Open AccessThe impact of pain-related fear on neural pathways of pain modulation in chronic low back pain
Author(s) -
Michael L. Meier,
Philipp Stämpfli,
B. Kim Humphreys,
Andrea Vrana,
Erich Seifritz,
Petra Schweinhardt
Publication year - 2017
Publication title -
pain reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.113
H-Index - 15
ISSN - 2471-2531
DOI - 10.1097/pr9.0000000000000601
Subject(s) - amygdala , periaqueductal gray , chronic pain , dysfunctional family , psychology , low back pain , affect (linguistics) , medicine , cognition , clinical psychology , physical therapy , psychiatry , neuroscience , central nervous system , alternative medicine , communication , pathology , midbrain
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 5 39.35) and 20 healthy controls (12 females, mean age 5 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 5 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 5 0.28, P 5 0.01) but not with Fear Avoidance Beliefs questionnaires scores. Discussion: Our findings might indicate a maladaptive psychobiological interaction in chronic LBP patients characterized by a disrupted amygdala-PAG-FC that is modulated by the degree of pain-related fear. These results shed new light on brain mechanisms underlying psychological factors that may have pronociceptive effects in chronic LBP