G. Lorimer Moseley and Lester Jones
3.5 LIMITATIONS, OPPORTUNITIES, AND CONCLUSION
As well, the person should be encouraged to use quotas to guide activity level, rather than pain being the guide. Quotas (e.g., repetitions of exercise, time spent on an activity) identify the level of activity to be performed regardless of the pain on the day. They should be set by the person in response to previous successful experiences.
The person must resist responding to low levels of pain by increasing activity beyond the set quota and should endeavor to reach the quota even when pain is interfering.
This should be done, with the knowledge from previous experience, that the task is achievable by challenging any unhelpful thoughts and using relaxation strategies during the task. A gradual increase in quotas allows activity to be paced up and should be achievable as the person becomes more competent in the use of cognitive strategies and used to the level of activity.
The rehabilitation professional should be able to facilitate this process of pac-ing up activity. Importantly, this requires effective education, the opportunity for the person with pain to experience successful performances, and the development of effective cognitive-behavioral strategies for self-management. Optimum levels of activity will most likely be achieved when the combined skills of thought challeng-ing, relaxation, and pacing are well developed and consistently applied (see Nicholas and Tonkin, 2004 for more specifi c detail on goal setting, pacing, and quotas).
3.4.2.9 Graded Exposure
The use of a graded exercise program is common in the rehabilitation of people with persistent pain. This has many potential benefi ts including physical improvements such as strength, range of movement, and coordination, and psychological benefi ts such as improved self-effi cacy and improved mood. There is also the possibility that there is a reduction in pain-related fear, as a person is able to confront fearful activi-ties or situations in the safety of the rehabilitation setting.
Graded exposure to fearful activities is a much more formalized approach to this, and arguably more effective (Vlaeyen and Linton, 2000). With fear as the target of the intervention, a hierarchy of situations or events is constructed ranging from a situation of no fear (i.e., baseline) to one that provokes intense fear. Treatment using graded exposure involves presenting the fear-inducing stimuli in order of the hierar-chy, progressing toward the most intense. This technique has been used successful in people with persistent pain including nonspecifi c low back pain (Vlaeyen et al., 2002) and complex regional pain syndrome (de Jong et al., 2005).
Notably, the application of these cognitive-behavioral principles forms just one aspect of the rehabilitation process, along with interdisciplinary interventions that tackle physical fi tness, ergonomic factors, and work practices.
can be conceptualized as conscious correlate of the brain’s implicit perception of threat to body tissue. There are several other key “take-home messages:”
1. Pain depends on the brain’s implicit appraisal of threat to body tissue. Noci-ception is very important, but it is neither suffi cient nor necessary for pain.
2. Many factors from sensory, psychological, and occupation (social) domains modulate pain.
3. Pain treatment can target the underpinning mechanisms in pain. That is, anti-infl ammatory strategies, including postural correction and appropriate work-related pacing to reduce peripheral sensitization, cognitive- behavioral strategies to promote descending inhibition, and provision of accurate information (“explaining pain”) to modify the meaning of pain.
4. This chapter is a starting place. We have tried to reference the key paper or source where the reader would benefi t greatly from further reading.
ACKNOWLEDGMENTS
G.L.M. is supported by the Nuffi eld Dominions Trust. L.J. is an honorary senior lecturer in pain sciences at the University of Sydney, Australia.
REFERENCES
Acerra N and Moseley GL 2005: Dysynchiria: Watching the mirror image of the unaffected limb elicits pain on the affected side. Neurology 65: 751–753.
Acerra N, Souvlis T, and Moseley G 2007: Stroke, complex regional pain syndrome and phantom limb pain: Can commonalities direct future management? J Rehabil Med 39:
109–114.
Apkarian AV, Bushnell MC, Treede R-D, and Zubieta J-K 2005: Human brain mechanisms of pain perception and regulation in health and disease. Eur J Pain 9: 463–484.
Arntz A and Claassens L 2004: The meaning of pain infl uences its experienced intensity.
Pain 109: 20–25.
