Vlaeyen Johan W S, Seelen Henk A M, Peters Madelon, de Jong Peter, Aretz Eveline, Beisiegel Elles, Weber Wilhelm E J
Institute for Rehabilitation Research, P.O. Box 192, 6430 AD, Hoensbroek, The Netherlands Department of Medical, Clinical and Experimental Psychology, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands Pain Management and Research Center, University Hospital Maastricht, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
Pain. 1999 Sep;82(3):297-304. doi: 10.1016/S0304-3959(99)00054-8.
This experiment was set up to test the hypothesis that confrontation with feared movements would lead to symptom-specific muscular reactivity in chronic low back pain patients who report high fear of movement/(re)injury. Thirty-one chronic low back pain patients were asked to watch a neutral nature documentary, followed by a fear-eliciting video-presentation, while surface electromyography (EMG) recordings were made from the lower paraspinal and the tibialis anterior muscles. It was further hypothesized that negative affectivity (NA) would moderate the effects of fear on symptom-specific muscular reactivity, as well as the effects of muscular reactivity on pain report. The results were partly as predicted. Unexpectedly, paraspinal EMG-readings decreased during video-exposure but this decrement tended to be less in fearful patients than in the non-fearful patients. Negative affectivity did not moderate this effect, but moderated the effect of pain-related fear on muscular reactivity of lower leg muscles. In addition, NA directly predicted muscular reactivity in the right tibialis anterior muscle. As predicted, there was a significant covariation between left paralumbar muscular activity and pain report. This association was moderated by NA, but in the opposite direction. The findings extend the symptom-specificity model of psychophysiological reactivity, and support the idea that pain-related fear perpetuates pain and pain disability through muscular reactivity.
对于报告对运动/（再）损伤高度恐惧的慢性下背痛患者，面对恐惧的运动会导致特定症状的肌肉反应。31名慢性下背痛患者被要求观看一部中性的自然纪录片，随后观看一段引发恐惧的视频，同时记录下椎旁肌和胫骨前肌的表面肌电图（EMG）。进一步假设消极情感（NA）会调节恐惧对特定症状肌肉反应的影响，以及肌肉反应对疼痛报告的影响。结果部分符合预期。出乎意料的是，在视频观看期间，椎旁肌的EMG读数下降，但这种下降在恐惧患者中往往比非恐惧患者中更小。消极情感并未调节这种效应，但调节了与疼痛相关的恐惧对小腿肌肉反应的影响。此外，消极情感直接预测了右侧胫骨前肌的肌肉反应。正如预期的那样，左腰旁肌活动与疼痛报告之间存在显著的协变关系。这种关联受到消极情感的调节，但方向相反。这些发现扩展了心理生理反应的特定症状模型，并支持了与疼痛相关的恐惧通过肌肉反应使疼痛和疼痛残疾持续存在的观点。
