Graded-Modelle – eine Einführung

Graded-Modelle haben eines gemeinsam: Sie alle haben das Ziel, Patient*innen mit chronischen Schmerzen stufenweise darin zu unterstützen, ihren Aktivitätsradius zu erweitern und somit mehr Partizipation zu ermöglichen. Die einzelnen Ansätze unterscheiden sich jedoch in der Herangehensweise und ihren zugrundeliegenden Theorien. Fünf Expert*innen führen Sie auf eine spannende Reise in die Konzepte der Graded-Modelle.

Publication History

Article published online:
22 May 2023

• Literatur

• 1 Hodges PW, Smeets RJ. Interaction between pain, movement, and physical activity: short-term benefits, long-term consequences, and targets for treatment. Clin J Pain 2015; 31: 97-107 DOI: 10.1097/AJP.0000000000000098.
• 2 Vlaeyen JWS, Crombez G, Linton SJ. The fear-avoidance model of pain. Pain 2016; 157: 1588-1589 DOI: 10.1097/j.pain.0000000000000574.
• 3 Zale EL, Lange KL, Fields SA. et al. The relation between pain-related fear and disability: a meta-analysis. J Pain 2013; 14: 1019-1030 DOI: 10.1016/j.jpain.2013.05.005.
• 4 Vlaeyen JWS, Crombez G. Behavioral Conceptualization and Treatment of Chronic Pain. Annu Rev Clin Psychol 2020; 16: 187-212
• 5 Craske MG, Treanor M, Conway CC. et al. Maximizing exposure therapy: an inhibitory learning approach. Behav Res Ther 2014; 58: 10-23 DOI: 10.1016/j.brat.2014.04.006.
• 6 Craske MG, Kircanski K, Zelikowsky M. et al. Optimizing inhibitory learning during exposure therapy. Behav Res Ther 2008; 46: 5-27 DOI: 10.1016/j.brat.2007.10.003.
• 7 Gatzounis R, den Hollander M, Meulders A. Optimizing Long-term Outcomes of Exposure for Chronic Primary Pain from the Lens of Learning Theory. J Pain 2021; 22: 1315-1327 DOI: 10.1016/j.jpain.2021.04.012.
• 8 Weisman JS, Rodebaugh TL. Exposure therapy augmentation: A review and extension of techniques informed by an inhibitory learning approach. Clin Psychol Rev 2018; 59: 41-51 DOI: 10.1016/j.cpr.2017.10.010.
• 9 Knowles KA, Olatunji BO. Enhancing Inhibitory Learning: The Utility of Variability in Exposure. Cogn Behav Pract 2019; 26: 186-200 DOI: 10.1016/j.cbpra.2017.12.001.
• 10 Baker A, Mystkowski J, Culver N. et al. Does habituation matter? Emotional processing theory and exposure therapy for acrophobia. Behav Res Ther 2010; 48: 1139-1143 DOI: 10.1016/j.brat.2010.07.009.
• 11 Lovibond PF, Mitchell CJ, Minard E. et al. Safety behaviours preserve threat beliefs: Protection from extinction of human fear conditioning by an avoidance response. Behav Res Ther 2009; 47: 716-720 DOI: 10.1016/j.brat.2009.04.013.
• 12 Volders S, Meulders A, De Peuter S. et al. Safety behavior can hamper the extinction of fear of movement-related pain: an experimental investigation in healthy participants. Behav Res Ther 2012; 50: 735-746 DOI: 10.1016/j.brat.2012.06.004.
• 13 Hasenbring MI, Andrews NE, Ebenbichler G. Overactivity in Chronic Pain, the Role of Pain-related Endurance and Neuromuscular Activity: An Interdisciplinary, Narrative Review. Clin J Pain 2020; 36: 162-171 DOI: 10.1097/AJP.0000000000000785.
• 14 Craske MG, Treanor M, Zbozinek TD. et al. Optimizing exposure therapy with an inhibitory retrieval approach and the OptEx Nexus. Behav Res Ther 2022; 152: 104069 DOI: 10.1016/j.brat.2022.104069.
• 15 Sharpe L, Todd J, Scott A. et al. Safety behaviours or safety precautions? The role of subtle avoidance in anxiety disorders in the context of chronic physical illness. Clin Psychol Rev 2022; 92: 102126 DOI: 10.1016/j.cpr.2022.102126.
• 16 Meulders A, Van Daele T, Volders S. et al. The use of safety-seeking behavior in exposure-based treatments for fear and anxiety: Benefit or burden? A meta-analytic review. Clin Psychol Rev 2016; 45: 144-156 DOI: 10.1016/j.cpr.2016.02.002.