Arntz A, Dreessen L, and De Jong P 1994: The infl uence of anxiety on pain: Attentional and attributional mediators. Pain 56: 307–314.
Arntz A, Vaneck M, and Heijmans M 1990: Predictions of dental pain—The fear of any expected evil, is worse than the evil itself. Behav Res Ther 28: 29–41.
Asghari A, Nicholas MK 2001: Pain self-effi cacy beliefs and pain behaviour. A prospective study. Pain 94: 85–100.
Asmundson GJ, Kuperos JL, and Norton GR 1997: Do patients with chronic pain selectively attend to pain-related information? Preliminary evidence for the mediating role of fear.
Pain 72: 27–32.
Awerbuch M. 2004: Repetitive strain injuries: Has the Australian epidemic burnt out? Intern Med J 34(7): 416–419.
Banks WA and Watkins LR 2006: Mediation of chronic pain: Not by neurons alone. Pain 124: 1–2.
Benedetti F, Pollo A, Lopiano L, Lanotte M, Vighetti S, and Rainero I 2003: Conscious expectation and unconscious conditioning in analgesic, motor, and hormonal placebo/
nocebo responses. J Neurosci 23: 4315–4323.
Bigos SJ, Battie MC, Spengler DM, Fisher LD, Fordyce WE, Hansson TH, Nachemson AL, and Wortley MD 1991: A prospective study of work perceptions and psychosocial factors affecting the report of back injury [published erratum appears in spine 1991 jun;16(6):688]. Spine 16: 1–6.
Bongers PM, Ijmker S, van den Heuvel S, and Blatter BM 2006: Epidemiology of work related neck and upper limb problems: Psychosocial and personal risk factors (part i) and effective interventions from a biobehavioural perspective (part ii). J Occup Rehabil 16: 279–302.
Boos N, Rieder R, Schade V, Spratt KF, Semmer N, and Aebi M 1995: 1995 Volvo Award in Clinical Sciences. The diagnostic accuracy of magnetic resonance imaging, work perception, and psychosocial factors in identifying symptomatic disc herniations. Spine 20: 2613–2625.
Butler D 2000: The Sensitive Nervous System. Adelaide: NOI Publications, 431 pp.
Butler D and Moseley GL 2003: Explain Pain. Adelaide: NOI Group Publishing, 114 pp.
Campbell JN and Meyer RA 2006: Mechanisms of neuropathic pain. Neuron 52: 77–92.
Carayon P, Smith MJ, and Haims MC 1999: Work organization, job stress, and work-related musculoskeletal disorders. Hum Factors 41: 644–663.
Chua P, Krams M, Toni I, Passingham R, and Dolan R 1999: A functional anatomy of antici-patory anxiety. Neuroimage 9: 563–571.
Coudeyre E, Rannou F, Tubach F, Baron G, Coriat F, Brin S, Revel M, and Poiraudeau S 2006: General practitioners’ fear-avoidance beliefs infl uence their management of patients with low back pain. Pain 124: 330–337.
Cousins MC, I. P 1999: Acute and postoperative pain. In Wall PD and Melzack R (Eds.):
Textbook of Pain (4th edn.). London: Churchill Livingstone, pp. 447–492.
Craig A 2002: How do you feel? Interoception: The sense of the physiological condition of the body. Nature Rev Neurosci 3: 655–666.
Crombez G, Eccleston C, Baeyens F, and Eelen P 1996: The disruptive nature of pain: An experimental investigation. Behav Res Ther 34: 911–918.
Crombez G, Eccleston C, Baeyens F, and Eelen P 1997: Habituation and the interference of pain with task performance. Pain 70: 149–154.
Crombez G, Eccleston C, Baeyens F, and Eelen P 1998: Attentional disruption is enhanced by the threat of pain. Behav Res Ther 36: 195–204.
Crombez G, Eccleston C, Baeyens F, van Houdenhove B, and van den Broeck A 1999: Atten-tion to chronic pain is dependent upon pain-related fear. J Psychosom Res 47: 403–410.
