Brain Areas Involved in Anticipation of Clinically Relevant Pain in Low Back Pain Populations With High Levels of Pain Behavior

Abstract

The purpose of this study was to identify neural correlates of pain anticipation in people with non-specific low back pain (NSLBP) that correlated with pain-related distress and disability, thus providing evidence for mechanisms underlying pain behaviour in this population. Thirty NSLBP sufferers, with either high levels of pain behaviour (WS-H) or low levels (WS-L) based on Waddell Signs (WS), were scanned with functional Magnetic Resonance Imaging (fMRI) whilst a straight-leg raise (of the side deemed to cause moderate pain in the lower back) was performed. On each trial coloured stimuli were presented and used to indicate when the leg definitely would be raised (Green; 100% certainty), might be raised (Yellow; 50% certainty) or would definitely not be raised (Red; 100% certainty). In response to expected vs. unexpected pain the group difference in activation between WS-H and WS-L co-varied as a function of anxiety scores in right insula and pregenual anterior cingulate cortex and as a function of catastrophizing in prefrontal and parietal cortex and hippocampus. The results suggest NSLBP populations with the highest levels of pain-related distress are more likely to attend to and infer threat from innocuous cues, which may contribute to the maintenance of pain behaviour associated with some chronic pain states.Perspective: This article demonstrates a likely neural network for exacerbating pain anticipation in NSLBP contributing to high levels of pain behaviour in some people. This information could potentially help clinicians and patients to understand how anticipation of pain may contribute to patient pain and disability.

Dimensions of pain catastrophising and specific structural and functional alterations in patients with chronic pain: Evidence in medication-overuse headache

“…Our study further highlights reduced FC in cerebellum as magnification increases, which might suggest a specific involvement of an intra-cerebellar network in magnification. Of note, cerebellar activity has been linked to PC in fibromyalgia (Gracely, Geisser et al 2004, Lazaridou, Kim et al 2017 and MOH (Chanraud, Di Scala et al 2014), which might underlie the cerebellar role in the anticipation of pain (Leung 2012) and several other processes usually associated with the multidimensional experience of pain (Moulton, Schmahmann et al 2010, Lloyd, Helbig et al 2016. Increased cerebellar metabolism has been found in MOH before withdrawal (Fumal, Laureys et al 2006).…”

Imagined and Actual Acupuncture Effects on Chronic Low Back Pain: A Preliminary Study

“…Anxiety may play an important role in perpetuating the distress associated with cLBP, as persistent pain and limited physical movement likely impact the brain circuitry that processes emotion. This increased distress, in turn, aggravates anxiety and worsens pain perception [38].…”

Chronic Pain and Mental Health Disorders

“…7 For instance, the anticipation of pain has been associated with activation of brain regions comprising the "perceptiveattentional" and "reappraisal-emotional" tiers in individuals with chronic pain with high levels of pain catastrophizing, fear-avoidance beliefs, and negative affect. 123 Cognitive-Behavioral Therapy. Cognitivebehavioral therapy is widely used to treat pain-related functional disabilities.…”