Format

Send to

Choose Destination
J Pain. 2018 Nov;19(11):1352-1365. doi: 10.1016/j.jpain.2018.05.012. Epub 2018 Jul 3.

Brain Mechanisms of Anticipated Painful Movements and Their Modulation by Manual Therapy in Chronic Low Back Pain.

Author information

1
A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: dellingsen@mgh.harvard.edu.
2
A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
3
A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; School of Medicine, University of California, San Francisco, California.
4
A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Neuroscience Graduate Program, University of Michigan Medical School, Ann Arbor Michigan.
5
Osher Integrative Care Center, Brigham and Women's Hospital, Boston, MA, Massachusetts.
6
Melrose Family Chiropractic & Sports Injury Centre, Melrose, Massachusetts.
7
Department of Anesthesiology, Harvard Medical School, Brigham & Women's Hospital, Boston, Massachusetts.
8
Department of Radiology, Logan University, Chesterfield, Missouri.

Abstract

Heightened anticipation and fear of movement-related pain has been linked to detrimental fear-avoidance behavior in chronic low back pain (cLBP). Spinal manipulative therapy (SMT) has been proposed to work partly by exposing patients to nonharmful but forceful mobilization of the painful joint, thereby disrupting the relationship among pain anticipation, fear, and movement. Here, we investigated the brain processes underpinning pain anticipation and fear of movement in cLBP, and their modulation by SMT, using functional magnetic resonance imaging. Fifteen cLBP patients and 16 healthy control (HC) subjects were scanned while observing and rating video clips depicting back-straining or neutral physical exercises, which they knew they would have to perform at the end of the visit. This task was repeated after a single session of spinal manipulation (cLBP and HC group) or mobilization (cLBP group only), in separate visits. Compared with HC subjects, cLBP patients reported higher expected pain and fear of performing the observed exercises. These ratings, along with clinical pain, were reduced by SMT. Moreover, cLBP, relative to HC subjects, demonstrated higher blood oxygen level-dependent signal in brain circuitry that has previously been implicated in salience, social cognition, and mentalizing, while observing back straining compared with neutral exercises. The engagement of this circuitry was reduced after SMT, and especially the spinal manipulation session, proportionally to the magnitude of SMT-induced reduction in anticipated pain and fear. This study sheds light on the brain processing of anticipated pain and fear of back-straining movement in cLBP, and suggests that SMT may reduce cognitive and affective-motivational aspects of fear-avoidance behavior, along with corresponding brain processes. PERSPECTIVE: This study of cLBP patients investigated how SMT affects clinical pain, expected pain, and fear of physical exercises. The results indicate that one of the mechanisms of SMT may be to reduce pain expectancy, fear of movement, and associated brain responses.

KEYWORDS:

Expectation; Fear-avoidance; Pain anticipation; Physical exercise; Spinal Manipulative Therapy; chronic Low Back Pain; functional Magnetic Resonance Imaging

PMID:
30392530
PMCID:
PMC6220681
[Available on 2019-11-01]
DOI:
10.1016/j.jpain.2018.05.012

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center