title: Fear avoidance beliefs in back pain-free subjects are reflected by amygdala-cingulate responses.
abstract: In most individuals suffering from chronic low back pain, psychosocial factors, specifically fear avoidance beliefs (FABs), play central roles in the absence of identifiable organic pathology. On a neurobiological level, encouraging research has shown brain system correlates of somatic and psychological factors during the transition from (sub) acute to chronic low back pain. The characterization of brain imaging signatures in pain-free individuals before any injury will be of high importance regarding the identification of relevant networks for low back pain (LBP) vulnerability. Fear-avoidance beliefs serve as strong predictors of disability and chronification in LBP and current research indicates that back pain related FABs already exist in the general and pain-free population. Therefore, we aimed at investigating possible differential neural functioning between high- and low fear-avoidant individuals in the general population using functional magnetic resonance imaging. Results revealed that pain-free individuals without a history of chronic pain episodes could be differentiated in amygdala activity and connectivity to the pregenual anterior cingulate cortex by their level of back pain related FABs. These results shed new light on brain networks underlying psychological factors that may become relevant for enhanced disability in a future LBP episode.
authors.affiliation: Balgrist University Hospital Zurich, Switzerland ; Center of Dental Medicine, University of Zurich Zurich, Switzerland.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Meier
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich Zurich, Switzerland ; MR-Center of the Psychiatric Hospital and Department of Child and Adolescent Psychiatry, University of Zurich Zurich, Switzerland.
authors.forename: Phillipp
authors.initials: P
authors.lastname: Stämpfli
authors.affiliation: Balgrist University Hospital Zurich, Switzerland.
authors.forename: Andrea
authors.initials: A
authors.lastname: Vrana
authors.affiliation: Balgrist University Hospital Zurich, Switzerland.
authors.forename: Barry K
authors.initials: BK
authors.lastname: Humphreys
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich Zurich, Switzerland.
authors.forename: Erich
authors.initials: E
authors.lastname: Seifritz
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich Zurich, Switzerland.
authors.forename: Sabina
authors.initials: S
authors.lastname: Hotz-Boendermaker
keywords: PPI analysis; amygdala; chronic low back pain; fMRI; fear avoidance; low back pain; pgACC; vulnerability