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Persistence behavior of chronic low back pain

patients : a medical psychological study

Citation for published version (APA):

Schmidt, A. J. M. (1986). Persistence behavior of chronic low back pain patients : a medical psychological

study. Rijksuniversiteit Limburg. https://doi.org/10.26481/dis.19861114as

Document status and date:

Published: 01/01/1986

DOI:

10.26481/dis.19861114as

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I n t h i s s t u d y a number of r e s e a r c h p a p e r s o n t h e p a r s i s t . e n c e b e h a v i o r of c h r o n i c low back p a i n (CLBP) patient,^ i n b a c k - s t r e s s i n g a a w e l l e s n a n - h a c k - s t r e s s i n g p e r f o r m a n c e s i k u a t i o n s a r e d e 3 c r i b e d . The p r l m a r y c o n s i d e r a t i o n on which t h e d e s i g n o f t h e s e e x p e r i m e n t a l e'udies was b e s e d , is t h a t CLBP i s s u c h a complex phenomenon t h a t e l i n e a r r e l a - t i o n s h i p between back p a i n i n t e n s i t y and p h y s i c a l stress o r p e r s i s - t e n c e b e h a v i o r was not. e x p e c t e d .

I t

was assumed t h a t c e r t a i n a s p e c t s o f t y p i c a l

CLBP

b e h a v i o r i n b a c k - s t r e s s i n g p e r f o r m a n c e sit.uek.xons

-

e s p e c i a l l y p o o r e r p e r s i s t s ~ n c e b e h a v i o r , i . e m g i v i n g - u p b e h a v i o r

-

would g e n e r a l i z e t o non-beck t a x i n g performance s i t u a k i o n s , s o that, i n t h e s e l a t t e r s i t u a t i a n s CLBP p a t i e n t s would a l s o f u n c t i o n l e e s w e l l . I n o r d e r t o p u t t h e s e s p e c i f i c questionle i n a more g e n e r a l psychologli- caL f r a m e o f r e f e r e n c e , t h e s t u d i e s i n t h e f i v e a r t i c l e s a r e p r e c e d e d by some i n t r o d u c t o r y c h a p t e r s i n which t h e most import.ank a s p e c t s o f CLBP e r e d i s c u s s e d on +.he b a s i s o f t l h e a v a i l a b l e p r a f e s s i o n a l L i t e r a - t u r e . These a r t i c l e s a r e f o l l o w e d by two i n t e g r a t i n g c h a p t . e r s .

I n c h a p t e r

1

some b a s i c c o n c e p t s a r e d i s c u s s e d . The CLBP syndrome 19 d e s c r i b e d end t h e c a u a e s o f i t ( o r r a t h e r t h e l a c k o f a d ~ e q u a t e ex p l a - n a t o r y c a u s e s ) a r e p r e s e n t e d . The d i a t . i n c t i o n between a c u t e a ~ n d cklro- n i c p a i n i a d i s c u s s a d ; p a r t i c u l a r a t t e n t i o n is p a i d t o cancomitanf: p h y s i c a l realcliorus, t h e r e l s l t i o n s h i p w i t h t.iaawa damage end k.lhe im~por- t a n c e o f p e r s o n a l i t y f a c t o r s . These v a r i o u a e s p s c t s

s r s

d e a l t wit.h more tlhoraughly i n l a t e r c h e p t e r a . I n chapf.er 2 s a n e e p i d e m i o l o g i c a l a s p e c t s o f CLIDP a r e d i s c u s s e d . S t u d i e s on t h e h i s k o r y o f low bslck p a i n c o m p l a i n t s i n ~ d i c e t e th a t e c u t e LBP a t t a c k s l e a d t o a n a v e r a g e s i c k l a e v e o f 18-20 work d a y a ; a f t s r a n a b s e n c e o f e i g h t weeks due t o i l l n e s s , t h e r e i s a 1 0 % c h a n c e t h e LBP p a t i e n t . w i l l hecome a c h r o n l i c p a i n pet,iemk when s i x months c r i b - r i o n is u s e d . On t,he b a s i s o f t h i s ,

It.

is ncecomended +.hat t h i s c h r o - n i ~ c i t y c r i t e r i o n b e l o w e r e d from 6 t o 2 rnont.hs.

