a complex phenomenon that goes beyond a simple medical diagnosis. The aetiology and chronification of back pain can be best described as an interaction between biological, psychological, and social processes. However, to date, multimodal prevention and intervention programs for back pain that target all three aetiological factors have demonstrated limited effectiveness. This lack of supportive evidence for multimodal programmes in the treatment of back pain could be due to the fact that few programs are suitable for long-term and unsupervised use in everyday life. Moreover, in combining the elements from various therapies, little attention has been paid to the mechanisms underlying the synergistic effects of the separate components. In this contribution, we will describe the development of a new multimodal intervention for back pain that set out to address these limitations. To this end, the biological elements of neuromuscular adaptation is supplemented with cognitive behavioral and psychophysiological techniques in an intervention that can be followed at home as well as in clinics, and that is suitable for all grades of pain. The efficacy of this intervention will be tested in a multicentric randomized controlled longitudinal trial (n = 714) at five time points over a period of 6 months. Here we will describe the development and the content of this new intervention.