• 17 den Hollander M, Smeets RJEM, van Meulenbroek T. et al. Exposure in Vivo as a Treatment Approach to Target Pain-Related Fear: Theory and New Insights From Research and Clinical Practice. Phys Ther 2022; 102: pzab270 DOI: 10.1093/ptj/pzab270.
• 18 Vlaeyen JW, Morley JS, Linton SJ, Boersma K, de Jong J. Pain-Related Fear: Exposure-Based Treatment of Chronic Pain. Washington D. C.: IASP Press; 2012
• 19 Matheve T, De Baets L, Bogaerts K. et al. Lumbar range of motion in chronic low back pain is predicted by task-specific, but not by general measures of pain-related fear. Eur J Pain 2019; 23: 1171-1184 DOI: 10.1002/ejp.1384.
• 20 Lindström I, Ohlund C, Eek C. et al. The effect of graded activity on patients with subacute low back pain: a randomized prospective clinical study with an operant-conditioning behavioral approach. Phys Ther 1992; 72: 279-90 DOI: 10.1093/ptj/72.4.279.
• 21 Lindström I, Ohlund C, Nachemson AL. Physical performance, pain, pain behavior and subjective disability in patients with subacute low back pain. Scand J Rehabil Med 1995; 27: 153-160
• 22 Traxler J, Glombiewski J, Vläyen JWS. Der Teufelskreis aus Schmerz, Angst und Bewegungsvermeidung: Ursachen und mögliche Auswege. Der Schmerzpatient 2020; 3: 8-17
• 23 Gil KM, Ross SL, Keefe FJ. Behavioural treatment of chronic pain: Four pain management protocols’. In: France RD, Krishnan KRR. Chronic Pain. Washington: American Psychiatric Press; 1988: 317-413
• 24 Harding V, Watson P. Increasing activity and improving function in chronic pain management. Physiotherapy 2000; 86: 619-630 DOI: 10.1016/S0031-9406(05)61298-9.
• 25 Butler DS, Moseley GL. Schmerzen Verstehen. 3. Aufl. Heidelberg: Springer Verlag; 2016
• 26 Heldmann P, Schöttger-Königer T, Schäfer A. Kulturelle Adaptation und Validierung der deutschen Version des PSFS. International Journal of Health Professions 2015; 2: 73-82 DOI: 10.1515/ijhp-2015-0002.
• 27 Ceunen E, Vlayen JWS, Van Diest I. On the origin of interoception. Front Psychol 2016; 7: 743 DOI: 10.3389/fpsyg.2016.00743.
• 28 Storch M, Cantieni B, Hüther G, Tschacher W. Embodiment – Die Wechselwirkungen zwischen Körper und Psyche verstehen und nutzen. Bern: Hogrefe; 2017
• 29 Brodal P. A neurobiologist‘s attempt to understand persistent pain. Scand J Pain 2017; 15: 140-147 DOI: 10.1016/j.sjpain.2017.03.001.
• 30 Crofford LJ. Chronic Pain: Where the body meets the brain. Trans Am Clin Climatol Assoc 2015; 126: 167-183
• 31 Flor H. Pain has an element of blank – a biobehavioural approach to chronicity. Pain 2017; 158: 92-96 DOI: 10.1097/j.pain.0000000000000850.
• 32 Kuner R, Flor H. Structural plasticity and reorganisation in chronic pain. Nat Rev Neurosci 2016; 18: 20-30 DOI: 10.1038/nrn.2016.162.
• 33 Zusman M. A review of the proposal that innocuous proprioceptive input may maintain movement-evoked joint pain. Physical Therapy Reviews 2012; 17: 346-349 DOI: 10.1179/1743288X12Y.0000000023.
• 34 Kuss K, Leonhardt C, Quint S. et al. Graded activity for older adults with chronic low back pain: program development and mixed methods feasibility cohort study. Pain Med 2016; 17: 2218-2229 DOI: 10.1093/pm/pnw062.
• 35 Macedo LC, Smeets RJEM, Maher CG. et al. Graded Activity and Graded Exposure for Persistent Nonspecific Low Back Pain: A Systematic Review. Phys Ther 2010; 90: 860-879 DOI: 10.2522/ptj.20090303.
• 36 Setchell J, Costa N, Ferreira M. et al. What constitutes back pain flare? A cross sectional survey of individuals with low back pain. Scand J Pain 2017; 17: 294-301 DOI: 10.1016/j.sjpain.2017.08.003.
• 37 Hasenbring MI, Kindermanns H. Avoidance and Endurance in chronic pain: a self-regulation perspective. In: Karoly P, Crombez G, eds. Motivational perspectives on chronic pain. Oxford Univ Press; London: 2018: 287-314 DOI: 10.1093/oso/9780190627898.003.0008
• 38 Hasenbring MI, Chehadi O, Titze C. et al. Fear and anxiety in the transition from acute to chronic pain: there is evidence for endurance besides avoidance. Pain Manag 2014; 4: 363-374 DOI: 10.2217/pmt.14.36.