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s c t i v i t ~ y , w h e t h e r w o r k - s e l e t e d a r nok, i s n o t c o ~ n s i d e r e d a s u f F i c i e n t e x p l a n a t i o n For t h e development o f CLBP. The e p i d m i o l o g i c a l s t u d i e s hewe p r o v i d e d l i t t l e e v i d e n c e o f p a y c h o l a g i c a l r i s k f a c t - o r s . Moreover, t h e n a t u r e o f t.hia r e s e a r c h d o e s not. adlrrrw c o n c l u e i l r ~ n s t o b e drawn a b o u t t h e d i r e c t i o n o f e p o s s i ~ b l e oeussll r e l a t i o n e h ~ i p between, f o r i n s t a n c e ChEP and d e p r e s s i o n .

C h a p t e r 3 dlslcueaes t h e o o n t r i b u t i o n o f psychology .as a n e m p i r i c a l e c i e n c e t o a b e t + - e r w n d e r s t ~ n d i n g o f t h e @LBlP p h e n m e n o n . The most important. khemles a p p e a r t o b e t h e p s y c h o d i a g n o s t i c s o f t h e CLBP pa- t . i e n t s , a s w e l l es t h e dewelopment. o f a p s y c h o l o g i c a l t h e o r y o f c h r o - n i c p a i n a~nd t h e p s y c h o l a g i c a l t r e a t m e n t m~ethods d e r i v e d from it. S p e c i f i c peraona1it.y v a r i a b l e s o f CLBP p a t i e n l t s hawe b e e n d e s c r i b e d many t i m e s ; i n t.hie c o n n l e c t f on t h e Minnesota M u l t ~ i p h e s i c Persona1it.y Invent-ory

EMM~PIE

h a s b e e n u s e d f r e q u e n t l y . The p i c t . u r e t h a t emerges 1s n o t v e r y homogeneous. More r e c e n t r e s e a r c h h a s b e e n d i r e c t e d st pre- d i c t i n g +.he o p e r e t i o n r e s u l t s on CLBP p a t i e n t s on t h e b a s i s o f e x t e n - s i v e p s y c h a d i a g n o a t i c r e s e a r c h . Very p o s i t i v e outcomes h a v e been c l a i m e d , especially i n the Slmerican l i t e r a t u r e ; t h e s t a t u s o f t.lhis r e s e a r c h i n c l i n i c a l d e c i s i o n - m a k i n g p r o c e d u r e s , however, is s t i l l u n c l e a r a n d m e t h o d a l o g i c a l l y u n c e r t a i n .

The d e w e l a p n e n t o f e m p i r i c a l p s y c h o l o g i c a l t h e o r y c o n c e r n i n g CLBP is m a i n l y b e s e d on t h e o p e r a n t a n d c o g n i t i v e paradigm. The o p e r a n t p o i n t

oF view e t e t e s t h a t b e h a v i o r

-

i n c l u d i n g CLBP b e h a v i o r

-

t h a t is r e i n f o r c e d p o s i t . i v s l y

will

i n c r e e e l e i n Frequency* Acute p a i n b e h a v i o r w i l l u n d e r tkuese cirlcumst.ances d e v e l o p i n t o c h r o n i c p a i n b e h a v i o r , w h i l e c h r o n i c p a i n b e h a v i o r a l r e a d y p r e s e n t w i l l nof b e e x t i n g u i s h e d . The ussflwlness o f khe o p e r a n t t h e o r y h a s been d e m o n s t r a t e d i n many s t u d i ~ e , e ~ p e ~ I a l L y t h e numerous t h e r a p y e v a l u a t i o n s t u d i e s i n which t h e t h e r a p e u t i c a p p l i ~ c a t i o n of" t h e o p e r a n t p r i n c i p l e i n t h e t r e a t m e n t a f CLDP p a t i e n t s i s c e n t r a l . Rep0rt.s i n d i c a t e t h a t s u c h t.reatment h a s belon p e r t i c u l e r l y e f f e c t i v e i n i n c r e a s i n g t h e l e v e l OF a c t i v i k y a n d d e c r e a s i n g d e p e n d e ~ n c e on m e d i c a t i o n .

