Johan Vlaeyen | KU Leuven (original) (raw)
Papers by Johan Vlaeyen
Over the course of a century, the meaning of interoception has changed from the restrictive to th... more Over the course of a century, the meaning of interoception has changed from the restrictive to the inclusive. In its inclusive sense, it bears relevance to every individual via its link to emotion, decision making, time-perception, health, pain, and various other areas of life. While the label for the perception of the body state changes over time, the need for an overarching concept remains. Many aspects can make any particular interoceptive sensation unique and distinct from any other interoceptive sensation. This can range from the sense of agency, to the physical cause of a sensation, the ontogenetic origin, the efferent innervation, and afferent pathways of the tissue involved amongst others. In its overarching meaning, interoception primarily is a product of the central nervous system, a construct based on an integration of various sources, not per se including afferent information. This paper proposes a definition of interoception as based on subjective experience, and pleas for the use of specific vocabulary in addressing the many aspects that contribute to it.
Tijdschrift Voor Psychotherapie, 2002
De uitvoering van fysieke bewegingen leidt bij vrijwel alle patiënten met rugpijn direct of enige... more De uitvoering van fysieke bewegingen leidt bij vrijwel alle patiënten met rugpijn direct of enige tijd later tot meer pijn. Hierdoor worden bewegingen vaak zo veel mogelijk vermeden. Deze vermijding is op korte termijn nuttig: zij laat het organisme toe zich te herstellen. Langdurige vermijding kan echter nadelige gevolgen hebben, zoals verslechtering van de algehele conditie en toename van functionele
The Clinical Journal of Pain, 2005
Spine, 2000
A systematic review of randomized controlled trials. The treatment of chronic low back pain is no... more A systematic review of randomized controlled trials. The treatment of chronic low back pain is not primarily focused on removing an underlying organic disease but at the reduction of disability through the modification of environmental contingencies and cognitive processes. Behavioral interventions are commonly used in the treatment of chronic (disabling) low back pain. To determine whether behavioral therapy is more effective than reference treatments for chronic nonspecific low back pain and which type of behavioral treatment is most effective. The authors searched the Medline and PsychLit databases and the Cochrane Controlled Trials Register up to April 1999, and Embase up to September 1999. Also screened were references of identified randomized trials and relevant systematic reviews. Methodologic quality assessment and data extraction were performed independently by two reviewers. The magnitude of effect was assessed by computing a pooled effect size for each domain (i.e., behavioral outcomes, overall improvement, back pain-specific and generic functional status, return to work, and pain intensity) using the random effects model. Only six (25%) studies were high quality. There is strong evidence (level 1) that behavioral treatment has a moderate positive effect on pain intensity (pooled effect size 0.62; 95% confidence interval [CI] 0. 25, 0.98), and small positive effects on generic functional status (pooled effect size 0.35; 95% CI: 0.04, 0.74) and behavioral outcomes (pooled effect size 0.40; 95% CI: 0.10, 0.70) of patients with chronic low back pain when compared with waiting-list controls or no treatment. There is moderate evidence (level 2) that a addition of behavioral component to a usual treatment program for chronic low backpain has no positive short-term effect on generic functional status (pooled effect size 0.31; 95% CI: 0.01, 0.64), pain intensity (pooled effect size 0.03; 95% CI: 0.30,0.36), and behavioral outcomes (pooled effect size 0.19; 95% CI: 0.08, 0.45). Behavioral treatment seems to be an effective treatment for patients with chronic low back pain,but it is still unknown what type of patients benefit most from what type of behavioral treatment.
