Unconditioned and conditioned muscular responses in patients with chronic back pain and chronic tension-type headaches and in healthy controls.
Muscular tension is assigned an important role in the development and maintenance of chronic pain syndromes. It is seen as a psychophysiological correlate of learned fear and avoidance behavior. Basic theoretical models emphasize classical conditioning of muscular responses as a mechanism of pain chronification. However, the empirical basis for this field is very small. Our aim was to investigate muscular factors in relation to unconditioned and conditioned pain stimuli. An experimental study was conducted using a differential classical conditioning paradigm with 18 patients with chronic back pain (BP) and tension-type headache (TTH), and 18 healthy controls (HC). A high-pitched sound served as the CS+, paired with an intracutaneous electric pain stimulus (US), while a neutral sound was used as the CS-. Simultaneously, integrated surface electromyograms (iEMGs) were recorded for seven muscle sites. Our hypothesis was that the pain patients would demonstrate enhanced conditionability. Baseline values between patients (TTH, BP) and HC showed no significant differences. Although the perception and pain thresholds were balanced, both patient groups revealed a higher number of significant muscular responses to the pain stimulus (UR) than the HC. All participants showed significant conditioned muscular responses, however, the patients displayed a higher number than the healthy controls. Furthermore a significant relation was found between muscular responses and the experience of pain 1day after the experiment. Muscular responses can be learned via classical conditioning. TTH and BP patients revealed a higher number of unconditioned and conditioned responses.
Klinger
Regine
R
Department of Psychology, Psychotherapeutic Outpatient Clinic Behavior Therapy, University of Hamburg, Von-Melle-Park 5, D-20146 Hamburg, Germany Spine Center, Klinikum Dortmund, Dortmund, Germany Department of Psychology, University of Hamburg, Germany Biosignal Processing and Neuro-Engineering, Institute for Signal Processing, University of Lübeck, Lübeck, Germany Department of Trauma Surgery, Schoen Klinik Hamburg, Germany.
Matter
Nadia
N
Kothe
Ralph
R
Dahme
Bernhard
B
Hofmann
Ulrich G
UG
Krug
Florian
F
D000704:Analysis of Variance; D001416:Back Pain / Q000503:physiopathology*; D003214:Conditioning, Classical / Q000502:physiology*; D004558:Electric Stimulation; D004562:Electrocardiography; D004576:Electromyography; D006801:Humans; D018482:Muscle, Skeletal / Q000503:physiopathology*; D017288:Pain Threshold / Q000502:physiology; D018781:Tension-Type Headache / Q000503:physiopathology*
Ashina M, Bendtsen L, Jensen R, Sakai F, Olesen J. Muscle hardness in patients with chronic tension-type headache: relation to actual headache state. Pain. 1999;79:201-205.
Ashina S, Babenko L, Jensen R, Ashina M, Magerl W, Bendtsen L. Increased muscular and cutaneous pain sensitivity in cephalic region in patients with chronic tension-type headache. Eur J Neurol. 2005;12:543-549.
Ashina S, Bendtsen L, Ashina M, Magerl W, Jensen R. Generalized hyperalgesia in patients with chronic tension-type headache. Cephalalgia. 2006;26:940-948.
Bendtsen L. Central sensitization in tension-type headache-possible pathophysiological mechanisms. Cephalalgia. 2000;20:486-508.
Bendtsen L. Central and peripheral sensitization in tension-type headache. Curr Pain Headache Rep. 2003;7:460-465.
Bloch R. Subtraction of electrocardiographic signal from respiratory electromyogram. J Appl Physiol: Respir Environ Exercise Physiol. 1983;55:619-623.
Bromm B, Meier W. The intracutaneous stimulus: a new pain model for algesimetric studies. Methods Find Exp Clin Pharmacol. 1984;6:405-410.
Escobar M, Arcediano F, Miller RR. Latent inhibition in human adults without masking. J Exp Psychol Learn Mem Cogn. 2003;29:1028-1040.
Flor H, Birbaumer N. A psychobiological view of chronic back pain and its management. Int J Psychol. 1992;27:441-442.
Flor H, Birbaumer H, Schugens MM, Lutzenberger W. Symptom-specific psychophysiological responses in chronic pain patients. Psychophysiology. 1992;29:452-460.
