Hotz-Boendermaker Sabina, Surbeck Ursula, Morf Rita, Pfeiffer Fabian
School of Health Professions, Institute of Physiotherapy, Zurich University of Applied Sciences (ZHAW), Winterthur, Switzerland.
Pain in Motion Research Group (www.paininmotion.be), Winterthur, Switzerland.
Eur J Pain. 2025 Feb;29(2):e4728. doi: 10.1002/ejp.4728. Epub 2024 Sep 30.
Low back pain (LBP) is increasingly understood as a long-lasting condition with a variable course. Avoidance and persistence behaviour have been described to mediate pain persistence by potentially linking psychosocial factors and biomechanics. The resulting maladaptive changes in musculoskeletal structures can result in movement control impairment (MCI). This investigation aimed to observe avoidance and persistence behaviour and MCI in participants with acute LBP over 1 year and explore their association with pain persistence.
In this observational cohort study, 165 participants were assessed at five time points: ≤ 1 month (baseline), 2, 3, 6, and 12 months after the onset of acute LBP. Simultaneously collected clinical data such as self-reported outcomes at baseline for avoidance and persistence and assessments of MCI were filled in linear mixed-effects regression models.
The mixed-effects analysis revealed for the adjusted model that a one-point increase in persistence scores resulted in a 3.31-point increase in pain intensity while interacting with state anxiety over time (p = 0.05, 95% confidence interval 0.07-6.07). This effect was not found for avoidance behaviour at baseline (p = 0.21) and MCI.
The relationship between persistence and pain intensity throughout measurement suggests that continuing usual activities beyond pain, coupled with feelings of distress, may lead to persistent LBP. These results underscore the need for a therapeutic shift toward a multidimensional approach that considers the physical and psychological characteristics of persons with LBP. Screening for activity patterns in acute LBP is critical for providing tailored treatment and counselling.
In acute low back pain (LBP), maintaining usual activities despite pain and distress can contribute to the continuation of LBP. Alongside a multidimensional approach that considers physical and psychological factors, attitudes toward daily activities are also important. Screening for both maladaptive and adaptive activity patterns in individuals with acute LBP is essential for effective LBP management, improving patient outcomes, and preventing persistent pain.
下腰痛（LBP）越来越被视为一种病程多变的长期病症。回避行为和坚持行为被认为可通过潜在地联系心理社会因素和生物力学来介导疼痛持续。肌肉骨骼结构由此产生的适应不良变化可导致运动控制障碍（MCI）。本研究旨在观察急性下腰痛患者1年期间的回避行为、坚持行为和运动控制障碍，并探讨它们与疼痛持续的关联。
在这项观察性队列研究中，165名参与者在五个时间点接受评估：急性下腰痛发作后≤1个月（基线）、2个月、3个月、6个月和12个月。同时收集临床数据，如基线时自我报告的回避和坚持结果以及运动控制障碍评估，并纳入线性混合效应回归模型。
混合效应分析显示，对于调整后的模型，坚持得分每增加1分，疼痛强度就会增加3.31分，且随着时间推移与状态焦虑相互作用（p = 0.05，95%置信区间0.07 - 6.07）。基线时的回避行为（p = 0.21）和运动控制障碍未发现这种效应。
整个测量过程中坚持行为与疼痛强度之间的关系表明，在疼痛时继续进行日常活动，再加上痛苦情绪，可能导致下腰痛持续。这些结果强调需要转向一种考虑下腰痛患者身体和心理特征的多维度治疗方法。筛查急性下腰痛患者的活动模式对于提供个性化治疗和咨询至关重要。
在急性下腰痛（LBP）中，尽管疼痛和痛苦仍维持日常活动会导致下腰痛持续。除了考虑身体和心理因素的多维度方法外，对日常活动的态度也很重要。筛查急性下腰痛患者的适应不良和适应性活动模式对于有效的下腰痛管理、改善患者预后以及预防持续性疼痛至关重要。
