Fear of movement/(re)injury and muscular reactivity in chronic low back pain patients: an experimental investigation

Abstract

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.

Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art

“…Psychophysiologic reactivity in fearful chronic low back pain patients was studied in an experiment where the subjects were presented a video recording including a neutral situation (a nature documentary) followed by a physical activity being performed rigorously by a dummy patient (Vlaeyen et al, 1999a). The patients remained seated during the 6 min video-exposure, and were instructed to watch carefully as they would be asked to perform the same activity at the end of the video presentation.…”

In a controlled trial training general practitioners and occupational physicians to collaborate did not influence sickleave of patients with low back pain

“…The baseline characteristics were age, gender, weight, level of education, sporting activities, driving a vehicle, psychological factors (General Health Questionnaire [11]), coping (Utrecht Coping List [12]), fear of movement (Tampa questionnaire [13]), history of LBP, and work characteristics. Work characteristics included type of work, number of working hours per week, psychosocial job characteristics (Karasek Questionnaire [14]), physical job characteristics, and physical effort (Borg Scale [15]).…”

Fear Avoidance Beliefs and Disability among Women with Low Back Pain

“…It has been proposed that confrontation is an adaptive response to pain while avoidance is a maladaptive behavior causing LBP patients to avoid certain daily activities that may cause pain [23]. In the acute phase of LBP, fear avoidance is considered an adaptive response to avoid movements that would cause tissue damage.…”