Two studies are presented that investigated 'fear of movement/(re)injury' in chronic musculoskeletal pain and its relation to behavioral performance. The 1st study examines the relation among fear of movement/(re)injury (as measured with the Dutch version of the Tampa Scale for Kinesiophobia (TSK-DV)) (Kori et al. 1990), biographical variables (age, pain duration, gender, use of supportive equipment, compensation status), pain-related variables (pain intensity, pain cognitions, pain coping) and affective distress (fear and depression) in a group of 103 chronic low back pain (CLBP) patients. In the 2nd study, motoric, psychophysiologic and self-report measures of fear are taken from 33 CLBP patients who are exposed to a single and relatively simple movement. Generally, findings demonstrated that the fear of movement/(re)injury is related to gender and compensation status, and more closely to measures of catastrophizing and depression, but in a much lesser degree to pain coping and pain intensity. Furthermore, subjects who report a high degree of fear of movement/(re)injury show more fear and escape/avoidance when exposed to a simple movement. The discussion focuses on the clinical relevance of the construct of fear of movement/(re)injury and research questions that remain to be answered.

/pdf/fear-of-movement-re-injury-in-chronic-low-back-pain-and-its-4udyc2mewt.pdf

Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance

It is now well established that in chronic low back pain, there is no direct relationship between impairments, pain, and disability. From a cognitive-behavioral perspective, pain disability is not only influenced by the organic pathology, but also by cognitive-perceptual, psychophysiological, and motoric-environmental factors. This paper focuses on the role of specific beliefs that are associated with avoidance of activities. These beliefs are related to fear of movement and physical activity, which is (wrongfully) assumed to cause (re)injury. Two studies are presented, of which the first examines the factor structure of the Tampa Scale for Kinesiophobia (TSK), a recently developed questionnaire that is aimed at quantifying fear of movement/(re)injury. In the second study, the value of fear of movement/(re)injury in predicting disability levels is analyzed, when the biomedical status of the patient and current pain intensity levels are controlled for. In addition, the determinants of fear of movement/(re)injury are examined. The discussion focuses on the clinical relevance of the fear-avoidance model in relation to risk assessment, assessment of functional capacity, and secondary prevention.

The role of fear of movement/(re)injury in pain disability.

• Endogenous anxiety (anxiety hysteria, agoraphobia with panic attacks) is characterized by sudden, spontaneous panic attacks accompanied by multiple autonomic symptoms, overwhelming fear, a flight response, and polyphobic behavior. Psychotherapy, behavior therapy, and tranquilizers have been of limited success in treating this syndrome. Fifty-seven patients severely disabled by the syndrome for a mean period of 13 years completed the three-month study. Randomly assigned in a double-blind, placebo-controlled design to imipramine hydrochloride, phenelzine sulfate, or placebo, they were seen in supportive group therapy every two weeks. Patients in the phenelzine and imipramine cells showed significant improvement over patients in the placebo group and over baseline on all outcome measures. The persistent trend for phenelzine to be superior to imipramine achieved significance only on the Work and Social Disability Scale and the Symptom Severity and Phobic Avoidance Scale. The implications for classification and theory are discussed.

Treatment of Endogenous Anxiety With Phobic, Hysterical, and Hypochondriacal Symptoms

Treatment of specific phobia in adults.

• Sixty-five patients with social phobia were treated in a study that compared a cognitive-behavioral group treatment program with pharmacotherapy with alprazolam, phenelzine sulfate, or pill-placebo plus instructions for self-directed exposure to phobic stimuli. Statistically significant repeated-measures effects were shown on all measures, indicating that the treatments studied were associated with substantial improvements in patients with severe and chronic social phobia. Patients who were treated with phenelzine were rated by clinicians as more improved on a measure of work and social disability than patients who were treated with alprazolam or placebo (patients in the cognitive-behavior therapy group were not rated on this measure). Subjects showed positive cognitive changes from before to after treatment, and there were no differences between treatment groups on the cognitive measure. We discuss the implications of these findings within the context of demographic and clinical predictors of response.

