title: Brain Areas Involved in Anticipation of Clinically Relevant Pain in Low Back Pain Populations With High Levels of Pain Behavior.
abstract: The purpose of this study was to identify neural correlates of pain anticipation in people with nonspecific low back pain (NSLBP) that correlated with pain-related distress and disability, thus providing evidence for mechanisms underlying pain behavior in this population. Thirty NSLBP sufferers, with either high levels of pain behavior or low levels on the basis of Waddell signs, were scanned with functional magnetic resonance imaging while a straight-leg raise (of the side deemed to cause moderate pain in the lower back) was performed. On each trial colored stimuli were presented and used to indicate when the leg definitely would be raised (green; 100% certainty), might be raised (yellow; 50% certainty), or would definitely not be raised (red; 100% certainty). In response to expected versus unexpected pain the group difference in activation between patients with high levels of pain behavior and low levels of pain behavior covaried as a function of anxiety scores in the right insula and pregenual anterior cingulate cortex and as a function of catastrophizing in prefrontal and parietal cortex and hippocampus. The results suggest NSLBP populations with the highest levels of pain-related distress are more likely to attend to and infer threat from innocuous cues, which may contribute to the maintenance of pain behavior associated with some chronic pain states.
  
  
  
  This article shows a likely neural network for exacerbating pain anticipation in NSLBP contributing to high levels of pain behavior in some people. This information could potentially help clinicians and patients to understand how anticipation of pain may contribute to patient pain and disability.
authors: Pain Research Institute, University of Liverpool, Liverpool, United Kingdom; Magnetic Resonance and Image Analysis Research Centre (MARIARC), University of Liverpool, Liverpool, United Kingdom. Electronic address: d.m.lloyd@leeds.ac.uk.
authors: Donna M
authors: DM
authors: Lloyd
authors: Department of Psychology, University of Innsbruck, Innsbruck, Austria.
authors: Torben
authors: T
authors: Helbig
authors: The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom.
authors: Gordon
authors: G
authors: Findlay
authors: Magnetic Resonance and Image Analysis Research Centre (MARIARC), University of Liverpool, Liverpool, United Kingdom; Clinical Research Imaging Centre (CRIC), School of Clinical Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom.
authors: Neil
authors: N
authors: Roberts
authors: Pain Research Institute, University of Liverpool, Liverpool, United Kingdom; The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom.
authors: Turo
authors: T
authors: Nurmikko
mesh_terms: D000328:Adult; D000368:Aged; D059031:Anticipation, Psychological / Q000502:physiology*; D001921:Brain / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001931:Brain Mapping; D058443:Catastrophization / Q000503:physiopathology / Q000523:psychology*; D005239:Fear; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D017116:Low Back Pain / Q000473:pathology / Q000503:physiopathology / Q000523:psychology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000209:etiology / Q000523:psychology; D010100:Oxygen / Q000097:blood; D010147:Pain Measurement; D010775:Photic Stimulation; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D010100:Oxygen
keywords: Anxiety; Waddell Signs; catastrophizing; nonspecific low back pain; pain behavior