Neural Correlates Differ in High and Low Fear-Avoidant Chronic Low Back Pain Patients When Imagining Back-Straining Movements.
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 functional magnetic resonance imaging 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 with 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 use some kind of strategy enabling them to react differently to the back-straining events.



It appears that low fear-avoidant back pain patients use some kind of strategy or underlying mechanism that enables them to react with less fear in the face of potentially painful movements. This warrants further investigation because countering fear and avoidance provide an important advantage with respect to disability.
Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps University Marburg, Marburg, Germany. Electronic address: abarke@gwdg.de.
Antonia
A
Barke
Department of Clinical Psychology and Psychotherapy, Georg-Elias-Müller-Institute for Psychology, University of Göttingen, Göttingen, Germany.
Mira A
MA
Preis
Department of Cognitive Neurology, University Medical Center Göttingen, Göttingen, Germany.
Carsten
C
Schmidt-Samoa
German Primate Center, Göttingen, Germany.
Jürgen
J
Baudewig
Department of Clinical Psychology and Psychotherapy, Georg-Elias-Müller-Institute for Psychology, University of Göttingen, Göttingen, Germany.
Birgit
B
Kröner-Herwig
Department of Cognitive Neurology, University Medical Center Göttingen, Göttingen, Germany.
Peter
P
Dechent
D000328:Adult; D000704:Analysis of Variance; D001362:Avoidance Learning / Q000502:physiology*; D001931:Brain Mapping; D004185:Disability Evaluation; D005239:Fear / Q000523:psychology*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007092:Imagination / Q000502:physiology*; D017116:Low Back Pain / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000523:psychology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009068:Movement / Q000502:physiology*; D010100:Oxygen / Q000097:blood; D010147:Pain Measurement; D011795:Surveys and Questionnaires
D010100:Oxygen
Fear avoidance; chronic low back pain; fear of movement; functional magnetic resonance imaging; kinesiophobia