title: Fear-avoidance- and endurance-related responses to pain: development and validation of the Avoidance-Endurance Questionnaire (AEQ).
abstract: OBJECTIVE
  Recent research indicated wide variability regarding pain-related cognitive/affective and behavioral responses to pain, showing that fear-avoidance responses (FAR) and endurance-responses (ER) play a prominent role in the maintenance of low back pain (LBP). Until now, there is a lack of reliable and valid instruments covering FAR and ER.
  
  
  METHODS
  A pool of 60 items, derived from the Kiel Pain Inventory was answered by 191 LBP patients. Principle components analyses (PCA) was used to explore the factor structure creating the Avoidance-Endurance Questionnaire (AEQ). Validity was calculated using the criteria variables pain intensity, disability, chronic pain grades (CPG) and number of sick days, further self-report measures (Fear-Avoidance Beliefs Questionnaire FABQ, Pain Anxiety Symptoms Scale PASS, Tampa Scale of Kinesiophobia TSK and Beck Depression Inventory BDI) evaluating construct validity.
  
  
  RESULTS
  PCA revealed five AEQ-FAR scales with anxiety/depression, catastrophizing, help-/hopelessness, avoidance of social activities, avoidance of physical activities, and four AEQ-ER scales with positive mood, thought suppression, pain persistence behavior and humor/distraction. All scales revealed high internal consistency. As expected, FAR scales showed positive associations with pain, disability and other FAR variables (correlations between r=.26 and r=.58), whereas ER scales showed negative associations (between r=-.19 and -.48). The only exception referred to positive correlations between both, FAR and ER and pain intensity.
  
  
  CONCLUSIONS
  The AEQ has shown as a reliable and valid measure to assess pattern of fear-avoidance and endurance-related responses to pain. Both aspects seem to play a role in the maintenance of LBP.
authors.affiliation: Dept. of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr-University of Bochum, Bochum, Germany. Monika.Hasenbring@ruhr-uni-bochum.de
authors.forename: Monika I
authors.initials: MI
authors.lastname: Hasenbring
authors.forename: Dirk
authors.initials: D
authors.lastname: Hallner
authors.forename: Adina C
authors.initials: AC
authors.lastname: Rusu
mesh_terms: D000223:Adaptation, Psychological / Q000502:physiology*; D000328:Adult; D001007:Anxiety / Q000523:psychology; D003071:Cognition / Q000502:physiology; D003863:Depression / Q000523:psychology; D004185:Disability Evaluation; D004644:Emotions / Q000502:physiology*; D005239:Fear / Q000502:physiology*; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010807:Physical Endurance / Q000502:physiology*; D015203:Reproducibility of Results; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires