Skip to main content
SpringerLink
Log in

Entstehung und Aufrechterhaltung von chronischen Schmerzen

Development and maintenance of chronic pain

  • CME Zertifizierte Fortbildung
  • Published:
Psychotherapeut Aims and scope Submit manuscript

Zusammenfassung

Bisher werden Schmerzen dann als chronisch definiert, wenn sie über einen Mindestzeitraum von 3 bzw. 6 Monaten auftreten. Dieses Zeitkriterium beschreibt den Chronifizierungsprozess, also die zunehmende Auftretenshäufigkeit und Intensität von Schmerzen, allerdings nur unzureichend. Daher wird Chronifizierung mehrdimensional erfasst; z. B. durch die Berücksichtigung von Beeinträchtigungen durch die Schmerzen und die Intensität. Verschiedene Lernprozesse tragen zur Chronifizierung von Schmerzen bei, da sie Veränderungen an den neuronalen Netzwerken mediieren, die in die Schmerzverarbeitung involviert sind. Zusätzlich konnte eine Reihe von psychosozialen Risikofaktoren identifiziert werden, die nicht nur die Chronifizierung begünstigen, sondern auch zur Aufrechterhaltung chronischer Schmerzen beitragen. Das „Fear-avoidance“-Modell fasst die meisten dieser Risikofaktoren zusammen, um so die Entstehung und Aufrechterhaltung chronischer muskuloskeletaler Schmerzen zu erklären.

Abstract

Chronic pain has previously been defined as lasting longer than 3 or 6 months. This criterion, however, does not adequately describe the process of pain becoming chronic. Consequently, pain chronicity is not only assessed by pain duration but by consideration of other factors, such as disability or intensity. A number of learning processes affect pain chronicity as they mediate changes in neural networks involved in pain processing. Furthermore, a number of psychosocial risk factors have been identified that affect not only the transition from acute to chronic pain but also the maintenance of chronic pain. The fear-avoidance model takes into account many of these risk factors to explain the development and maintenance of chronic musculoskeletal pain.

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

Literatur

  1. Schmidt CO, Fahland RA, Kohlmann T (2011) Epidemiologie und gesundheitsökonomische Aspekte des chronischen Schmerzes. In: Kröner-Herwig B, Frettlöh J, Klinger R, Nilges P (Hrsg) Schmerzpsychotherapie, 7. Aufl. Springer, Berlin Heidelberg New York Tokio, S 15–28

  2. Zenz M (2004) Rückenschmerz. Viele Fragen und immer noch zu wenig Antworten. Schmerz 21:199–201

    Article  Google Scholar 

  3. IASP Subcommittee on Taxonomy (1979) Pain terms: a list with definitions and notes on usage. Pain 6:249–252

    Google Scholar 

  4. Kröner-Herwig B (2011) Schmerz als biopsychosoziales Phänomen – eine Einführung. In: Kröner-Herwig B, Frettlöh J, Klinger R, Nilges P (Hrsg) Schmerzpsychotherapie, 7. Aufl. Springer, Berlin Heidelberg New York Tokio, S 3–14

  5. Kohlmann T (2003) Die Chronifizierung von Rückenschmerzen. Ergebnisse eines internationalen WHO-Workshops. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 46:327–335

    Article  Google Scholar 

  6. Rief W, Treede R-D, Schweiger U et al (2009) Neue Schmerzdiagnose in der deutschen ICD-10-Version. Nervenarzt 80:340–342

    Article  PubMed  Google Scholar 

  7. Von Korff M, Dunn KM (2008) Chronic pain reconsidered. Pain 138:267–276

    Article  Google Scholar 

  8. Von Korff M, Ormel J, Keefe FJ, Dworkin SF (1992) Grading the severity of chronic pain. Pain 50:133–149

    Article  Google Scholar 

  9. Klasen BW, Hallner D, Schaub C et al (2004) Validation and reliability of the German version of the chronic pain grade questionnaire in primary care back pain patients. Psychosoc Med 1:Doc07

    PubMed  Google Scholar 

  10. Stewart WF, Lipton RB, Dowson AJ, Sawyer J (2001) Development and testing of the Migraine Disability Assessment (MIDAS) Questionnaire to assess headache-related disability. Neurology 56:20–28

