Perceived psychosocial stressors and coping resources in chronic low back pain patients as classified by the avoidance-endurance model

Elisabeth Fehrmann; Linda Fischer-Grote; Thomas Kienbacher; Kerstin Tuechler; Patrick Mair; Gerold Ebenbichler

doi:10.3389/fresc.2022.996945

Perceived psychosocial stressors and coping resources in chronic low back pain patients as classified by the avoidance-endurance model

Front Rehabil Sci. 2022 Oct 31:3:996945. doi: 10.3389/fresc.2022.996945. eCollection 2022.

Authors

Elisabeth Fehrmann^{1

2}, Linda Fischer-Grote¹, Thomas Kienbacher¹, Kerstin Tuechler¹, Patrick Mair³, Gerold Ebenbichler⁴

Affiliations

¹ Department of Psychology, Karl Landsteiner Institute of Outpatient Rehabilitation Research, Vienna, Austria.
² Rehab Zentrum Liesing, Karl Landsteiner University of Health Sciences, Krems, Austria.
³ Department of Psychology, Harvard University, Cambridge, MA, United States.
⁴ Department of Physical Medicine, Rehabilitation and Occupational Medicine, Vienna Medical University, Vienna, Austria.

Abstract

Objectives: The Avoidance-Endurance Model distinguishes between subgroups of low back pain (LBP) patients with three maladaptive styles of coping with pain: fear-avoidance (FAR), distress-endurance (DER), eustress-endurance (EER), and one adaptive coping style (AR). This study aimed to compare the quantity of patients' perceived psychosocial stressors and coping resources across these subgroups.

Materials and methods: This cross-sectional study was conducted at an outpatient rehabilitation center for patients with chronic musculoskeletal pain. One hundred and thirty-seven patients (69 women/68 men) with chronic LBP were assessed using the following: a demographic checklist, the visual analogue scale, Avoidance-Endurance Questionnaire, Roland-Morris Disability Questionnaire, Pain Disability Index, and 36-Item Short Form. Subsequently, patients participated in semi-structured interviews led by clinical psychologists, which were intended to identify their perception of stressors and coping resources. The quantity of psychosocial stressors and coping resources were analyzed using deductive and inductive content analyses and then compared between subgroups using chi-square-tests.

Results: FARs experienced significantly higher levels of "mental suffering" (p = <0.001) and "other workplace problems" compared to ARs and EERs (p = <0.001). DERs reported significantly higher levels of "mental suffering" (p = <0.001), "job stress" (p = 0.022), and "familial losses" (p = 0.029) compared to ARs, whereas the AR group demonstrated significantly more "coping resources" (p = 0.001) compared to FARs.

Conclusion: AEM-subgroups differed in the quantity of perceived psychosocial stressors and coping resources with AR, who demonstrated a lower risk for pain chronicity and reported the highest quantity of resources. The variability across subgroups may imply differences in patientś needs regarding therapeutic interventions and suggests that a resource-centered approach to cope with stress and pain may be beneficial.

Keywords: avoidance-endurance; chronic low back pain; coping resources; psychosocial stressors; subgroups.