Crombez G, Van Damme S, and Eccleston C 2005: Hypervigilance to pain: An experimental and clinical analysis. Pain 116: 4–7.
de Jong JR, Vlaeyen JWS, Onghena P, Cuypers C, Hollander MD, and Ruijgrok J 2005:
Reduction of pain-related fear in complex regional pain syndrome type i: The applica-tion of graded exposure in vivo. Pain 116: 264–275.
Duckworth MP, Iezzi A, Adams HE, and Hale D 1997: Information processing in chronic pain disorder: A preliminary analysis. J Psychopathol Behav Assess 19: 239–255.
Eccleston C 1994: Chronic pain and attention: A cognitive approach. Br J Clin Psychol 33:
535–547.
Eccleston C and Crombez G 1999: Pain demands attention: A cognitive-affective model of the interruptive function of pain. Psychol Bull 125: 356–366.
Eccleston C, Crombez G, Aldrich S, and Stannard C 1997: Attention and somatic awareness in chronic pain. Pain 72: 209–215.
Fabrega H and Tyma S 1976: Language and cultural infl uences in description of pain. Br J Med Psychol 49: 349–371.
Feuerstein M, Harrington CB, Lopez M, and Haufl er A 2006: How do job stress and ergo-nomic factors impact clinic visits in acute low back pain? A prospective study. J Occup Environ Med 48: 607–614.
Fisher K and Johnston M 1997: Validation of the oswestry low back pain disability ques-tionnaire, its sensitivity as a measure of change following treatment and its relation-ship with other aspects of the chronic pain experience. Physiother Theory Pract 13:
67–80.
Flor H 2003: Cortical reorganisation and chronic pain: Implications for rehabilitation.
J Rehabil Med 35: 66–72.
Flor H, Braun C, Elbert T, and Birbaumer N 1997: Extensive reorganization of primary somatosensory cortex in chronic back pain patients. Neurosci Lett 224: 5–8.
Flor H, Denke C, Schaefer M, and Grusser S 2001: Effect of sensory discrimination training on cortical reorganisation and phantom limb pain. Lancet 357: 1763–1764.
Flor H, Elbert T, Knecht S, Wienbruch C, Pantev C, Birbaumer N, Larbig W, and Taub E 1995: Phantom-limb pain as a perceptual correlate of cortical reorganization following arm amputation. Nature 375: 482–484.
Flor H, Nikolajsen L, and Jensen TS 2006: Phantom limb pain: A case of maladaptive CNS plasticity? Nat Rev Neurosci 7: 873–881.
Gifford L: Red and yellow fl ags and improving patient outcomes. OCPPP Annual Congress 2006, Nottingham, U.K.
Godinho F, Magnin M, Frot M, Perchet C, and Garcia-Larrea L 2006: Emotional modulation of pain: Is it the sensation or what we recall? J Neurosci 26: 11454–11461.
Gore M, Brandenburg NA, Dukes E, Hoffman DL, Tai KS, and Stacey B 2005: Pain severity in diabetic peripheral neuropathy is associated with patient functioning, symptom levels of anxiety and depression, and sleep. J Pain Symptom Manage 30:
374–385.
Gracely RH, Dubner R, Deeter WR, and Wolskee PJ 1985: Clinicians’ expectations infl uence placebo analgesia. Lancet 1: 43.
Gracely RH, Geisser ME, Giesecke T, Grant MAB, Petzke F, Williams DA, and Clauw DJ 2004: Pain catastrophizing and neural responses to pain among persons with fi bromy-algia. Brain 127: 835–843.
Greenhalgh S and Selfe J 2006: Red fl ags. A Guide to Identifying Serious Pathology of the Spine. Oxford: Churchill Livingstone Elsevier, 214 pp.
Harris AJ 1999: Cortical origin of pathological pain. Lancet 354: 1464–1466.
Helliwell PS and Taylor WJ. 2004: Repetitive strain injury. Postgrad Med J 80(946):
438–443.
