The Impact of Pain-related Fear on Neural Pathways of Pain Modulation in Chronic Low Back Pain
SOURCE: Pain Rep. 2017 (Apr 11); 2 (3): e601
Michael Lukas Meiera, Philipp Stampfli, Barry Kim Humphreys, Andrea Vrana, Erich Seifritz, Petra Schweinhardt
Department of Chiropractic Medicine,
Interdisciplinary Spinal Research,
University Hospital Balgrist,
INTRODUCTION: Pain-related fear plays a substantial role in chronic low back pain (LBP) by amplifying the experienced disability. Related dysfunctional emotions and cognitions may also affect sensory aspects of pain through a modulatory pathway in which the periaqueductal gray (PAG) and the amygdala play key roles.
OBJECTIVES: We therefore hypothesized a differential amygdala-PAG functional connectivity (FC) in patients with chronic LBP that is modulated by the degree of pain-related fear.
METHODS: We used data of a previously reported fMRI study where 20 chronic LBP patients (7 females, mean age = 39.35) and 20 healthy controls (12 females, mean age = 32.10) were asked to observe video clips showing potentially harmful and neutral activities for the back. Pain-related fear was assessed using the Tampa Scale of kinesiophobia (TSK) and Fear Avoidance Beliefs questionnaires (FABQ). Generalized psychophysiological interactions were used to reveal task-based FC.
RESULTS: Compared to controls, patients exhibited a significant decrease in amygdala-PAG-FC (P = 0.022) during observation of harmful activities, but not of neutral activities. Furthermore, amygdala-PAG-FC correlated negatively with Tampa Scale of kinesiophobia scores in patients (R2 = 0.28, P = 0.01) but not with Fear Avoidance Beliefs questionnaires scores.
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