(4)

b e h a v i o r a l r e ~ l c t i o n s t o o e s t - e i n s i t u a t i o n s . Because e m o t i o n a l v a r i - e b l e s , e s p e c i a l l y f e a r , i n f l u e n c e thle p e i n e x p e r i e n c e , i t is e l s o assumed t h a t c o g n i t i v e modiFLcatzons i n f l u e n c e t h e p a i n e x p e r i e n c e i t s e l f . I n t h i s c h a p t e r t h i s i n t e r a c t i o n is d i s c u s s e d e x t e n s i v e l y w i t h r e f e r e n c e t.0 f o u r k i n d s o f s t u d i e s : 1. s t u d i e s on t h e i n f l u e n c e o f a d v a n c e inFornet.fon on a s u b s e q u e n t e x p e r i m e n t e l p a i n st.imulus. 2. s t u d i e s on t h e i n f l u e n c e o f a d v a n c e i n f o r m a t i o n on a subsequent. p a i n f u l m e d i c a l o p e r e t i o n . 3 . s t u d i e s on t h e i n f l u e n c e o f s e v e r a l c o p i n g s t y l e s o n a subsequent. experiment-a1 p a i n s t i m u l u s . I . s t u d i e s an +.he i n f l u e n l c e a f s e v e r a l c o p i n g s t y l e e on c l i n i c a l p e i n . I n t.he L i t e r a t u r e , t h e s i g n i f i c a n t r e l a t i o n s a r e moat c l e n r l y between t h e u s e o f c e r t a i n p a i n - c o p i n g t e c h n i q u e s and a n i n c r e a s e uT p a i n p e r c e p t i o n o r p a i n t o l e r a n c e t h r e s h o l d i n experimontaY s i t . u e t iorrs

( s t . u d i e s o f t y p e 3 ) .

I n c h a p t e r 4 t h e l i t e r a t u r e r e v i e w i a summerized and t h e gaps i n ape- c i f i c , p s y c h o l o g i c a l knowledge c o n c e r n i n g CLBP a r e i n d i c a t e d .

Chapt-er 5 i n t - r o d u c e s t h e g e n e r a l q u e s t i o n from which t h e s f . u d ~ i e s th a t : f o l l o w arle d e r i v e d . I f , a c c o r d i n g t.o t h e operant. p r i n c i p l e , GLRP b e h a v i o r , e s p e c i a l l y p o o r p e r e i e k e n c e b e h a v i o r , i n s i t u ~ s t i o l n s expe- r i e n c e d a s b a c k p a i n t a x i n g is mainIkeined by p a e l f i v e r e i n f ' o r c m e n t from t h e environment. o f t t i ~ e p a t i e n t , t h e n t h e removal oF t h ~ i s l f e e d b a c k nust l e a d t o +.he d i s e p p e e r a n c e o f t h i s CLBP b e h a v i o r .

LC,

i n a d d i t i o n ,

CLBP

b e h a v i o r is a l s o d i r e c t e d by c o g n i t i o n s ( e l r p a c t a t . i a n s 3 , t h e n e x p e r i m e n t a l m a n i p u l a t i o n OF t h e s e e x p e c t a t i o n s must lcrad 1.0 enother b e h a v i o r i n b a c k - s t r ~ e s s i n g s i t u a t i o n s . I n s e v e r e l studies a f k e r n p t s were nede t o o p e r a t . i o n s L i r e t h e s e q u e s t . l o n s i n e x p e r i m e n t a l r e s e a r c h .

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t.eat. P h y s i o l o g i c a l f ~ f i g n u e l e v e l s were n o t c o r r e c t . l y a p p r a i s e d by

CLBP

p a t i e n t s . Peychornet.ric v a r i s b l e s s y o t s m a t i c a l l y a p p e a r e d t-a b e l e e e f a r o u ~ r e b l e f o r CILBP p a t i e n t . 8 .