Flor H, Birbaumer N, Schulte W, Roos R. Stress-related electromyographic responses in patients with chronic temporomandibular pain. Pain. 1991;46:145-152.
Flor H, Birbaumer N, Turk DC. The psychobiology of chronic pain. Adv Behav Res Ther. 1990;12:47-84.
Flor H, Turk DC. Psychophysiology of chronic pain – do chronic pain patients exhibit symptom-specific psychophysiological responses. Psychol Bull. 1989;105:215-259.
Flor H, Turk DC, Birbaumer N. Assessment of stress-related psychophysiological reactions in chronic back pain patients. J Consult Clin Psychol. 1985;53:354-364.
Geisser ME, Haig AJ, Wallboom AS, Wiggert EA. Pain-related fear, lumbar flexion, and dynamic EMG among persons with chronic musculoskeletal low back pain. Clin J Pain. 2004;20:61-69.
Hermens HJ, Freriks B, Disselhorst-Klug C, Rau G. Development of recommendations for SEMG sensors and sensor placement procedures. J Electromyogr Kinesiol. 2000;10:361-374.
Hoheisel U, Mense S, Simons DG, Yu X-M. Appearance of new receptive fields in rat dorsal horn neurons following noxious stimulation of skeletal muscle: a model for referral of muscle pain? Neurosci Lett. 1993;153:9-12.
Houy-Schäfer S, Grotemeyer K-H. Spannungskopfschmerz (tension headache). Schmerz Pain. 2004;18:104-108.
Jensen R. Pathophysiological mechanisms of tension-type headache: a review of epidemiological and experimental studies. Cephalalgia. 1999;19:602-621.
Jensen R, Bendtsen L, Olesen J. Muscular factors are of importance in tension-type headache. Headache. 1998;38:10-17.
Klosterhalfen S, Kellermann S, Stockhorst U, Wolf J, Kirschbaum C, Hall G, Enck P. Latent inhibition of rotation chair-induced nausea in healthy male and female volunteers. Psychosom Med. 2005;67:335-340.
Leeuw M, Goossens MEJB, Linton SJ, Crombez G, Boersma K, Vlaeyen JWS. The fear-avoidance model of musculoskeletal pain: current state of scientific evidence. J Behav Med. 2007;30:77-94.
Lipp OV, Siddle DAT, Arnold SL. Psychosis proneness in a non-clinical sample II: a multi-experimental study of “attentional malfunctioning”. Personality Individ Differ. 1994;17:405-424.
Lubow RE, Gewirtz JC. Latent Inhibition in humans: data, theory, and implications for schizophrenia. Psychol Bull. 1995;117:87-103.
Marlowe NI. Pain sensitivity and headache: an examination of the central theory. J Psychosom Res. 1992;36:17-24.
Pittenger C, Kandel ER. In search of general mechanisms for long-lasting plasticity: aplysia and the hippocampus. Philos Trans R Soc B Biol Sci. 2003;358:757-763.
Schneider C, Palomba D, Flor H. Pavlovian conditioning of muscular responses in chronic pain patients: central and peripheral correlates. Pain. 2004;112:239-247.
Spalding TW, Schleifer LM, Hatfield BD, Kerick S, Cram J. Removing the influence of the heart from surface-recorded EMG. Biofeedback. 2003;31:6-10.
Traue HC, Bischoff C, Zenz H. Sozialer StreΒ, Muskelspannung und Spannungskopfschmerz (Social stress, muscle tension and tension-type headache). Z Klin Psychol. 1985;1:57-70.
Vlaeyen JWS, Seelen HAM, Peters M, de Jong P, Aretz E, Beisiegel E, Weber WEJ. Fear of movement/(re)injury and muscular reactivity in chronic low back pain patients: an experimental investigation. Pain. 1999;82:297-304.
Vlaeyen JWS, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain. 2000;85:317-332.
Voudouris NJ, Peck CL, Coleman G. The role of conditioning and verbal expectancy in the placebo response. Pain. 1990;43:121-128.
Wittrock DA. The comparison of individuals with tension-type headache and headache-free controls on frontal EMG level: a meta analysis. Headache. 1997;37:424-432.