• 39 Costa N, Ferreira ML, Setchell J. et al. A definition of “Flare” in low back pain: a multiphase process involving perspectives of individuals with low back pain and expert consensus. J Pain 2019; 20: 1267-1275
• 40 Hodges PW, Tucker K. Moving differently in pain: a new theory to explain the adaptation to pain. Pain 2011; 152: 90-98 DOI: 10.1016/j.pain.2010.10.020.
• 41 Stokes IAF, Iatridis JC. Mechanical conditions that accelerate intervertebral disc degeneration: overload versus immobilization. Spine 2004; 29: 2724-2732 DOI: 10.1097/01.brs.0000146049.52152.da.
• 42 Hasenbring MI, Andrews NE, Ebenbichler G. Overactivity in Chronic Pain, the Role of Pain-related Endurance and Neuromuscular Activity: An Interdisciplinary, Narrative Review. Clin J Pain 2020; 36: 162-171 DOI: 10.1097/AJP.0000000000000785.
• 43 Andrews NE, Strong J, Meredith PJ. et al. “It’s very hard to change yourself”: an exploration of overactivity in people with chronic pain using interpretative phenomenological analysis. Pain 2015; 156: 1215-1231 DOI: 10.1097/j.pain.0000000000000161.
• 44 Fehrmann E, Tuechler K, Kienbacher T. et al. Comparisons in muscle function and training rehabilitation outcomes between avoidance-endurance model-subgroups. Clin J Pain 2017; 33: 912-920 DOI: 10.1097/AJP.0000000000000479.
• 45 Titze C, Fett D, Trompeter K. et al. Psychosocial subgroups in high-performance-athletes with low back pain: eustress-endurance is most frequent, distress-endurance most problematic! . Scand J Pain 2021; 21: 59-69 DOI: 10.1515/sjpain-2020-0053.
• 46 Titze C, Hasenbring MI, Kristensen L. et al. Patterns of approach to activity in 851 patients with severe chronic pain: translation and preliminary validation of the 9-item Avoidance-Endurance Fast-Screen (AEFS) into Danish. Clin J Pain 2021; 37: 226-236 DOI: 10.1097/AJP.0000000000000912.
• 47 Grebner M, Breme K, Rothoerl R. et al. Coping und Genesungsverlauf nach lumbaler Bandscheibenoperation [Coping and convalescence course after lumbar disk operations]. Schmerz 1999; 13: 19-30 DOI: 10.1007/s004829900011.
• 48 Hasenbring MI, Hallner D, Klasen BW. et al. Pain-related avoidance versus endurance in primary care patients with subacute back pain: psychological characteristics and outcome at a 6-month follow-up. Pain 2012; 153: 211-217 DOI: 10.1016/j.pain.2011.10.019.
• 49 Glombiewski JA, Hasenbring MI, Levenig CG, Karimi Z. Psychologische Verfahren. In: Casser HR, Hasenbring MI, Becker A, Baron R, Hrsg. Rückenschmerzen und Nackenschmerzen. Interdisziplinäre Diagnostik und Therapie, Versorgungspfade, Patientenedukation, Begutachtung, Langzeitbetreuung. Berlin, Heidelberg: Springer; 2016: 297-310
• 50 Wolff SV, Willburger R, Hallner D. et al. Avoidance-endurance fast screening (AE-FS): Content and predictive validity of a 9-item screening instrument for patients with unspecific subacute low back pain. Schmerz 2018; 32: 283-292 DOI: 10.1007/s00482-018-0310-x.
• 51 Hasenbring MI, Pfingsten M. Psychosoziale Diagnostik. In: Casser HR, Hasenbring MI, Becker A, Baron R, Hrsg. Rückenschmerzen und Nackenschmerzen. Interdisziplinäre Diagnostik und Therapie, Versorgungspfade, Patientenedukation, Begutachtung, Langzeitbetreuung. Berlin, Heidelberg: Springer; 2016: 149-164
• 52 Hasenbring MI. Biopsychosoziale Krankheitsmodelle. In: Casser HR, Hasenbring MI, Becker A, Baron R, Hrsg. Rückenschmerzen und Nackenschmerzen. Interdisziplinäre Diagnostik und Therapie, Versorgungspfade, Patientenedukation, Begutachtung, Langzeitbetreuung. Berlin, Heidelberg: Springer; 2016: 205-215
• 53 Craske MG, Treanor M, Convey CC. et al. Maximizing exposure therapy: An inhibitory learning approach. Behav Res Ther 2014; 58: 10-23 DOI: 10.1016/j.brat.2014.04.006.