Chept.es: 7 a l s o d e s c r i b e s t h e b a s i c e x p e r F n ~ n k , i ~ n which advancle i n f o r - n a t i o n wea p r i w e n t e d , which l e d t.o C U P p e t i e n t . ~ n o t s u c c e e d i n g i n r e a c h i n g t h e r e f e r e n c e v a l u e s o f f e r e d . I n t h i s t h r e a k e n i n q f a i l u r e c o n d f t i o n , t.he c o n t r o l a u b g " e c t s made e n e x t r a e f f a r k ; CLBP p a t i e n t s d i d n o t . I t c o u l d b e d e m o n s t r a t e d t h a t t h e s i g n i T i c a n t i n c r e a s e i n p a i n report.ed d u r i n g t h e e x e r t i o n was n o t r e l a t e d t a b a c k - s t r e s s , b u t t.o t h e f a i l u r e c o n d i t i o n . A l s o i n c a n t r e s t t o t h e c o n t r o l g r o u p , t h l e p r e - t e s t p a i n v s r i a b l e s were more r e l a t e d t.101 khle p e r f o r m a n c e o f t h e

CLBP p a t i e n t s t h a n t h e t e s t p a i n v a r i a b l e s .

C h e p t e r 8 a l s o d e s c r i b e e khe t r e a d m i l l t e s t , b u t now i n exlpected

success

o r a d e q u a t e f e e d b a c k c o n d i k i o n s . Adding t h e s e c o n d i t i o n s l e d

k.o t h e c ~ n f i r m a t i o n u o f e a r l i e r findinrga, b u t d i d not. r e s u l t i n s p e - c i f i c new f i n d i n g s .

I n c h a p t e r 9 the next. two a r t . i c L e s a r e i n t r o d u c e d . I f t.he p e r s i s t e n c e b e h a v i o r of CLBP p a t i e n t s i n o b j e c k i v e beclk a t ~ r e s s i n g p e r f o r m a n c e sitwet.icsns is e t e l o w e r l e v e l t h a n t h a t o f non-CLRP p a t - i e n f s , b u t

t h i s is rnot c a u s e d by i n c r e a s i n g p a i n l e v e l s , i t c a n be assumed t h e t g i v i n g up qluiclkly h a s became a c Y i i ~ r a c t . e r i s t i c o f CLOP p a t i e n k s elnil h a s e l s o y s n e s ~ l i s e d

t o

o t h e r p e r f o r m a n c e s i t u e t i o n s . To i n v e s f i q a f e t h i s h y p a t h e s i s t h e p e r s i s t . e n c e b e h a v i o r o f CLBP p s t . i e n t s was a l s o st.udied i ~ r o non-back-taxing, gc1ut.e p a i n s i t w a t - i o n ( c h a p t e r 9.1) lend i n a non- p a i n - r e l e v a n t psrFormance a l t . u e t f o n ( c h a p t e r 9 - 2 1 .

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I n c h a p k e r 9.2 it is demonst.reted t h a t t h e p e r f o r m a n c e b e h a v i o r a f CLBP p a t - i e n t s , compared t o e c o n t r o l g r o u p , was a d e q u a t e o n a psycho- mot-oric t a s k ( r e a c t i o n t i m e t e s t ) .

No

i n d i c a t i o n s were Found Tor

F e s t e r g i v i n g - u ~ p b e h a v i o r , L e e . e l o w e r t o l e r a n c e f o r f a i l u r e f o r t h e CLBP group. Yet back p a i n w i t h i n t h e CLBP g r o u p i n ~ f l u e n c e d th e i n d i v i - d u a l perFormance l e v e l s : more back p a i n i n a d v e n c e l e d poi a p o o r e r p e r f o r m a n c e on t h i s non-pain r e l e v a n t t a s k .

I n c h a p t e r 1 0 t h e f o r e g o i n g r e s u l t s a r e summarized, r e s u l t i n g i n a scheme i n which t h e i n t e r r e l a t . i o n s h i p s o f p o s i t i v e and n e g a t . i v e , i . e . p e r f o r m a n c e i n c r e s s i n g end p e r f o r m a n c e d e c r e s s i n g , p s y c h o l o g i c a h i n f l u e n c e s on the p e r s i s t e n c e b e h a v i o r o f CLBP p e t i s n t s e r e p r e s e n t a d .