Cognitive-Behavioral and Pharmacological Treatments of Social Phobia: A Controlled Study

Une etude portant sur l'efficacite du phenelzine dans le nevrose phobique en comparaison avec trois differentes formes de therapie de comportement et un groupe de controle soumis au placebo a ete completee.Cinq groupes de 10 patients chacun ont ete evalues. Un questionnaire psychiatrique standardise, plusieurs tests psychometriques ainsi que deux livrets d'auto-evaluation confirmaient surtout l'existence d'une nevrose phobique mais aussi l'existence de d'autres symptomes nevrotiques et d'inadaptation sociale dans chacun des groupes. Les trois groupes de therapie de comportement: La desensibilisation systematique (systematic desensitization) (DS), soulagement de l'aversion (aversion relief) (A) et l'immersion (Flooding) (I) ont recu 12 heures de therapie pendant une periode de trois mois. Les deux autres groupes soit, celui recevant le phenelzine (P-BP) et l'autre groupe de controle recevant un placebo (PI-BP), ont recu a tous les jours, trois tablettes de phenelzine ou placebo pendant une duree de trois m...

Behaviour Therapy versus Drug Therapy in the Treatment of Phobic Neurosis

Ten low-weight (mean, 87.8% of ideal), chronic bulimic patients, seven of whom were previously unsuccessfully treated with antidepressant drugs, received fluoxetine 80 mg/day for 3 months. Endpoint analysis showed a significant decrease in bulimic episodes (p = 0.01), vomiting frequency (p less than 0.05), and depression scores (Hamilton Rating Scale for Depression, p less than 0.04; Beck Depression Inventory, p = 0.05; Hopkins Symptom Checklist-90 depression subscale, p less than 0.05). In addition, trait anxiety (State-Trait Anxiety Inventory trait: p less than 0.002), obsessive symptoms (Leyton Obsessional Inventory symptom: p = 0.01; Symptom Checklist-90 obsessive-compulsive disorders subscale: p = 0.02), and traits (Leyton Obsessional Inventory trait: p = 0.005) also decreased significantly. There was no change in state anxiety or in Leyton Obsessional Inventory interference and resistance scores. There was no significant increase in weight. Two patients were in remission, two were much improved, two improved, and four showed no change. Side effects were minimal. There were no dropouts.

The fluoxetine treatment of low-weight, chronic bulimia nervosa.

Two patients suffering from severe obsessive-compulsive disorder which had proven refractory to clomipramine and/or phenelzine treatment were successfully treated with fluoxetine, a new drug with a strong serotonin uptake inhibiting action. Outcome of treatment was measured on psychometric tests including the Leyton Obsessive Inventory, Hopkins Symptom Checklist-90, Beck Depression Inventory, and daily self-reports of the duration and degree of discomfort of their most severe obsessions. The delay in responding to fluoxetine, the continuing improvement even after one year on the drug, and the prompt relapse with abrupt withdrawal of treatment were noted.

Fluoxetine treatment of obsessive-compulsive disorder.

Cross-national validity of the five-components model of self-assessed fears: Canadian psychiatric outpatients data vs. Dutch target ratings on the fear survey schedule-III

This paper presents the cases of two patients who suffered from panic disorder with agoraphobia and depression. One had been refractory to alprazolam and tricyclics and to behaviour therapy; she had responded to phenelzine, but due to a weight gain of 50 lbs, had discontinued treatment and she relapsed. The second patient, who also suffered from post-traumatic stress disorder, did not respond to alprazolam, imipramine or to phenelzine, but gained weight (33 lbs) on phenelzine. Both patients responded to fluoxetine 80 mg per day without concomitant weight gain.

B. Ledwidge

Papers

Behaviour Therapy versus Drug Therapy in the Treatment of Phobic Neurosis

The fluoxetine treatment of low-weight, chronic bulimia nervosa.

Fluoxetine treatment of obsessive-compulsive disorder.

Cross-national validity of the five-components model of self-assessed fears: Canadian psychiatric outpatients data vs. Dutch target ratings on the fear survey schedule-III

Fluoxetine in panic disorder.