    Article  Google Scholar 

  11. Gerbershagen HU, Korb J, Nagel B, Nilges P (2013) Das Mainzer Stadiensystem der Schmerzchronifizierung: Mainz Pain Staging System (MPSS) – Testanweisung. http://www.drk-schmerz-zentrum.de.drktg.de/mz/pdf/downloads/mpss_testanweisungen.pdf

  12. Frettlöh J, Maier C, Gockel H, Hüppe M (2003) Validität des Mainzer Stadienmodells der Schmerzchronifizierung bei unterschiedlichen Schmerzdiagnosen. Schmerz 17:240–251

    Article  PubMed  Google Scholar 

  13. Pfingsten M, Kröner-Herwig B, Leibing E et al (2000) Validation of the German version of the Fear-Avoidance Beliefs Questionnaire (FABQ). Eur J Pain 4:259–266

    Article  PubMed  Google Scholar 

  14. Pfingsten M, Schöps P, Wille T et al (2000) Chronifizierungsausmaß von Schmerzerkrankungen. Schmerz 14:10–17

    Article  PubMed  Google Scholar 

  15. Davis KD, Moayedi M (2013) Central mechanisms of pain revealed through functional and structural MRI. J Neuroimmune Pharmacol 8:518–534

    Article  PubMed  Google Scholar 

  16. Seifert F, Maihöfner C (2011) Functional and structural imaging of pain-induced neuroplasticity. Curr Opin Anaesthesiol 24:515–523

    Article  PubMed  Google Scholar 

  17. Diers M, Koeppe C, Diesch E et al (2007) Central processing of acute muscle pain in chronic low back pain patients: an EEG mapping study. J Clin Neurophysiol 24:76–83

    Article  PubMed  Google Scholar 

  18. Smallwood RF, Laird AR, Ramage AE et al (2013) Structural brain anomalies and chronic pain: a quantitative meta-analysis of gray matter volume. J Pain. DOI 10.1016/j.jpain.2013.03.001

  19. Seminowicz DA, Wideman TH, Naos L et al (2011) Effective treatment of chronic low back pain in humans reverses abnormal brain anatomy and function. J Neurosci 31:7540–7550

    Article  PubMed  Google Scholar 

  20. De Peuter S, Van Diest I, Vansteenwegen D et al (2011) Understanding fear of pain in chronic pain: interoceptive fear conditioning as a novel approach. Eur J Pain 15:889–894

    Article  Google Scholar 

  21. Lethem J, Slade PD, Troup JD, Bentley G (1983) Outline of a fear-avoidance model of exaggerated pain perception. Behav Res Ther 21:401–408

    Article  PubMed  Google Scholar 

  22. Meulders A, Vlaeyen JW (2013) The acquisition and generalization of cued and contextual pain-related fear: an experimental study using a voluntary movement paradigm. Pain 154:272–282

    Article  PubMed  Google Scholar 

  23. Hubbard CS, Ornitz E, Gaspar JX et al (2011) Modulation of nociceptive and acoustic startle responses to an unpredictable threat in men and women. Pain 152:1632–1640

    Article  PubMed  Google Scholar 

  24. Fordyce WE (1976) Behavioral methods for chronic pain and illness. Mosby, St. Louis

  25. Fillingim RB, Doleys DM, Edwards RR, Lowery D (2003) Spousal responses are differentially associated with clinical variables in women and men with chronic pain. Clin J Pain 19:217–224

    Article  PubMed  Google Scholar 

  26. Vlaeyen JW, Morley SJ, Linton SJ et al (2012) Pain-related fear: exposure-based treatment of chronic pain. IASP, Seattle

  27. Goubert L, Vlaeyen JWS, Crombez G, Craig KD (2011) Learning about pain from others: an observational learning account. J Pain 12:167–174

    Article  PubMed  Google Scholar 

  28. Hermann C (2013) Modeling, social learning in pain. In: Schmidt RF, Gebhart GF (Hrsg) Encyclopedia of pain. Springer, Berlin Heidelberg New York Tokio. DOI 10.1007/978-3-642-28753-4

  29. Helsen K, Goubert L, Peters ML, Vlaeyen JW (2011) Observational learning and pain-related fear: an experimental study with colored cold pressor tasks. J Pain 12:1230–1239

    Article  PubMed  Google Scholar 

  30. Hasenbring M, Hallner D, Klasen B (2001) Psychologische Mechanismen im Prozess der Schmerzchronifizierung. Schmerz 15:442–447