Hodges PW, Moseley GL, Gabrielsson A, and Gandevia SC 2003: Experimental muscle pain changes feedforward postural responses of the trunk muscles. Exp Brain Res 151:
262–271.
Janig W, Chapman CR, and Green P 2006: Pain and body protection: sensory, autonomic, neuroendocrine and behavioural mechanisms in the control of infl ammation and hype-ralgesia. In: Flor H, Kalso E, and Dostrovsky J (Eds.): 11th World Congress of Pain, Sydney: IASP Press.
Jensen M 1994: Magnetic resonance imaging of the lumbar spine in people without low back pain. N Engl J Med 331(2): 69–73.
Jensen MP, Karoly P, and Huger R 1987: The development and preliminary validation of an instrument to assess patients’ attitudes toward pain. J Psychosom Res 31: 393–400.
Jones AKP 2005: The role of the cerebral cortex in pain perception. In Justins DM (Ed.): Pain 2005—An Update Review, Seattle, WA: IASP Press, pp. 59–68.
Jones L and Moseley GL 2008: Pain. In Porter S (Ed.): Tidy’s Physiotherapy (14th edn.).
Oxford: Elsevier, pp. 485–502.
Keller, S., Bann, C.M., Dodd, S.L., Schein, J., Mendoza, T.R., and Cleeland, C. 2004: Valid-ity of the brief pain inventory for use in documenting the outcomes of patients with noncancer pain. Clin J Pain, 20(50): 309–318.
Keltner JR, Furst A, Fan C, Redfern R, Inglis B, and Fields HL 2006: Isolating the modula-tory effect of expectation on pain transmission: A functional magnetic resonance
imag-Kendall NAS, Linton SJ, and Main CJ 1997. Guide to assessing psychosocial yellow fl ags in acute low back pain: Risk factors in long-term disability and work loss. Accident Reha-bilitation and Compensation Insurance Corporation of New Zealand, and the National Health Committee Ministry of Health. Wellington, New Zealand, 1997.
Klages U, Kianifard S, Ulusoy O, and Wehrbein H 2006: Anxiety sensitivity as predictor of pain in patients undergoing restorative dental procedures. Community Dent Oral Epidemiol 34: 139–145.
LaJoie AS, McCabe SJ, Thomas B, and Edgell SE 2005: Determining the sensitivity and specifi city of common diagnostic tests for carpal tunnel syndrome using latent class analysis. Plast Reconstr Surg 116: 502–507.
Lasch KE 2002: Culture and pain. Pain Clinical Updates, Accessed on 12 December 2008 from http://www.iasp-pain.org/AM/AMTemplate.cfm?Section=Home&TEMPLATE
=/CM/ContentDisplay.cfm&CONTENTID=7578
Linton SJ 2005: Do psychological factors increase the risk for back pain in the general popu-lation in both a cross-sectional and prospective analysis. Eur J Pain, 9(4): 354–361.
Lucire Y 2003: Constructing RSI: Belief and Desire. Sydney, Australia: UNSW Press, 216 pp.
Maihofner C, Handwerker HO, Neundorfer B, and Birklein F 2004: Cortical reorganization during recovery from complex regional pain syndrome. Neurology 63: 693–701.
Main CJ 1983: The modifi ed somatic perception questionnaire (mspq). J Psychosom Res 27:
503–514.
Marras WS 2000: Occupational low back disorder causation and control. Ergonomics 43:
880–902.
Marras WS, Davis KG, Heaney CA, Maronitis AB, and Allread WG 2000: The infl uence of psychosocial stress, gender, and personality on mechanical loading of the lumbar spine.
Spine 25: 3045–3054.
Matthews KA, Schier MF, Brunson BI, and Carducci B 1980: Attention, unpredictability, and reports of physical symptoms eliminating the benefi ts of predictability. J Personal Soc Psychol 38: 525–537.
McCracken LM 1997: “Attention” to pain in persons with chronic pain: A behavioral approach. Behav Ther 28: 271–284.
McCracken LM, Zayfert C, and Gross RT 1992: The pain anxiety symptoms scale: Develop-ment and validation of a scale to measure fear of pain. Pain 50: 67–73.