The Clinical Journal of Pain, 2005
Since the introduction of behavioral medicine in the early 70s, cognitive-behavioral treatment in... more Since the introduction of behavioral medicine in the early 70s, cognitive-behavioral treatment interventions for chronic pain have expanded considerably. It is now well established that these interventions are effective in reducing the enormous suffering that patients with chronic pain have to bear. In addition, these interventions have potential economic benefits in that they appear to be cost-effective as well. Despite these achievements, there is still room for improvement. First, there is a substantial proportion of patients who do not appear to benefit from treatment interventions available. Second, although the effect sizes of most cognitive-behavioral treatments for chronic pain are comparable to those in psychopathology, they are quite modest. Third, there is little evidence for differential outcomes for different treatment methods. Fourth, there still is relatively little known about the specific biobehavioral mechanisms that lead to chronic pain and pain disability. One direction is to better match treatment programs to patients' characteristics. This can be done according to an "Aptitude X Treatment Interaction" framework, or from the perspective of the Moderator-Mediator distinction. In this introduction to the special series on what works for whom in cognitive-behavioral treatments for chronic pain, we review existing knowledge concerning both moderating and mediating variables in cognitive-behavioral treatments for chronic pain. We further argue in favor of theory-driven research as the only way to define specific a priori hypotheses about which patient-treatment interactions to expect. We also argue that replicated single-participant studies, with appropriate statistics, are likely to enhance new developments in this clinical research area.
European Journal of Pain, 2011
This study examines the changes in self-perception during resolution of an acutely painful neck i... more This study examines the changes in self-perception during resolution of an acutely painful neck injury sustained in a motor vehicle accident. We tested predictions from selfdiscrepancy theory and a model of self-pain enmeshment. Measures of discrepancy between the current (actual) self and both the ideal and feared-for self were predicted to remain stable over a 21-day recovery period whereas a measure of enmeshment was predicted to decrease as pain resolved. We also examined the relationship between daily ratings of achievement in several domains and participants perceived ideal performance. 60 patients with possible acute neck injury recruited within one month after a motor vehicle accident gave consent and data were obtained from 42 participants. Standard questionnaire measures of pain, disability, fear of movement, pain catastrophizing and self-discrepancies, self-pain enmeshment and data from diaries (measures of pain, mood, self-discrepancies, pain catastrophizing and fear of movement) were obtained.
European Journal of Pain, 2009
Objectives: It is well established that catastrophic misinterpretations and fear are involved in ... more Objectives: It is well established that catastrophic misinterpretations and fear are involved in the suffering and disability of patients with chronic pain. This study investigated whether similar processes explain suffering and disability in patients with chronic tinnitus. We hypothesized that patients who catastrophically (mis)interpret their tinnitus would be more fearful of tinnitus, more vigilant toward their tinnitus, and report less quality of life. Moreover, tinnitus-related fear was expected to act as a mediator in reduced quality of life. Design: Sixty-one tinnitus patients from an outpatient ENT department of the University Hospital of Antwerp (Belgium) completed a number of questionnaires about their tinnitus. Hierarchical regression analyses were performed to test hypothesized associations and to assess mediation by tinnitus-related fear. Results: Analyses revealed significant associations between catastro-phizing and fear and between catastrophizing and increased attention toward the tinnitus. Furthermore, both tinnitus-related catastrophizing and fear were negatively associated with quality of life; moreover, tinnitus-related fear fully mediated the association between catastroph-izing about the tinnitus and quality of life. Conclusions: The findings confirm earlier suggestions that tinnitus-related concerns and fears are associated with impaired quality of life, which is in line with a cognitive behavioral account of chronic tinnitus. Future research avenues and clinical applications are discussed.
BMC Pregnancy and Childbirth, 2008
Background: Pregnancy-related low back pain is considered an important health problem and potenti... more Background: Pregnancy-related low back pain is considered an important health problem and potentially leads to long-lasting pain and disability. Investigators draw particular attention to biomedical factors but there is growing evidence that psychosocial and social factors might be important. It prompted us to start a large cohort study (n = 7526) during pregnancy until one year after delivery and a nested randomized controlled intervention study in the Netherlands.
![Research paper thumbnail of Effectiveness of a tailor-made intervention for pregnancy-related pelvic girdle and/or low back pain after delivery: Short-term results of a randomized clinical trial [ISRCTN08477490]](https://attachments.academia-assets.com/39488377/thumbnails/1.jpg)
](BMC Musculoskeletal Disorders, 2006
Background: For the moment, scientific evaluation of programs on treatment of pregnancy-related p... more Background: For the moment, scientific evaluation of programs on treatment of pregnancy-related pelvic girdle and/or low back pain after delivery is hardly available with only one study with a positive result, suggesting uncertainty about the optimal approach. Investigators draw particular attention to biomedical factors but there is growing evidence that biopsychosocial factors appear to be even more important as a basis of an intervention program.