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(9)

grens ven 6 maanden wordlt g e s t e l d . Mede op grond h i e r v a n ward~t b e p l e i t m d i t c h r a n i s i t . e i t 8 c r i k e r i u m t e v e r l e g e n van 6 naar 2 meenden.

En d l i t h o o f d s t u k wordt. tewens ingeqaan op de r o l wen r i s i e o f a c f t o r e n liij het. o n t s t a a n van CLBIP. Langdurige (zware) l i c h e r n e l i jk e a c t . i v i k e i - ten, a l o f n i e t i n r e l a t i e t o t arbleid, wordt i n de l i t e r a t - u u r zeker n i e t g e z i e n e l s een afdoende werklarintg voor h e t a n t s t e e n ven CLBP. Paychologieche r i a i c o f e c t o l r e n z i j n i n e p i d e m i o l o g i s c h e s t u d i e s nauwe- l i j k s eanqetaond. De a a r d ven diF. onderzoek l a a f o v e r i g e n s ook geen c o n c l u s i e s t o e o v e r dle r i c l h t i n g van een m o g e l i j k e c a u s e l i t e i t . s r e l a t i e b.v. t u s s e n CLBP en d e p r e m i e ,

Hoofdstuk 3 behandelt de b i j d r a g e van de p s y c h o l o g i e a l s e m p i r i s c h e weten~schap t o t eEin b e t e r b e g r i p ven h e t f e n m e e n van de CLBP. De be- l e ~ n g r i j k s t e f.hema% b l i j k e n zrooral t e z i j n : da psyohodieqnostieik van de CL8B-patient

,

alsmede dle pa y c h o l o p i s c h e th~eiar i e v o r m i ng ven ch~ro- n i s e h e p i j n met de daarvan a f g e l e i d e p s y c h o l o g i s c h e behandelingsmetho- dien

.

S p e c i f i e k e persoonlijkheidsvariabelen ven CLBR-patienten z i j n v e e l v u l - d i g beschreven, w a a r b i j met. name de Minnesote M u l t i p h a s i c P e r s o n e l i t y I n v e n t o r y (MHPI) vaak w o r d t g e b r u i k t . Toch i s h e t b e e l d wat naer v o r e n komt, w e i n i g homogeen. Recent-er onderzoek r i c h t . z i c h meer op d~e voor- s p e l b a a r h e i d wan o p e r a t . i a - s e s u l t e t e n b i j LBP-pakienken aan de hand van u i t g ~ e b r e î d p s y c h o d i ~ a g n o s t i s c h onderzoek. H i e r b l i j worden, m.n. i n de Amerikaanse lîireraf'uun', z e e r p o s i t i e v e rie-aulkaten giaclaimed; de e t s k u s ven d i k onderzoek b i j k l i n i s c h e besluitvormingeproictadeires i s e c h ~ t e r

rtog ondwide;liJk e n rne?f.~hodologisch nog onzeker.

De mpiriacYirpsycholegi~cbii8i t h e o r i e v o r m i n g m.b.t. CLBP geat v o o r a l u i t wan h e t operante e n h e t c o g n i t i e v e paredigrna. Wet operante u i t g e n g s - p u n t s t e l t d a t gedrag

-

du5 ook CLBP-gedrag

- d a t p o s i t i e f wordt be-

k r a c h t i g d , i n f r e q u e n t i e z a l toenemen. Acuut pljngedlreg z a l onder deze omst.endighsden u i t g r o e i e n k o t c h r o n i e c h p i j n q e d r a g y t e r w i j l reeds aan- wezig chrolnisch p i j n g a d r e g n i e t

ral

u i t d o v e n .

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c e n t r a a l s t a a t . Zeer g o e d e b e h a n d e l i n g l a r e s u l t a t e n worden m. 41. vernield wat b e t r e f t v e r h o g i n g ven b a t a c ì + i v i t e i t e n n i v e e u e n afname ven madica- t i e - a f h a n k e l i j k h e i d l .