McQuay HJ, Moore RA, Eccleston C, Morley S, and Williams AC 1997: Systematic review of outpatient services for chronic pain control. Health Technol Assess 1: i–iv, 1–135.
Melzack R 1975: The Mcgill pain questionnaire: Major properties and scoring methods. Pain 1: 277–299.
Melzack R 1990: Phantom limbs and the concept of a neuromatrix. Trends Neurosci 13:
88–92.
Melzack R 1996: Gate control theory. On the evolution of pain concepts. Pain Forum 5:
128–138.
Melzack R 1999: From the gate to the neuromatrix. Pain 6(Suppl.): S121–S126.
Melzack R and Wall PD 1965: Pain mechanisms: A new theory. Science 150: 971–979.
Merskey H and Bogduk N 1994: Classifi cation of Chronic Pain (2nd edn.). Seattle, WA: IASP Press, 210 pp.
Meyer R, Ringkamp M, Campbell JN, and Raja SN 2006: Peripheral mechanisms of cuta-neous nociception. In McMahon SB and Koltzenburg M (Eds.): Textbook of Pain (5th edn.). London: Elsevier, pp. 3–35.
Miller R, Kori S, and Todd D. The tampa scale for kinesiphobia. Unpublished report. Tampa, FL, 1991.
Millson HB, Gray J, Stretch RA, and Lambert MI 2004: Dissociation between back pain and bone stress reaction as measured by CT scan in young cricket fast bowlers. Br J Sports
Morley S, Eccleston C, and Williams A 1999: Systematic review and meta-analysis of ran-domized controlled trials of cognitive behaviour therapy and behaviour therapy for chronic pain in adults, excluding headache. Pain 80: 1–13.
Morris DB 2001: Narrative, ethics, and pain: Thinking with stories. Narrative 9(1): 55–77.
Moseley GL 2002: Combined physiotherapy and education is effective for chronic low back pain. A randomised controlled trial. Aust J Physiother 48: 297–302.
Moseley GL 2003a: A pain neuromatrix approach to patients with chronic pain. Man Ther 8: 130–140.
Moseley GL 2003b: Joining forces—Combining cognition-targeted motor control training with group or individual pain physiology education: A successful treatment for chronic low back pain. J Man Manip Ther 11: 88–94.
Moseley GL 2004a: Evidence for a direct relationship between cognitive and physical change during an education intervention in people with chronic low back pain. Eur J Pain 8:
39–45.
Moseley GL 2004b: Imagined movements cause pain and swelling in a patient with complex regional pain syndrome. Neurology 62: 1644.
Moseley GL 2006: Making sense of s1 mania—Are things really that simple? In Gifford L (Ed.): Topical Issues in Pain, Vol. 5. Falmouth: CNS Press, pp. 321–340.
Moseley GL 2007: Reconceptualising pain according to its underlying biology. Phys Ther Rev 12:169–178.
Moseley GL and Arntz A 2007: The context of a noxious stimulus affects the pain it evokes.
Pain 133:64–71.
Moseley GL and Gandevia SC 2005: Sensory-motor incongruence and reports of “pain”.
Rheumatology 44: 1083–1085.
Moseley GL, Nicholas MK, and Hodges PW 2004a: A randomized controlled trial of intensive neurophysiology education in chronic low back pain. Clin J Pain 20:
324–330.
Moseley GL, Nicholas MK, and Hodges PW 2004b: Does anticipation of back pain predis-pose to back trouble? Brain 127: 2339–2347.
Moseley GL, Nicholas MK, and Hodges PW 2004c: Pain differs from non-painful attention-demanding or stressful tasks in its effect on postural control patterns of trunk muscles.
Exp Brain Res 156: 64–71.
Moseley GL, Zalucki NM, and Wiech K 2008: Tactile discrimination, but not tactile stimula-tion alone, reduces chronic limb pain. Pain 137(3):600–608.