Dth, 2000
Page 1. De angst voor bewegen: geleidelijke exposure in vivo bij chronische lagerugpijn * Jeroen ... more Page 1. De angst voor bewegen: geleidelijke exposure in vivo bij chronische lagerugpijn * Jeroen de Jong Johan Vlaeyen Mario Geilen Peter Heuts Samenvatting In dit artikel ... hernieuwd) letsel Jeroen de Jong, en, (*) Drs. JR de ...
The Journal of Pain, 2015
Cognitive-behavioral treatments for chronic pain typically target pain-related fear - exposure in... more Cognitive-behavioral treatments for chronic pain typically target pain-related fear - exposure in vivo is a common treatment focusing on disconfirming harm expectancy of feared movements. Exposure therapy is tailored on Pavlovian extinction; an alternative fear reduction technique that also alters stimulus valence is counterconditioning. We compared both procedures to reduce pain-related fear using a Voluntary Joystick Movement Paradigm. Participants were randomly allocated to the Counterconditioning or Extinction Group. During fear acquisition, moving the joystick in two directions (CS+) was followed by a painful electrocutaneous stimulus (pain-US), while moving the joystick in two other directions was not (CS-). During fear reduction, one CS+ was extinguished, but another CS+ was still followed by pain in the Extinction Group; in the Counterconditioning Group one CS+ was extinguished and followed by a monetary reward-US, and another CS+ was followed by both USs (pain-US and reward-US). Results indicate that counterconditioning effectively reduces pain-related fear but that it does not produce deeper fear reduction than extinction. Adding a reward-US to a painful movement did neither attenuate fear nor the intensity/unpleasantness of the pain itself. Both procedures changed stimulus valence. We contend that changing the affective valence of feared movements might improve fear reduction and may prevent relapse. This article reports no immediate differences between counterconditioning and extinction in reducing pain-related fear in the lab. Unexpectedly, both methods also altered stimulus valence. We cautiously suggest however that methods explicitly focusing on altering the affective valence of feared movements may improve long-term effectiveness of fear reduction and prevent relapse.
Pain Medicine, 2015
The experiential acquisition of pain-related fear has been demonstrated by pairing a painful elec... more The experiential acquisition of pain-related fear has been demonstrated by pairing a painful electrocutaneous stimulus pain-US; unconditioned pain stimulus) with one movement (CS+; conditioned stimulus) but not with another (CS-). However, it is expected that during acquisition through direct experience, pain-related fear can be intensified or weakened by verbally/visually transmitted information about the pain and its meaning. Participants received threatening information (US-inflation), safety information (US-deflation), or no information about the pain-US (US-same). Additionally, we measured return of fear after a reinstatement procedure: two unsignaled pain-USs were presented in the experimental groups, but not in the control groups. We replicated the acquisition and extinction of experimentally induced fear of movement-related pain in healthy subjects both in the verbal reports and the eye-blink startle measures. Two reinstating pain-US presentations led to a differential return of self-reported fear and a nondifferential return of fear in the eye-blink startle responses. Although, we failed to find an effect of verbal/visual information regarding the meaning of the pain-US on the acquisition, extinction, or reinstatement of pain-related fear, we did observe a pain sensitization effect over time suggesting that our threat manipulation induced an increase of perceived threat in all groups. The results suggest that our threat manipulation might not have worked or that it was not sensitive enough to yield group-specific effects. We replicated acquisition, extinction, and return of experimentally conditioned fear of movement-related pain, but the threat manipulation failed to generate any additional effects.
