Abstract
Fear of movement (FOM) can be acquired by a direct aversive experience such as pain or by social learning through observation and instruction. Excessive FOM results in heightened disability and is an obstacle for recovery from acute, subacute, and chronic low back pain (cLBP). FOM has further been identified as a significant explanatory factor in the Fear Avoidance (FA) model of cLBP that describes how individuals experiencing acute back pain may become trapped into a vicious circle of chronic disability and suffering. Despite a wealth of evidence emphasizing the importance of FOM in cLBP, to date, no related neural correlates in patients were found and this therefore has initiated a debate about the precise contribution of fear in the FA model. In the current fMRI study, we applied a novel approach encompassing: (1) video clips of potentially harmful activities for the back as FOM inducing stimuli; and (2) the assessment of FOM in both, cLBP patients (N = 20) and age- and gender-matched pain-free subjects (N = 20). Derived from the FA model, we hypothesized that FOM differentially affects brain regions involved in fear processing in patients with cLBP compared to pain-free individuals due to the recurrent pain and subsequent avoidance behavior. The results of the whole brain voxel-wise regression analysis revealed that: (1) FOM positively correlated with brain activity in fear-related brain regions such as the amygdala and the insula; and (2) differential effects of FOM between patients with cLBP and pain-free subjects were found in the extended amygdala and in its connectivity to the anterior insula. Current findings support the FOM component of the FA model in cLBP.
Highlights
Most individuals suffering from acute low back pain (LBP) recover within 6 weeks (Koes et al, 2001)
Derived from the Fear Avoidance (FA) model, we hypothesized that Fear of movement (FOM) differentially affects brain regions involved in fear processing in patients with chronic LBP (cLBP) patients compared to pain-free individuals due to the recurrent pain and subsequent avoidance behavior in patients with cLBP
Current findings may contribute to the knowledge of underlying emotions described in the FA model by demonstrating that: (1) FOM positively correlated with activity in fear-related brain regions such as the insula and amygdala in both, cLBP patients and pain-free subjects; and (2) differential effects of FOM between pain-free subjects and cLBP patients were found in the extended amygdala and in its functional connectivity to the anterior insula
Summary
Most individuals suffering from acute low back pain (LBP) recover within 6 weeks (Koes et al, 2001). The only fMRI study involving cLBP patients with low and high FOM, measured by means of the Tampa Scale of Kinesiophobia (TSK) questionnaire, revealed no differential effects in fear-related brain activity between low and high FOM individuals. In support of these null results, a further study that investigated chronic musculoskeletal pain patients was not able to demonstrate a potential relationship between the TSK score and brain activity (Taylor et al, 2015). Derived from the FA model, we hypothesized that FOM differentially affects brain regions involved in fear processing in patients with cLBP patients compared to pain-free individuals due to the recurrent pain and subsequent avoidance behavior in patients with cLBP
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