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      Diseño de un instrumento educativo para pacientes con lumbalgia crónica inespecífica atendidos en Atención Primaria Translated title: Design of an educational tool for Primary Care patients with chronic non-specific low back pain

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          Resumen

          Evidencias científicas actuales sobre el manejo de la lumbalgia crónica inespecífica ponen de relieve los beneficios del ejercicio físico. Este objetivo es frecuentemente minado por déficits educativos en materias relacionadas con la naturaleza multifactorial y benigna del dolor lumbar inespecífico, los cuales constituyen auténticos factores de riesgo psicosocial para la cronificación. Su perversa influencia podría interferir no solo con la decisión individual de adoptar conductas de afrontamiento más adaptativas, sino también, con los mecanismos endógenos de neuromodulación del dolor. Así, las estrategias educativas y el control de dichos factores se han convertido en objetivos relevantes a incorporar en el manejo del trastorno y en las directrices de investigación. Este trabajo presenta los modelos teóricos y las bases científicas sobre los que se ha sustentado el diseño de un instrumento educativo para pacientes con lumbalgia crónica inespecífica atendidos en Fisioterapia de Atención Primaria. Su estructuración, contenido y objetivos también son presentados.

          Translated abstract

          Current scientific evidence on the management of chronic non-specific low back pain highlights the benefits of physical exercise. This goal is frequently undermined due to lack of education of the subjects on the multifactorial, benign, and non-specific nature of low back pain, which can lead to a chronic disease with genuine psychosocial risk factors. Its influence may not only interfere with individual decision to adopt more adaptive coping behaviors, but also with the endogenous mechanisms of pain neuromodulation. Thus, the educational strategies and control of these factors have become important objectives to be incorporated into the management of the disorder and research guidelines. This paper presents the theoretical models and the scientific basis on which it has based the design of an educational tool for patients with chronic non-specific low back pain treated in Primary Care physiotherapy. Structure, content and objectives are also presented.

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          Most cited references20

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          Fear-avoidance model of chronic pain: the next generation.

          The fear-avoidance (FA) model of chronic pain describes how individuals experiencing acute pain may become trapped into a vicious circle of chronic disability and suffering. We propose to extend the FA model by adopting a motivational perspective on chronic pain and disability. A narrative review. There is ample evidence to support the validity of the FA model as originally formulated. There are, however, some key challenges that call for a next generation of the FA model. First, the FA model has its roots in psychopathology, and investigators will have to find a way to account for findings that do not easily fit within such framework. Second, the FA model needs to address the dynamics and complexities of disability and functional recovery. Third, the FA model should incorporate the idea that pain-related fear and avoidance occurs in a context of multiple and often competing personal goals. To address these 3 key challenges, we argue that the next generation of the FA model needs to more explicitly adopt a motivational perspective, one that is built around the organizing powers of goals and self-regulatory processes. Using this framework, the FA model is recast as capturing the persistent but futile attempts to solve pain-related problems to protect and restore life goals.
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            1987 Volvo award in clinical sciences. A new clinical model for the treatment of low-back pain.

            Because there is increasing concern about low-back disability and its current medical management, this analysis attempts to construct a new theoretic framework for treatment. Observations of natural history and epidemiology suggest that low-back pain should be a benign, self-limiting condition, that low back-disability as opposed to pain is a relatively recent Western epidemic, and that the role of medicine in that epidemic must be critically examined. The traditional medical model of disease is contrasted with a biopsychosocial model of illness to analyze success and failure in low-back disorders. Studies of the mathematical relationship between the elements of illness in chronic low-back pain suggest that the biopsychosocial concept can be used as an operational model that explains many clinical observations. This model is used to compare rest and active rehabilitation for low-back pain. Rest is the commonest treatment prescribed after analgesics but is based on a doubtful rationale, and there is little evidence of any lasting benefit. There is, however, little doubt about the harmful effects--especially of prolonged bed rest. Conversely, there is no evidence that activity is harmful and, contrary to common belief, it does not necessarily make the pain worse. Experimental studies clearly show that controlled exercises not only restore function, reduce distress and illness behavior, and promote return to work, but actually reduce pain. Clinical studies confirm the value of active rehabilitation in practice. To achieve the goal of treating patients rather than spines, we must approach low-back disability as an illness rather than low-back pain as a purely physical disease. We must distinguish pain as a purely the symptoms and signs of distress and illness behavior from those of physical disease, and nominal from substantive diagnoses. Management must change from a negative philosophy of rest for pain to more active restoration of function. Only a new model and understanding of illness by physicians and patients alike makes real change possible.
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              Pain and emotion: a biopsychosocial review of recent research.

              Research on emotion and pain has burgeoned. We review the last decade's literature, focusing on links between emotional processes and persistent pain. Neurobiological research documents the neural processes that distinguish affective from sensory pain dimensions, link emotion and pain, and generate central nervous system pain sensitization. Psychological research demonstrates that greater pain is related to emotional stress and limited emotional awareness, expression, and processing. Social research shows the potential importance of emotional communication, empathy, attachment, and rejection. Emotions are integral to the conceptualization, assessment, and treatment of persistent pain. Research should clarify when to eliminate or attenuate negative emotions, and when to access, experience, and express them. Theory and practice should integrate emotion into cognitive-behavioral models of persistent pain. © 2011 Wiley Periodicals, Inc.
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                Author and article information

                Contributors
                Journal
                Aten Primaria
                Aten Primaria
                Atencion Primaria
                Elsevier
                0212-6567
                1578-1275
                23 August 2014
                February 2015
                23 August 2014
                : 47
                : 2
                : 117-123
                Affiliations
                [0005]Unidad de Gestión Clínica Las Lagunas, Distrito Sanitario Costa del Sol, Sistema Sanitario Público de Andalucía, Mijas-Costa, Málaga, España
                Author notes
                [* ]Autor para correspondencia. juanlu1x2@ 123456hotmail.com
                Article
                S0212-6567(14)00128-0
                10.1016/j.aprim.2014.03.005
                6985600
                25159025
                885355ff-d3ad-45a1-af59-01a464c96deb
                © 2013 Elsevier Espa˜na, S.L.U. Todos los derechos reservados.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/).

                History
                : 11 December 2013
                : 18 March 2014
                Categories
                Artículo especial

                lumbalgia,dolor crónico,fisioterapia,educación en salud,control de conducta,atención primaria,low back pain,chronic pain,physical therapy modalities,health education,behavior control,primary health care

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