Behavior Therapy, 2015
Recent research suggests that the mere intention to perform a painful movement can elicit painrel... more Recent research suggests that the mere intention to perform a painful movement can elicit painrelated fear. Based on these findings, the present study aimed to determine whether imagining a movement that is associated with pain (CS+) can start to elicit conditioned pain-related fear as well and whether pain-related fear elicited by imagining a painful movement can spread towards novel, similar but distinct imagined movements. We proposed a new experimental paradigm that integrates the left-right hand judgment task (HJT) with a differential fear conditioning procedure. During Acquisition, one hand posture (CS+) was consistently followed by a painful electrocutaneous stimulus (pain-US) and another hand posture (CS-) was not. Participants were instructed to make left-right judgments, which involve mentally rotating their own hand to match the displayed hand postures (i.e. motor imagery). During Generalization, participants were presented with a series of novel hand postures with six grades of perceptual similarity to the CS+ (generalization stimuli; GSs). Finally, during Extinction, the CS+ hand posture was no longer reinforced. The results showed that (1) a painful hand posture triggers fear and increased US-expectancy as compared to a non-painful hand posture, (2) this pain-related fear spreads to similar but distinct hand postures following a generalization gradient, and subsequently, (3) it can be successfully reduced during extinction. These effects were apparent in the verbal ratings, but not in the startle measures.
Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2015
Headache has been reported to occur during cryoballoon ablation for atrial fibrillation (AF). No ... more Headache has been reported to occur during cryoballoon ablation for atrial fibrillation (AF). No study has systematically analysed this phenomenon. Twenty consecutive patients with symptomatic AF underwent cryoballoon ablation without sedation. Headache was evaluated before, during, and after the first cryoapplication in every pulmonary vein (PV) using a visual representation of a head for location of the headache, a numerical rating scale (NRS) for measuring pain intensity and the short-form McGill pain questionnaire (MPQ) for qualitative analysis of pain. The order in which the PVs were ablated was randomized. Sixteen (80%) patients perceived mainly frontal headache during cryoablation. The overall NRS scores were significantly higher during (5.1 ± 1.7), compared with before (2.7 ± 1.4), and after (3.5 ± 2.2) a cryoapplication (P < 0.05). The NRS score was significantly higher during ablation of the first PV. The intensity of the perceived headache was not related to the temper...
Pain, 2015
Pain is a biologically relevant signal and response to bodily threat, associated with the urge to... more Pain is a biologically relevant signal and response to bodily threat, associated with the urge to restore the integrity of the body. Immediate protective responses include increased arousal, selective attention, escape, and facial expressions, followed by recuperative avoidance and safety-seeking behaviors. To facilitate early and effective protection against future bodily threat or injury, learning takes place rapidly. Learning is the observable change in behavior due to events in the internal and external environmental and includes nonassociative (habituation and sensitization) and associative learning (Pavlovian and operant conditioning). Once acquired, these knowledge representations remain stored in memory and may generalize to perceptually or functionally similar events. Moreover, these processes are not just a consequence of pain; they may directly influence pain perception. In contrast to the rapid acquisition of learned responses, their extinction is slow, fragile, context ...
![Research paper thumbnail of Treatment of pregnancy-related pelvic girdle and/or low back pain after delivery design of a randomized clinical trial within a comprehensive prognostic cohort study [ISRCTN08477490]](https://attachments.academia-assets.com/39673042/thumbnails/1.jpg)
](BMC Public Health, 2004
Background: Pregnancy-related pelvic girdle and/or low back pain is a controversial syndrome beca... more Background: Pregnancy-related pelvic girdle and/or low back pain is a controversial syndrome because insight in etiology and prognosis is lacking. The controversy relates to factors eliciting pain and some prognostic factors such as the interpretation of pain at the symphysis. Recent research about treatment strategies also reflects those various opinions, in fact suggesting there is professional uncertainty about the optimal approach. Currently, physiotherapists often prescribe a pain-contingent treatment regime of relative rest and avoiding several day-today activities. Additionally, treatment more often includes an exercise program to guide rectification of the muscle imbalance and alignment of the pelvic girdle. Effectiveness of those interventions is not proven and the majority of the studies are methodologically flawed. Investigators draw particular attention to biomedical factors but there is growing evidence that important prognostic issues such as biopsychosocial factors appear to be even more important as point of action in a treatment program.
