Neural correlates differ in high and low fear-avoidant chronic low back pain patients when imagining back-straining movements

• Published in: The journal of pain Vol. 17; no. 8; pp. 930 - 943
• Main Authors: Barke, Antonia, Preis, Mira A, Schmidt-Samoa, Carsten, Baudewig, Jürgen, Kröner-Herwig, Birgit, Dechent, Peter
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2016
• Subjects: Adult; Analysis of Variance; Anesthesia & Perioperative Care; Avoidance Learning - physiology; Brain Mapping; chronic low back pain; Disability Evaluation; Fear - psychology; Fear avoidance; fear of movement; Female; functional magnetic resonance imaging; Humans; Image Processing, Computer-Assisted; Imagination - physiology; kinesiophobia; Low Back Pain - diagnostic imaging; Low Back Pain - physiopathology; Low Back Pain - psychology; Magnetic Resonance Imaging; Male; Middle Aged; Movement - physiology; Oxygen - blood; Pain Measurement; Pain Medicine; Surveys and Questionnaires; chronic low back pain; fMRI; fear avoidance; fear of movement; kinesiophobia; Fear avoidance; functional magnetic resonance imaging
• ISSN: 1526-5900; 1528-8447; 1528-8447
• DOI: 10.1016/j.jpain.2016.05.005

Abstract The fear-avoidance model postulates that in an initial acute phase chronic low back pain (CLBP) patients acquire a fear of movement that results in avoidance of physical activity and contributes to the pain becoming chronic. The current fMRI study investigated the neural correlates of imagining back-straining and neutral movements in CLBP patients with high (HFA) and low fear avoidance (LFA) and healthy pain-free participants. Ninety-three persons (62 CLBP patients, 31 healthy controls; age 49.7 ± 9.2 years) participated. The CLBP patients were divided into an HFA and an LFA group using the Tampa Scale of Kinesiophobia. The participants viewed pictures of back-straining and neutral movements and were instructed to imagine that they themselves were executing the activity shown. When imagining back-straining movements, HFA patients as well as healthy controls showed stronger anterior hippocampus activity than LFA patients. The neural activations of HFA patients did not differ from those of healthy controls. This may indicate that imagining back-straining movements triggered pain-related evaluations in healthy controls and HFA participants, but not in LFA participants. Although heightened pain expectancy in HFA compared to LFA patients fits well with the fear-avoidance model, the difference between healthy controls and LFA patients was unexpected and contrary to the fear-avoidance model. Possibly, negative evaluations of the back-straining movements are common but the LFA patients employ some kind of strategy enabling them to react differently to the back-straining events. Perspective It appears that low fear-avoidant back pain patients utilise some kind of strategy or underlying mechanism which enables them to react with less fear in the face of potentially painful movements. This warrants further investigation since countering fear and avoidance provide an important advantage with respect to disability.