    Article  PubMed  Google Scholar 

  31. Pfingsten M, Korb J, Hasenbring M (2011) Psychologische Mechanismen der Chronifizierung – Konsequenzen für die Prävention. In: Kröner-Herwig B, Frettlöh J, Klinger R, Nilges P (Hrsg) Schmerzpsychotherapie, 7. Aufl. Springer, Berlin Heidelberg New York Tokio, S 115–134

  32. Linton SJ (2000) A review of psychological risk factors in back and neck pain. Spine 25:1148–1156

    Article  PubMed  Google Scholar 

  33. Pincus T, Burton AK, Vogel S, Field AP (2002) A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain. Spine 27:E109–E120

    Article  PubMed  Google Scholar 

  34. Quartana PJ, Campbell CM, Edwards RR (2009) Pain catastrophizing: a critical review. Expert Rev Neurother 9:745–758

    Article  PubMed  Google Scholar 

  35. Rosentiel AK, Keefe FJ (1983) The use of coping strategies in chronic low back pain patients: relationship to patient characteristics and current adjustment. Pain 17:33–44

    Article  Google Scholar 

  36. Verra ML, Angst F, Lehmann S, Aeschlimann A (2006) Translation, cross-cultural adaptation, reliability, and validity of the German version of the Coping Strategies Questionnaire (CSQ-D). J Pain 7:327–336

    Article  PubMed  Google Scholar 

  37. Sullivan MJ, Bishop SR, Pivik J (1995) The pain catastrophizing scale: development and validation. Psychol Assess 7:524–532

    Article  Google Scholar 

  38. Meyer K, Sprott H, Mannion AF (2008) Cross-cultural adaptation, reliability, and validity of the German version of the pain catastrophizing scale. J Psychosom Res 64:469–478

    Article  PubMed  Google Scholar 

  39. Linton SJ (2005) Do psychological factors increase the risk for back pain in the general population in both a cross-sectional and prospective analysis? Eur J Pain 9:355–361

    Article  PubMed  Google Scholar 

  40. Edwards RR, Bingham CO, Bathon J, Haythornthwaite JA (2006) Catastrophizing and pain in arthritis, fibromyalgia and other rheumatic disease. Arthritis Rheum 55:325–332

    Article  PubMed  Google Scholar 

  41. Sullivan MJ, Thorn B, Haythornthwaite JA et al (2001) Theoretical perspectives on the relation between pain catastrophizing and pain. Clin J Pain 17:52–64

    Article  PubMed  Google Scholar 

  42. Severeijns R, Vlaeyen JWS, Hout M van den, Picavet HSJ (2005) Pain catastrophizing and consequences of musculoskeletal pain: a prospective study in the Dutch community. J Pain 6:125–132

    Article  PubMed  Google Scholar 

  43. Beck AT, Steer RA (1987) Beck depression inventory – manual. Psychological Corporation, San Antonio

  44. Hautzinger M, Bailer M, Worrall H, Keller F (2000) Beck-Depressions-Inventar (BDI). Testhandbuch, 3. Aufl. Huber, Bern

  45. Morley S, Williams AC, Black S (2002) A confirmatory factor analysis of the Beck Depression Inventory in chronic pain. Pain 99:289–298

    Article  PubMed  Google Scholar 

  46. Hautzinger M, Keller F, Kühner C (2009) BDI-II. Beck-Depressions-Inventar. Revision. 2. Aufl. Pearson Assessment, Frankfurt a. M.

  47. Casey CY, Greenberg NA, Nicassio PM et al (2008) Transition from acute to chronic pain and disability: a model including cognitive, affective, and trauma factors. Pain 134:69–79

    Article  Google Scholar 

  48. Sieben JM, Vlaeyen JW, Portegijs PJ et al (2005) A longitudinal study on the predictive validity of the fear-avoidance model in low back pain. Pain 117:162–170

    Article  PubMed  Google Scholar 

  49. Campbell LC, Clauw DJ, Keefe FJ (2003) Persistent pain and depression: a biopsychosocial perspective. Biol Psychiatry 54:399–409

    Article  PubMed  Google Scholar 

  50. Waddell G, Newton M, Henderson I et al (1993) A fear-avoidance beliefs questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain 52:157–168