![Research paper thumbnail of Effectiveness of a tailor-made intervention for pregnancy-related pelvic girdle and/or low back pain after delivery: Short-term results of a randomized clinical trial [ISRCTN08477490]](https://attachments.academia-assets.com/39673041/thumbnails/1.jpg)
](BMC Musculoskeletal Disorders, 2006
Background: For the moment, scientific evaluation of programs on treatment of pregnancy-related p... more Background: For the moment, scientific evaluation of programs on treatment of pregnancy-related pelvic girdle and/or low back pain after delivery is hardly available with only one study with a positive result, suggesting uncertainty about the optimal approach. Investigators draw particular attention to biomedical factors but there is growing evidence that biopsychosocial factors appear to be even more important as a basis of an intervention program.
Over the course of a century, the meaning of interoception has changed from the restrictive to th... more Over the course of a century, the meaning of interoception has changed from the restrictive to the inclusive. In its inclusive sense, it bears relevance to every individual via its link to emotion, decision making, time-perception, health, pain, and various other areas of life. While the label for the perception of the body state changes over time, the need for an overarching concept remains. Many aspects can make any particular interoceptive sensation unique and distinct from any other interoceptive sensation. This can range from the sense of agency, to the physical cause of a sensation, the ontogenetic origin, the efferent innervation, and afferent pathways of the tissue involved amongst others. In its overarching meaning, interoception primarily is a product of the central nervous system, a construct based on an integration of various sources, not per se including afferent information. This paper proposes a definition of interoception as based on subjective experience, and pleas for the use of specific vocabulary in addressing the many aspects that contribute to it.
Tijdschrift Voor Psychotherapie, 2002
De uitvoering van fysieke bewegingen leidt bij vrijwel alle patiënten met rugpijn direct of enige... more De uitvoering van fysieke bewegingen leidt bij vrijwel alle patiënten met rugpijn direct of enige tijd later tot meer pijn. Hierdoor worden bewegingen vaak zo veel mogelijk vermeden. Deze vermijding is op korte termijn nuttig: zij laat het organisme toe zich te herstellen. Langdurige vermijding kan echter nadelige gevolgen hebben, zoals verslechtering van de algehele conditie en toename van functionele
The Clinical Journal of Pain, 2005
Spine, 2000
A systematic review of randomized controlled trials. The treatment of chronic low back pain is no... more A systematic review of randomized controlled trials. The treatment of chronic low back pain is not primarily focused on removing an underlying organic disease but at the reduction of disability through the modification of environmental contingencies and cognitive processes. Behavioral interventions are commonly used in the treatment of chronic (disabling) low back pain. To determine whether behavioral therapy is more effective than reference treatments for chronic nonspecific low back pain and which type of behavioral treatment is most effective. The authors searched the Medline and PsychLit databases and the Cochrane Controlled Trials Register up to April 1999, and Embase up to September 1999. Also screened were references of identified randomized trials and relevant systematic reviews. Methodologic quality assessment and data extraction were performed independently by two reviewers. The magnitude of effect was assessed by computing a pooled effect size for each domain (i.e., behavioral outcomes, overall improvement, back pain-specific and generic functional status, return to work, and pain intensity) using the random effects model. Only six (25%) studies were high quality. There is strong evidence (level 1) that behavioral treatment has a moderate positive effect on pain intensity (pooled effect size 0.62; 95% confidence interval [CI] 0. 25, 0.98), and small positive effects on generic functional status (pooled effect size 0.35; 95% CI: 0.04, 0.74) and behavioral outcomes (pooled effect size 0.40; 95% CI: 0.10, 0.70) of patients with chronic low back pain when compared with waiting-list controls or no treatment. There is moderate evidence (level 2) that a addition of behavioral component to a usual treatment program for chronic low backpain has no positive short-term effect on generic functional status (pooled effect size 0.31; 95% CI: 0.01, 0.64), pain intensity (pooled effect size 0.03; 95% CI: 0.30,0.36), and behavioral outcomes (pooled effect size 0.19; 95% CI: 0.08, 0.45). Behavioral treatment seems to be an effective treatment for patients with chronic low back pain,but it is still unknown what type of patients benefit most from what type of behavioral treatment.