Het c o g n i L i e v e u i k g a n g s p u n t b i j c h r o n i s c h e p i j n s t e l t det. c o g n i t i e s ( a t t . i t u d e s , o\rert..ullgiingen, verweehtinigen) van CLBP-patient.sni t e n aan- zilen valn hun h a n d e l i n g s m o g e l i j k h e d e n s t e r k b e p a l e n d zijn v o o r hun erna- t i o n e l e e n g e d r a g s m a t i g e r e a i c t f e s i n b e p a a l d e s i t u a t i e s . Aangezien e m o t i o n e l e v a r i a b e l e n (m.n. a n g s t ) de p i j n e r v a r i n g b e l n v l o e d e n , w o r d t e r v a n u i t g e g a a n d a k c o g n i t f e v e m o d i f i c a t i e s van i n v l o e d r i j n o p d e

p i j n e r v e i r i n g z e l f . I n d i t lhcaofdstuk wordt: o p d e s e i n t e r a c t i e uibge- b r e i d i n g e g a a n , a a n d e hand ven e e n v i e r t e l s o o r t e n s t u d i e s ;

1. s t . u d i e s n a a r d e i n v l o e d ven woorafqqaamde i n f o r m a t i e o p e e n s u b s e - q u e n t e e x p e r i m e n t e l e p i j n p r i k k e l ,

2. s t u d i e s n a a r d e i n v l o e d ven v o o r a f g a a n d e i n l f o r m e t i e o p e e n eubse- qwente p i j n l i j k k l i n i s c h e i n g r e e p ,

3. s t u d i e s maer d e i n v l o e d ven d i v e r s e c o p i n g - s t i j l e n olp e e n ewbee- quent.e e x p e r i i r i e n t e l e p i jn p r i k k e l ,

4. s t u d i e s n a a r d e i n v l o e d van d i v e r s e c o p i n ~ g - s t i j l e n b i j k l i n i s c h e p i j n .

I n d e l i t e r a t u u r komen h e t d u i d e l i j k s t d e s i g n i f i c a n t e r e l a t i e s n e e r v o r e n t u s s e n het. h a n t e r e n vFin b e p e a l ~ d e c o g n i t i e v e c o p i n g - t e e h ~ n i e k e n e n e e n toename van p i j n p e r c e p t i e - o f p i j n t o l e r e n t i e d r e m p e l a i n experime* t e l e s i t u a t i e s (m.a.w. s t u d i e s van h e t t y p e 3 ) .

In h o o f d s t u k 4 w o r d t h e t l i t e r a t . . u i u r ~ w e r t L ~ h i h semcslnqewat en worde?n d e g r o t e l a c u n e s i n s i p e c i F f e k e , psychollt3gieche kenniia m.b.t. CLBP aanga- geven.

Hoofdstuk 5 l e i d t d e algemene v r a a g l a t e l l i n g i i n w a a r u i t die e r o p volgen-

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e e n a n d e r g e d r a g i n r u g b e l a s t e n d e s i t u a t i e a m I n d e d i v e r s e s t u d i e s werd gellxacht. om d e z e w r a a g a k e l l i n g e n i n e x p e r i m e n t e e l andlerroek t e n p e e a t i a n e 2 i s e s e n .

Hoofdait..uk 6 b e s c h r i j f t hef. b a s a l e e x p e r i m e n t . H i e r i n v o e r d e n d e CLBP p s t i e n t e n e e n g e s t a n d a a r d i s e e r d e , i n b e l a s t i n g toenemende loopban~d- o e f e n i n g uit i n a f w e z i g h e i d ven mogelijlke f e e d b a c k - c o n d i t i e s . De, ver- geileken mek s e n c o n t r o l e g r o e p , s l e c h t e r e p r e a t - a t i e - s c o r e s ven d e CLBP- g r o e p b l e k e n n i e t g e r e l a t e e r d a a n p i j n t o e n a m e o f maximaal p i j n n i v e a u t.ijdeina d ~ e t a s t . F y s i o l o g i s c h e v e r m o e i d h e i d s n i v e a u i s werden dloor CLBA- pat-ienken n i e t goed i n g e s c h a t . P a y c h o m e t r î s c h e g e g e v e n e b l e k e n v o e r CLE3P-lpatientevr s y e t m a t i s c h a n g u n s t i g e r w i t t e v a l l e n . Maofdetuk S b e s c h r i j f t e v e n e e n s h e t b a s a l e e x p e r i m e n t , w a a r b i j e c h t e r v o o r a f g a a n d e i n f o r r n e t i e werd v e r a c h l a f t , d i e e r t o e l e i d d e d e t d e CLBP p e t - i e n ~ t e n e r n i e t i n s l a a g d e n aangaboden r e f e r e n t i e - w a a r d e n t e blerei- ken. I n d e z e dreiglende f e a l c o n d i t i e s p a n d e n d e c o n t r o l e p e r s o n e n z i c h e x t r a i n ; C U P - p a t i e n t e n n ~ i e t . Aan,getoond kon worden d a t d e g e r a p p o r - t e e r d e s i g n i f i c a n t e p i j n t o e n a m e t i j d e n s d e i n s p a n n i n g n i e t g e r e l a t e e r d was e e n d e r u g b e l a s t i n g , maar ann d e f a a l c o n d i t i e . Eveneens i n tegen- s t . e l l i n g t.at d e co~ntac~iPegroep warein b i j CLBP-patien~ken p r e - t . e s t v a r i a - b e l e n meer a a n d e g e l e v e r d e p r e s t a t i e g e r e l a t e e r d d a n t s s t - v a r i a b e l e n .

