title: The relationship between activity and pain in patients 6 months after lumbar disc surgery: do pain-related coping modes act as moderator variables?
abstract: BACKGROUND
  In LBP patients, the relationship between pain and physical activity remains unclear. Whereas a negative relationship between pain and self-reported physical activity was found, this relation disappeared in the case of overt behavioral data (e.g., accelerometer). Cognitive-behavioral models of the development of chronic pain suggest subgroups with signs of physical underuse and overuse.
  
  
  OBJECTIVE
  To examine if patients with pain-related adaptive, endurance and fear-avoidance coping differ in pain, self-reported physical function and overt physical activity 6 months after disc surgery.
  
  
  METHODS
  24 patients completed questionnaires (Von Korff chronic pain grade (CPG), Kiel pain inventory (KPI), Funktionsfragebogen Hannover-Rücken FFbH-R) and underwent an 8-h accelerometer assessment in their daily life (physical activity level (PAL), number of constant postures (CP)). The KPI differed between adaptive coping (AC) (N=9), fear avoidance coping (FAC) (N=1) and endurance coping (EC) (N=14).
  
  
  RESULTS
  In the whole group, pain intensity was negative related to self-reported physical activity whereas PAL and CP displayed no correlation with pain. EC patients showed significantly higher pain scores and lower self-reported physical functioning compared to AC but the same level of PAL and furthermore, a significantly higher number of CPs in daily life. The visual inspection of the FAC patient revealed also high pain, low physical functioning and low overt physical activity.
  
  
  CONCLUSIONS
  The assessment of pain-related coping modes yielded an important differentiation between subgroups of LBP patients 6 months after surgery. Endurance copers displayed signs of overuse in their daily behavior in spite of pain than adaptive copers. The one fear avoidance coper tends to do less physical activity in the sense of underuse.
authors.affiliation: Ruhr-University of Bochum, Faculty of Medicine, Department of Medical Psychology and Medical Sociology, 44780 Bochum, NRW, Germany.
authors.forename: Monika Ilona
authors.initials: MI
authors.lastname: Hasenbring
authors.forename: Heike
authors.initials: H
authors.lastname: Plaas
authors.forename: Benjamin
authors.initials: B
authors.lastname: Fischbein
authors.forename: Roland
authors.initials: R
authors.lastname: Willburger
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001007:Anxiety / Q000209:etiology; D001362:Avoidance Learning; D005221:Fatigue / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D007403:Intervertebral Disc / Q000601:surgery*; D017116:Low Back Pain / Q000503:physiopathology* / Q000523:psychology*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology*; D013997:Time Factors