The Clinical Journal of Pain, 2005
Since the introduction of behavioral medicine in the early 70s, cognitive-behavioral treatment in... more Since the introduction of behavioral medicine in the early 70s, cognitive-behavioral treatment interventions for chronic pain have expanded considerably. It is now well established that these interventions are effective in reducing the enormous suffering that patients with chronic pain have to bear. In addition, these interventions have potential economic benefits in that they appear to be cost-effective as well. Despite these achievements, there is still room for improvement. First, there is a substantial proportion of patients who do not appear to benefit from treatment interventions available. Second, although the effect sizes of most cognitive-behavioral treatments for chronic pain are comparable to those in psychopathology, they are quite modest. Third, there is little evidence for differential outcomes for different treatment methods. Fourth, there still is relatively little known about the specific biobehavioral mechanisms that lead to chronic pain and pain disability. One direction is to better match treatment programs to patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; characteristics. This can be done according to an &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;Aptitude X Treatment Interaction&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; framework, or from the perspective of the Moderator-Mediator distinction. In this introduction to the special series on what works for whom in cognitive-behavioral treatments for chronic pain, we review existing knowledge concerning both moderating and mediating variables in cognitive-behavioral treatments for chronic pain. We further argue in favor of theory-driven research as the only way to define specific a priori hypotheses about which patient-treatment interactions to expect. We also argue that replicated single-participant studies, with appropriate statistics, are likely to enhance new developments in this clinical research area.
European Journal of Pain, 2011
This study examines the changes in self-perception during resolution of an acutely painful neck i... more This study examines the changes in self-perception during resolution of an acutely painful neck injury sustained in a motor vehicle accident. We tested predictions from selfdiscrepancy theory and a model of self-pain enmeshment. Measures of discrepancy between the current (actual) self and both the ideal and feared-for self were predicted to remain stable over a 21-day recovery period whereas a measure of enmeshment was predicted to decrease as pain resolved. We also examined the relationship between daily ratings of achievement in several domains and participants perceived ideal performance. 60 patients with possible acute neck injury recruited within one month after a motor vehicle accident gave consent and data were obtained from 42 participants. Standard questionnaire measures of pain, disability, fear of movement, pain catastrophizing and self-discrepancies, self-pain enmeshment and data from diaries (measures of pain, mood, self-discrepancies, pain catastrophizing and fear of movement) were obtained.
European Journal of Pain, 2009
Objectives: It is well established that catastrophic misinterpretations and fear are involved in ... more Objectives: It is well established that catastrophic misinterpretations and fear are involved in the suffering and disability of patients with chronic pain. This study investigated whether similar processes explain suffering and disability in patients with chronic tinnitus. We hypothesized that patients who catastrophically (mis)interpret their tinnitus would be more fearful of tinnitus, more vigilant toward their tinnitus, and report less quality of life. Moreover, tinnitus-related fear was expected to act as a mediator in reduced quality of life. Design: Sixty-one tinnitus patients from an outpatient ENT department of the University Hospital of Antwerp (Belgium) completed a number of questionnaires about their tinnitus. Hierarchical regression analyses were performed to test hypothesized associations and to assess mediation by tinnitus-related fear. Results: Analyses revealed significant associations between catastro-phizing and fear and between catastrophizing and increased attention toward the tinnitus. Furthermore, both tinnitus-related catastrophizing and fear were negatively associated with quality of life; moreover, tinnitus-related fear fully mediated the association between catastroph-izing about the tinnitus and quality of life. Conclusions: The findings confirm earlier suggestions that tinnitus-related concerns and fears are associated with impaired quality of life, which is in line with a cognitive behavioral account of chronic tinnitus. Future research avenues and clinical applications are discussed.
BMC Pregnancy and Childbirth, 2008
Background: Pregnancy-related low back pain is considered an important health problem and potenti... more Background: Pregnancy-related low back pain is considered an important health problem and potentially leads to long-lasting pain and disability. Investigators draw particular attention to biomedical factors but there is growing evidence that psychosocial and social factors might be important. It prompted us to start a large cohort study (n = 7526) during pregnancy until one year after delivery and a nested randomized controlled intervention study in the Netherlands.
