Schouppe Stijn, Clauwaert Amanda, Van Oosterwijck Jessica, Van Damme Stefaan, Palmans Tanneke, Wiersema Jan R, Sanchis-Sanchéz Enrique, Danneels Lieven
SPINE Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
Pain in Motion International Research Group.
Pain. 2020 Jun;161(6):1212-1226. doi: 10.1097/j.pain.0000000000001813.
Nonspecific chronic low back pain (CLBP) is a multifactorial disorder. Pain-related fear and altered movement preparation are considered to be key factors in the chronification process. Interactions between both have been hypothesized, but studies examining the influence of situational fear on movement preparation in low back pain (LBP) are wanting, as well as studies differentiating between recurrent LBP (RLBP) and CLBP. Therefore, this study examined whether experimentally induced pain-related fear influences movement preparation. In healthy controls (n = 32), RLBP (n = 31) and CLBP (n = 30) patients central and peripheral measures of movement preparation were assessed by concurrently measuring trunk muscle anticipatory postural adjustments (APA) with electromyography and contingent negative variation with EEG during performance of rapid arm movements. Two conditions were compared, one without (no fear) and one with (fear) possibility of painful stimulation to the back during rapid arm movements. Visual analogue scales were used to assess pain-related expectations/fear in both conditions. The experimentally induced fear of pain during movement performance led to an increase in contingent negative variation amplitude, which was similar in all 3 groups. Concerning APAs, no effects of fear were found, but group differences with generally delayed APAs in CLBP compared with controls and RLBP patients were evident. These results suggest that with fear, an attentional redirection towards more conscious central movement preparation strategies occurs. Furthermore, differences in movement preparation in patients with RLBP and CLBP exist, which could explain why patients with RLBP have more recovery capabilities than patients with CLBP.
非特异性慢性下腰痛（CLBP）是一种多因素疾病。与疼痛相关的恐惧和运动准备的改变被认为是慢性化过程中的关键因素。两者之间的相互作用已被提出假设，但研究情境恐惧对下腰痛（LBP）患者运动准备的影响的研究尚缺乏，区分复发性下腰痛（RLBP）和CLBP的研究也不足。因此，本研究探讨了实验诱导的与疼痛相关的恐惧是否会影响运动准备。在健康对照组（n = 32）、RLBP患者（n = 31）和CLBP患者（n = 30）中，通过在快速手臂运动过程中同时使用肌电图测量躯干肌肉预期姿势调整（APA）和脑电图测量伴随负变化，评估运动准备的中枢和外周指标。比较了两种情况，一种是在快速手臂运动期间背部没有（无恐惧）疼痛刺激的可能性，另一种是有（恐惧）疼痛刺激的可能性。使用视觉模拟量表评估两种情况下与疼痛相关的期望/恐惧。运动表现期间实验诱导的对疼痛的恐惧导致伴随负变化幅度增加，这在所有3组中相似。关于APA，未发现恐惧的影响，但与对照组和RLBP患者相比，CLBP患者的APA普遍延迟，存在组间差异。这些结果表明，在恐惧状态下，会出现注意力转向更有意识的中枢运动准备策略的情况。此外，RLBP和CLBP患者在运动准备方面存在差异，这可以解释为什么RLBP患者比CLBP患者具有更强的恢复能力。