Myers CD, Tsao JCI, Glover DA, Kim SC, Turk N, and Zeltzer LK 2006: Sex, gender, and age: Contributions to laboratory pain responding in children and adolescents. J Pain 7: 556–564.
Naveteur J, Mars F, and Crombez G 2005: The effect of eye orientation on slowly increasing pain. Eur J Pain 9: 79–85.
Nicholas MK 2007: The pain self-effi cacy questionnaire: Taking pain into account. Eur J Pain 11: 153–163.
Nicholas MK 2010: Cognitive behavioural pain management. In Moseley GL (Ed.): Pain. Do You Get It? Oxford: Elsevier.
Nicholas MK, Siddal P, Tonkin L, and Beeston L 2002: Manage Your Pain. Sydney: ABC Books.
Nicholas MK and Tonkin L 2004: Application of cognitive-behavioural principles to activity-based pain management programs. In Refshauge K and Gaff E (Eds.): Musculoskeletal Physiotherapy: Clinical Science and Evidence Based Practice. Oxford: Elsevier, pp. 277–293.
Nicholas MK, Wilson PH, and Goyen J 1991: Operant-behavioural and cognitive-behavioural treatment for chronic low back pain. Behav Res Ther 29: 225–238.
Ohara PT, Vit JP, and Jasmin L 2005: Cortical modulation of pain. Cell Mol Life Sci 62:
44–52.
Peters ML, Vlaeyen JW, and van Drunen C 2000: Do fi bromyalgia patients display hypervig-ilance for innocuous somatosensory stimuli? Application of a body scanning reaction time paradigm. Pain 86: 283–292.
Petrovic P and Ingvar M 2002: Imaging cognitive modulation of pain processing. Pain 95: 1–5.
Pleger B, Ragert P, Schwenkreis P, Forster AF, Wilimzig C, Dinse H, Nicolas V, Maier C, and Tegenthoff M 2006: Patterns of cortical reorganization parallel impaired tactile discrimination and pain intensity in complex regional pain syndrome. Neuroimage 32:
503–510.
Pleger B, Tegenthoff M, Ragert P, Forster AF, Dinse HR, Schwenkreis P, Nicolas V, and Maier C 2005: Sensorimotor returning in complex regional pain syndrome parallels pain reduction. Ann Neurol 57: 425–429.
Ploghaus A, Becerra L, Borras C, and Borsook D 2003: Neural circuitry underlying pain modulation: Expectation, hypnosis, placebo. Trends Cogn Sci 7: 197–200.
Ploghaus A, Tracey I, Gati JS, Clare S, Menon RS, Matthews PM, and Rawlins JN 1999: Dis-sociating pain from its anticipation in the human brain. Science 284: 1979–1981.
Poiraudeau S, Rannou F, Baron G, Henanff AL, Coudeyre E, Rozenberg S, Huas D, Martineau C, Jolivet-Landreau I, and Garcia-Mace J 2006: Fear-avoidance beliefs about back pain in patients with subacute low back pain. Pain 124: 305–311.
Pollo A, Amanzio M, Arslanian A, Casadio C, Maggi G, and Benedetti F 2001: Response expectancies in placebo analgesia and their clinical relevance. Pain 93: 77–84.
Pud D and Amit A 2005: Anxiety as a predictor of pain magnitude following termination of fi rst-trimester pregnancy. Pain Med 6: 143–148.
Rhudy JL and Williams AE 2005: Gender differences in pain: Do emotions play a role?
Gender Med 2: 208–226.
Roland M and Morris R 1983: A study of the natural history of back pain. Part 1: Development of a reliable and sensitive measure of disability in low-back pain. Spine 8: 141–144.
Rommel O, Gehling M, Dertwinkel R, Witscher K, Zenz M, Malin JP, and Janig W 1999:
Hemisensory impairment in patients with complex regional pain syndrome. Pain 80:
95–101.
Sawamoto N, Honda M, Okada T, Hanakawa T, Kanda M, Fukuyama H, Konishi J, and Shibasaki H 2000: Expectation of pain enhances responses to nonpainful somatosen-sory stimulation in the anterior cingulate cortex and parietal operculum/posterior insula: An event-related functional magnetic resonance imaging study. J Neurosci 20:
7438–7445.