BMC Musculoskeletal Disorders, 2006
Background: For the moment, scientific evaluation of programs on treatment of pregnancy-related p... more Background: For the moment, scientific evaluation of programs on treatment of pregnancy-related pelvic girdle and/or low back pain after delivery is hardly available with only one study with a positive result, suggesting uncertainty about the optimal approach. Investigators draw particular attention to biomedical factors but there is growing evidence that biopsychosocial factors appear to be even more important as a basis of an intervention program.
Dth, 2000
Page 1. De angst voor bewegen: geleidelijke exposure in vivo bij chronische lagerugpijn * Jeroen ... more Page 1. De angst voor bewegen: geleidelijke exposure in vivo bij chronische lagerugpijn * Jeroen de Jong Johan Vlaeyen Mario Geilen Peter Heuts Samenvatting In dit artikel ... hernieuwd) letsel Jeroen de Jong, en, (*) Drs. JR de ...
The Journal of Pain, 2015
Cognitive-behavioral treatments for chronic pain typically target pain-related fear - exposure in... more Cognitive-behavioral treatments for chronic pain typically target pain-related fear - exposure in vivo is a common treatment focusing on disconfirming harm expectancy of feared movements. Exposure therapy is tailored on Pavlovian extinction; an alternative fear reduction technique that also alters stimulus valence is counterconditioning. We compared both procedures to reduce pain-related fear using a Voluntary Joystick Movement Paradigm. Participants were randomly allocated to the Counterconditioning or Extinction Group. During fear acquisition, moving the joystick in two directions (CS+) was followed by a painful electrocutaneous stimulus (pain-US), while moving the joystick in two other directions was not (CS-). During fear reduction, one CS+ was extinguished, but another CS+ was still followed by pain in the Extinction Group; in the Counterconditioning Group one CS+ was extinguished and followed by a monetary reward-US, and another CS+ was followed by both USs (pain-US and reward-US). Results indicate that counterconditioning effectively reduces pain-related fear but that it does not produce deeper fear reduction than extinction. Adding a reward-US to a painful movement did neither attenuate fear nor the intensity/unpleasantness of the pain itself. Both procedures changed stimulus valence. We contend that changing the affective valence of feared movements might improve fear reduction and may prevent relapse. This article reports no immediate differences between counterconditioning and extinction in reducing pain-related fear in the lab. Unexpectedly, both methods also altered stimulus valence. We cautiously suggest however that methods explicitly focusing on altering the affective valence of feared movements may improve long-term effectiveness of fear reduction and prevent relapse.
Pain Medicine, 2015
The experiential acquisition of pain-related fear has been demonstrated by pairing a painful elec... more The experiential acquisition of pain-related fear has been demonstrated by pairing a painful electrocutaneous stimulus pain-US; unconditioned pain stimulus) with one movement (CS+; conditioned stimulus) but not with another (CS-). However, it is expected that during acquisition through direct experience, pain-related fear can be intensified or weakened by verbally/visually transmitted information about the pain and its meaning. Participants received threatening information (US-inflation), safety information (US-deflation), or no information about the pain-US (US-same). Additionally, we measured return of fear after a reinstatement procedure: two unsignaled pain-USs were presented in the experimental groups, but not in the control groups. We replicated the acquisition and extinction of experimentally induced fear of movement-related pain in healthy subjects both in the verbal reports and the eye-blink startle measures. Two reinstating pain-US presentations led to a differential return of self-reported fear and a nondifferential return of fear in the eye-blink startle responses. Although, we failed to find an effect of verbal/visual information regarding the meaning of the pain-US on the acquisition, extinction, or reinstatement of pain-related fear, we did observe a pain sensitization effect over time suggesting that our threat manipulation induced an increase of perceived threat in all groups. The results suggest that our threat manipulation might not have worked or that it was not sensitive enough to yield group-specific effects. We replicated acquisition, extinction, and return of experimentally conditioned fear of movement-related pain, but the threat manipulation failed to generate any additional effects.
