Lumbar range of motion in chronic low back pain is predicted by task‐specific, but not by general measures of pain‐related fear

Abstract

Background Most studies fail to show an association between higher levels of pain‐related fear and protective movement behaviour in patients with chronic low back pain (CLBP). This may be explained by the fact that only general measures of pain‐related fear have been used to examine the association with movement patterns. This study explored whether task‐specific, instead of general measures of pain‐related fear can predict movement behaviour. Methods Fifty‐five patients with CLBP and 54 healthy persons performed a lifting task while kinematic measurements were obtained to assess lumbar range of motion (ROM). Scores on the Photograph Daily Activities Series‐Short Electronic Version (PHODA‐SeV), Tampa Scale for Kinesiophobia and its Activity Avoidance and Somatic Focus subscales were used as general measures of pain‐related fear. The score on a picture of the PHODA‐SeV, showing a person lifting a heavy object with a bent back, was used as task‐specific measure of pain‐related fear. Results Lumbar ROM was predicted by task‐specific, but not by general measures of pain‐related fear. Only the scores on one other picture of the PHODA‐SeV, similar to the task‐specific picture regarding threat value and movement characteristics, predicted the lumbar ROM. Compared to healthy persons, patients with CLBP used significantly less ROM, except the subgroup with a low score on the task‐specific measure of pain‐related fear, who used a similar ROM. Conclusions Our results suggest to use task‐specific measures of pain‐related fear when assessing the relationship with movement. It would be of interest to investigate whether reducing task‐specific fear changes protective movement behaviour. Significance This study shows that lumbar range of motion in CLBP is predicted by task‐specific, but not by general measures of pain‐related fear. This suggests that both in clinical practice and for research purposes, it might be recommended to use task‐specific measures of pain‐related fear when assessing the relationship with movement behaviour. This may help to disentangle the complex interactions between pain‐related fear, movement and disability in patients with CLBP.

Fear avoidance beliefs limit lumbar spine flexion during object lifting in pain-free adults

“…Our results support the evolving evidence that fear avoidance beliefs and associated pain- [34]. In line with the current study, that study observed a significant negative relationship between movement-specific pain-related fear, reflected by the PHODA-lift item, and lumbar motion during a lifting task, supporting the construct validity of the PHODA-lift item.…”

“…To compare the actual data in pain-free adults with similar analyses recently performed in chronic LBP patients [34], we conducted the following complementary analyses: (1)…”

“…On the contrary, maintaining a protective strategy, e.g. by keeping a neutral spine (through "stiffening" the lumbar spine) during lifting, has been shown to be associated with increased muscle co-contraction and mechanical loading on spinal tissues, which might result in ongoing nociceptive input in the long term [8,16,19,32,34,39,47,59]. Yet, many health care professionals still promote lifting with a neutral spine as the safer lifting technique [42,50,62], potentially nurturing erroneous beliefs underlying pain-related fear (e.g.…”

Movement, posture and low back pain. How do they relate? A replicated single‐case design in 12 people with persistent, disabling low back pain

“…whether less protective movement and postural patterns resulted in changes to pain or activity limitation, vice versa, or whether changes in both had a separate common cause) remain unknown. Carefully designed experimental and mediational studies, that include psychological factors known to be important for people with disabling NSLBP, such as pain catastrophising, fear and pain self-efficacy, would be required to make causal inferences (Lee et al, 2017;Matheve, De Baets, Bogaerts, & Timmermans, 2019).…”

“…Psychological factors (such as pain catastrophising, fear and pain self-efficacy) have been shown to relate more to improved pain or activity limitation than physical parameters such as movement or abdominal muscle function (Mannion, Caporaso, Pulkovski, & Sprott, 2012;Mannion et al, 2001;Nordstoga, Meisingset, Vasseljen, Nilsen, & Unsgaard-Tondel, 2019). Psychological factors have also been shown to influence the embodiment of cautious and protective movement behaviours (Matheve et al, 2019;Olugbade, Bianchi-Berthouze, & Williams, 2019;Osumi et al, 2019) and mediate improvement (Lee et al, 2017;Liew et al, 2020;Mansell, Kamper, & Kent, 2013;Smeets, Vlaeyen, Kester, & Knottnerus, 2006). It may be that threat reduction, following the safe completion of previously painful, feared, or avoided activities perceived as dangerous or damaging, led to clinical improvement, irrespective of whether this was related to changes in movement or posture (Mannion et al, 2012;Steiger et al, 2012).…”