Hoofdstuk t9 b e s c h r i j f t e v e n ~ e e n s d e l a o p b a n d p r o e f onder v o o r z i e n e eulcoes o f adoqueits f e e d b a c k - c o n d i t i e s

.

Toevoeging van d e z e c o n d i t i e s L e i d d e t.at b e w e e t i g l n g van e e r d l s r e , maar n i a t t o t s p e c i i e i e k e , nieuwe b ~ v i n d i n g a n .

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a c u t e p i j n s i t u a t i e ( h o o f d s t u k 9 - 1 1 e n i n e e n n i e t - p i j n r e l e v a n t e pres- t a t i s s i t u a t - i e ( h o o f d s t u k 9 . 2 ) . I n h o o f d s t u k 9.1. w o r d t a a n g e t o o n d d a t CLBP-patienken, w e r q e l e k e n met e e n c o n t . r o l e g r o e p , e e n a c u t e p i j n p r i k k e l ( i n d i t g e v a l d.m.v. d e c o l + p r e s s o r t e s t ) rnln~der l e n g v e r d r a g e n e n bowendien a l s p i j n l i j k e r e r v a - r e n . De v e r s c l ~ i l l e n i n p r e s t a t i e t u s e e n CLBP-yrxiep e n c o n t r o l e q r o e p b l i j k e n n i e t salmen ts hanglen mef. v e r s c h i l l e n i n c o p i n g - s t l j l .

I n h o o f d s t u k 9.2. w o r d t aanget.coiond d a t h e t p r e s t a k i e g e d r a g van CLBP- p a t i e n t e n , v e r g e l e k e n met e e n c o n t r o l e g r o e p , e d e q u a a t was o p e e n psy-

c h o m o t o r i s c h e kaak ( r e a c t i e t i j d e n - t . e s a . r . Er werdlen geen a a n w i j z i n g e n gevonden voor e e n s n e l l e r opgeef gedrag^, c . q . e e n l a g e s e f a a l t o l e r a n t - i e v o o r de CLBP-groep. Toch belnvlloedde d e r u ~ g p i j n b i n n e n d e CLBP-groep h e t I n d i v i d u e l e p r e s t a t i e n i v e a u : meer r u q p i j n van ke v o r e n l e i d d e t,ot e e n s l e c h t e r e p r e s t a t i e o p d e z e n i e t - p i j n r e l e v a n t e kaak.

I n h o o f d s t u k

10

warden d e g e g e v e n s u i t h e t v o o r a f g a a n d e s a m e n g e v a t , r e s u l t e r e n d i n e e n schema w a a r i n z o v e e l mogelliJk d e p o s i t i e v e e n nege- t i e v e , d a t w i l z e g g e n p r e s t e t i e v e r h o g e ~ n d e e n p r e s t e t i e v e r l e g e n d e psy- c h o l o g i s c h e i n v l o e d e n o p h e k wolhoudgedreg van CLBP-patierifen worden weergegeven i n hun o n d e r l i n g e v e r b a n d .

References

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