Behavior Therapy, 2015
Recent research suggests that the mere intention to perform a painful movement can elicit painrel... more Recent research suggests that the mere intention to perform a painful movement can elicit painrelated fear. Based on these findings, the present study aimed to determine whether imagining a movement that is associated with pain (CS+) can start to elicit conditioned pain-related fear as well and whether pain-related fear elicited by imagining a painful movement can spread towards novel, similar but distinct imagined movements. We proposed a new experimental paradigm that integrates the left-right hand judgment task (HJT) with a differential fear conditioning procedure. During Acquisition, one hand posture (CS+) was consistently followed by a painful electrocutaneous stimulus (pain-US) and another hand posture (CS-) was not. Participants were instructed to make left-right judgments, which involve mentally rotating their own hand to match the displayed hand postures (i.e. motor imagery). During Generalization, participants were presented with a series of novel hand postures with six grades of perceptual similarity to the CS+ (generalization stimuli; GSs). Finally, during Extinction, the CS+ hand posture was no longer reinforced. The results showed that (1) a painful hand posture triggers fear and increased US-expectancy as compared to a non-painful hand posture, (2) this pain-related fear spreads to similar but distinct hand postures following a generalization gradient, and subsequently, (3) it can be successfully reduced during extinction. These effects were apparent in the verbal ratings, but not in the startle measures.
Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2015
Headache has been reported to occur during cryoballoon ablation for atrial fibrillation (AF). No ... more Headache has been reported to occur during cryoballoon ablation for atrial fibrillation (AF). No study has systematically analysed this phenomenon. Twenty consecutive patients with symptomatic AF underwent cryoballoon ablation without sedation. Headache was evaluated before, during, and after the first cryoapplication in every pulmonary vein (PV) using a visual representation of a head for location of the headache, a numerical rating scale (NRS) for measuring pain intensity and the short-form McGill pain questionnaire (MPQ) for qualitative analysis of pain. The order in which the PVs were ablated was randomized. Sixteen (80%) patients perceived mainly frontal headache during cryoablation. The overall NRS scores were significantly higher during (5.1 ± 1.7), compared with before (2.7 ± 1.4), and after (3.5 ± 2.2) a cryoapplication (P < 0.05). The NRS score was significantly higher during ablation of the first PV. The intensity of the perceived headache was not related to the temper...
Pain, 2015
Pain is a biologically relevant signal and response to bodily threat, associated with the urge to... more Pain is a biologically relevant signal and response to bodily threat, associated with the urge to restore the integrity of the body. Immediate protective responses include increased arousal, selective attention, escape, and facial expressions, followed by recuperative avoidance and safety-seeking behaviors. To facilitate early and effective protection against future bodily threat or injury, learning takes place rapidly. Learning is the observable change in behavior due to events in the internal and external environmental and includes nonassociative (habituation and sensitization) and associative learning (Pavlovian and operant conditioning). Once acquired, these knowledge representations remain stored in memory and may generalize to perceptually or functionally similar events. Moreover, these processes are not just a consequence of pain; they may directly influence pain perception. In contrast to the rapid acquisition of learned responses, their extinction is slow, fragile, context ...
BMC Public Health, 2004
Background: Pregnancy-related pelvic girdle and/or low back pain is a controversial syndrome beca... more Background: Pregnancy-related pelvic girdle and/or low back pain is a controversial syndrome because insight in etiology and prognosis is lacking. The controversy relates to factors eliciting pain and some prognostic factors such as the interpretation of pain at the symphysis. Recent research about treatment strategies also reflects those various opinions, in fact suggesting there is professional uncertainty about the optimal approach. Currently, physiotherapists often prescribe a pain-contingent treatment regime of relative rest and avoiding several day-today activities. Additionally, treatment more often includes an exercise program to guide rectification of the muscle imbalance and alignment of the pelvic girdle. Effectiveness of those interventions is not proven and the majority of the studies are methodologically flawed. Investigators draw particular attention to biomedical factors but there is growing evidence that important prognostic issues such as biopsychosocial factors appear to be even more important as point of action in a treatment program.
BMC Musculoskeletal Disorders, 2006
Background: For the moment, scientific evaluation of programs on treatment of pregnancy-related p... more Background: For the moment, scientific evaluation of programs on treatment of pregnancy-related pelvic girdle and/or low back pain after delivery is hardly available with only one study with a positive result, suggesting uncertainty about the optimal approach. Investigators draw particular attention to biomedical factors but there is growing evidence that biopsychosocial factors appear to be even more important as a basis of an intervention program.