    Article  PubMed  Google Scholar 

  51. Pfingsten M, Leibing E, Franz C et al (1997) Erfassung der „fear-avoidance-beliefs“ bei Patienten mit Rückenschmerzen. Deutsche Version des „fear-avoidance-beliefs questionnaire (FABQ-D). Schmerz 11:387–395

    Article  PubMed  Google Scholar 

  52. Leeuw M, Goossens ME, Breukelen GJP van et al (2007) Measuring perceived harmfulness of physical activities in patients with chronic low back pain: the photograph series of daily activities – short electronic version. J Pain 8:840–849

    Article  PubMed  Google Scholar 

  53. Leeuw M, Goossens ME, Linton SJ et al (2007) The fear-avoidance model of musculoskeletal pain: current state of scientific evidence. J Behav Med 30:77–93

    Article  PubMed  Google Scholar 

  54. 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 141:276–282

    Article  PubMed  Google Scholar 

  55. Bailey KM, Carleton RN, Vlaeyen JW, Asmundson GJ (2010) Treatments addressing pain-related fear and anxiety in patients with chronic musculoskeletal pain: a preliminary review. Cogn Behav Ther 39:46–63

    Article  PubMed  Google Scholar 

  56. Wieser T, Walliser U, Womastek I, Kress HG (2012) Dysfunctional coping in headache: avoidance and endurance is not associated with chronic forms of headache. Eur J Pain 16:268–277

    Article  PubMed  Google Scholar 

  57. Miller RP, Kori S, Todd D (1991) The Tampa Scale: a measure of kinesiophobia. Clin J Pain 7:51–52

    Article  Google Scholar 

  58. Nigbur K, Rusu AC, Hallner D, Hasenbring MI (2009) Fear of movement/(re)injury in chronic pain: preliminary validation of a German version of the Tampa scale for kinesiophobia. Eur J Pain 13:S239

    Article  Google Scholar 

  59. Swinkels-Meewisse IEJ, Roelofs J, Verbeek ALM et al (2003) Fear of movement/(re)injury, disability and participation in acute low back pain. Pain 105:371–379

    Article  PubMed  Google Scholar 

  60. Pincus T, Vogel S, Burton AK et al (2006) Fear avoidance and prognosis in back pain. A systematic review and synthesis of current evidence. Arthritis Rheum 54:3999–4010

    Article  PubMed  Google Scholar 

  61. Kindermans H, Roelofs J, Goossens ME et al (2011) Activity patterns in chronic pain: underlying dimensions and associations with disability and depressed mood. J Pain 12:1049–1058

    PubMed  Google Scholar 

  62. Vlaeyen JW, Linton S (2000) Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain 85:317–332

    Article  PubMed  Google Scholar 

  63. Van Tulder M, Koes B (2006) Low back pain. In: McMahon SB, Koltzenburg M (Hrsg) Wall and Melzack’s textbook of pain, 5. Aufl. Elsevier, Amsterdam, S 699–708

  64. Crombez G, Eccleston C, Damme S van et al (2012) Fear-avoidance model of chronic pain. The next generation. Clin J Pain 28:475–483

    Article  PubMed  Google Scholar 

  65. Damme S van, Ryckeghem DM van, Wyffels F et al (2012) No pain no gain? Pursuing a competing goal inhibits avoidance behavior. Pain 153:800–804

    Article  PubMed  Google Scholar 

  66. Kröner-Herwig B, Frettlöh J, Klinger R, Nilges P (Hrsg) (2011) Schmerzpsychotherapie, 7. Aufl. Springer, Berlin Heidelberg New York Tokio

Download references

Einhaltung der ethischen Richtlinien

Interessenkonflikt. Judith Kappesser und Christiane Hermann geben an, dass kein Interessenkonflikt besteht. Das vorliegende Manuskript enthält keine Studien an Menschen oder Tieren.

Author information

Authors and Affiliations

  1. Abteilung für Klinische Psychologie, Justus-Liebig-Universität, Otto-Behaghel-Str. 10F, 35394, Gießen, Deutschland

    Judith Kappesser &  Christiane Hermann

Authors
  1. Judith Kappesser
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christiane Hermann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Judith Kappesser or Christiane Hermann.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kappesser, J., Hermann, C. Entstehung und Aufrechterhaltung von chronischen Schmerzen. Psychotherapeut 58, 503–517 (2013). https://doi.org/10.1007/s00278-013-1004-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00278-013-1004-6

Schlüsselwörter

Keywords

Search

Navigation