Neuromuscular adaptations predict functional disability independently of clinical pain and psychological factors in patients with chronic non-specific low back pain.
Patients with chronic low back pain exhibit characteristics such as clinical pain, psychological symptoms and neuromuscular adaptations. The purpose of this study was to determine the independent contribution of clinical pain, psychological factors and neuromuscular adaptations to disability in patients with chronic low back pain. Clinical pain intensity, pain catastrophizing, fear-avoidance beliefs, anxiety, neuromuscular adaptations to chronic pain and neuromuscular responses to experimental pain were assessed in 52 patients with chronic low back pain. Lumbar muscle electromyographic activity was assessed during a flexion-extension task (flexion relaxation phenomenon) to assess both chronic neuromuscular adaptations and neuromuscular responses to experimental pain during the task. Multiple regressions showed that independent predictors of disability included neuromuscular adaptations to chronic pain (β=0.25, p=0.006, sr(2)=0.06), neuromuscular responses to experimental pain (β=-0.24, p=0.011, sr(2)=0.05), clinical pain intensity (β=0.28, p=0.002, sr(2)=0.08) and psychological factors (β=0.58, p<0.001, sr(2)=0.32). Together, these predictors accounted for 65% of variance in disability (R(2)=0.65 p<0.001). The current investigation revealed that neuromuscular adaptations are independent from clinical pain intensity and psychological factors, and contribute to inter-individual differences in patients' disability. This suggests that disability, in chronic low back pain patients, is determined by a combination of factors, including clinical pain, psychological factors and neuromuscular adaptations.
Département de psychologie, Université du Québec à Trois-Rivières, Canada; Groupe de Recherche sur les Affections Neuro-musculo-squelettiques, Université du Québec à Trois-Rivières, Canada; Centre de Recherche en Neuropsychologie et Cognition - CERNEC, Université de Montréal, Canada.
Jean-Daniel
JD
Dubois
Département des sciences de l'activité physique, Université du Québec à Trois-Rivières, Canada; Groupe de Recherche sur les Affections Neuro-musculo-squelettiques, Université du Québec à Trois-Rivières, Canada.
Jacques
J
Abboud
Département de chiropratique, Université du Québec à Trois-Rivières, Canada; Groupe de Recherche sur les Affections Neuro-musculo-squelettiques, Université du Québec à Trois-Rivières, Canada.
Charles
C
St-Pierre
Département de chiropratique, Université du Québec à Trois-Rivières, Canada; Groupe de Recherche sur les Affections Neuro-musculo-squelettiques, Université du Québec à Trois-Rivières, Canada; Centre de Recherche en Neuropsychologie et Cognition - CERNEC, Université de Montréal, Canada.
Mathieu
M
Piché
Département des sciences de l'activité physique, Université du Québec à Trois-Rivières, Canada; Groupe de Recherche sur les Affections Neuro-musculo-squelettiques, Université du Québec à Trois-Rivières, Canada. Electronic address: martin.descarreaux@uqtr.ca.
Martin
M
Descarreaux
D000328:Adult; D001696:Biomechanical Phenomena; D004185:Disability Evaluation; D004576:Electromyography / Q000379:methods*; D005239:Fear; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000503:physiopathology* / Q000523:psychology*; D008161:Lumbosacral Region; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000503:physiopathology; D010147:Pain Measurement / Q000379:methods*; D016059:Range of Motion, Articular; D012044:Regression Analysis; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires
Chronic low back pain; Experimental pain; Fear-avoidance model; Functional disability; Neuromuscular adaptations