Schupp CJ, Berbaum K, Berbaum M, and Lang EV 2005: Pain and anxiety during interven-tional radiologic procedures: Effect of patients’ state anxiety at baseline and modulation by nonpharmacologic analgesia adjuncts. J Vasc Interv Radiol 16: 1585–1592.
Schwarzer AC, Aprill CN, Derby R, Fortin J, Kine G, and Bogduk N 1994: The false-positive rate of uncontrolled diagnostic blocks of the lumbar zygapophysial joints. Pain 58:
195–200.
Seminowicz DA and Davis KD 2006: Cortical responses to pain in healthy individuals depends on pain catastrophizing. Pain 120: 297–306.
Sommer C, Sorkin L, and Kress M 2006: Cytokine-induced pain: From molecular mecha-nisms to human pain states. In: Flor H, Kalso E, and Dostrovsky J (Eds.): 11th World Congress on Pain, Sydney, Australia: IASP Press.
Soetanto AL, Chung JW, and Wong TK 2006: Are there gender differences in pain percep-tion? J Neurosci Nurs 38: 172–176.
Sowden G 2006: Vocational rehabilitation. In Gifford L (Ed.): Topical Issues in Pain 5.
Falmouth: CNS Press, pp. 149–66.
Sullivan MJL, Bishop SR, and Pivik J 1995: The pain catastrophizing scale: Development and validation. Psychol Assessment 7: 524–532.
Tang J and Gibson SJ 2005: A psychophysical evaluation of the relationship between trait anxiety, pain perception, and induced state anxiety. J Pain 6: 612–619.
Turk DC and Melzack R (Eds.). Handbook of Pain Assessment (2nd edn.) New York: Guild-ford Press, 2001.
Unruh AM 1996: Gender variations in clinical pain experience. Pain 65: 123–167.
Van Nieuwenhuyse A, Somville PR, Crombez G, Burdorf A, Verbeke G, Johannik K, Van den Bergh O, Masschelein R, Mairiaux P, and Moens GF 2006: The role of physical workload and pain related fear in the development of low back pain in young workers:
Evidence from the belcoback study; results after one year of follow up. Occup Environ Med 63: 45–52.
Vernon H and Mior S 1991: The neck disability index: A study of reliability and validity.
J Manip Physiol Ther 14: 409–415.
Vlaeyen JW and Linton SJ 2000: Fear-avoidance and its consequences in chronic musculosk-eletal pain: A state of the art. Pain 85: 317–332.
Vlaeyen JWS, de Jong J, Geilen M, Heuts P, and van Breukelen G 2002: The treatment of fear of movement/(re)injury in chronic low back pain: Further evidence on the effectiveness of exposure in vivo. Clin J Pain 18: 251–261.
Von Korff M 1994: Studying the natural history of back pain. Spine 19(18 Suppl):
2041S–2046S.
Waddell G, Newton M, Henderson I, Somerville D, and Main CJ 1993: A fear-avoidance beliefs questionnaire (fabq) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain 52: 157–168.
Wager TD 2005: Expectations and anxiety as mediators of placebo effects in pain. Pain 115:
225–226.
Watkins L and Maier S 2000: The pain of being sick: Implications of immune-to-brain com-munication for understanding pain. Ann Rev Psychol 51: 29–57.
Watkins LR and Maier SF 2005: Immune regulation of central nervous system functions:
From sickness responses to pathological pain. J Intern Med 257: 139–155.
Watson P and Kendall NAS 2000: Assessing psychosocial yellow fl ags. In Gifford L (Ed.):
Topical Issues in Pain. Falmouth: CNS Press.
Williams DA, Robinson ME, and Geisser ME 1994: Pain beliefs: Assessment and utility.
Pain 59: 71–78.
Woolf CJ and Salter MW 2000: Neuroscience—Neuronal plasticity: Increasing the gain in pain. Science 288: 1765–1768.