Neural correlates of fear of movement in high and low fear-avoidant chronic low back pain patients: An event-related fMRI study

Barke, Antonia; Baudewig, Jürgen; Schmidt-Samoa, Carsten; Dechent, Peter; Kröner-Herwig, Birgit

doi:10.1016/j.pain.2011.11.012

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Volume 153, Issue 3 , Pages 540-552, March 2012

Neural correlates of fear of movement in high and low fear-avoidant chronic low back pain patients: An event-related fMRI study

Antonia Barke
- Georg-Elias-Müller-Institute of Psychology, Department of Clinical Psychology and Psychotherapy, University of Göttingen, Göttingen, Germany
- Corresponding author. Address: Georg-Elias-Müller-Institute für Psychologie, Georg-August-Universität Göttingen, Goßlerstr. 14, Göttingen D-37073, Germany. Tel.: +49 551 395502; fax: +49 551 393544.
Jürgen Baudewig
- Dahlem Institute for Neuroimaging of Emotion (D.I.N.E.), Freie Universität Berlin, Berlin, Germany
Carsten Schmidt-Samoa
- Department of Cognitive Neurology, University Medicine Göttingen, Göttingen, Germany
Peter Dechent
- Department of Cognitive Neurology, University Medicine Göttingen, Göttingen, Germany
Birgit Kröner-Herwig
- Georg-Elias-Müller-Institute of Psychology, Department of Clinical Psychology and Psychotherapy, University of Göttingen, Göttingen, Germany

Received 8 March 2011; received in revised form 8 September 2011; accepted 8 November 2011. published online 09 January 2012.

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Summary

High and low fear-avoidant chronic low back pain patients did not differ with regard to brain activation when they viewed photographs of aversive movements.

Abstract

The fear-avoidance model postulates that in chronic low back pain (CLBP) a fear of movement is acquired in the acute phase, which leads to subsequent avoidance of physical activity and contributes to the pain syndrome’s becoming chronic. In the present event-related functional magnetic resonance imaging (fMRI) study of the neural correlates of the fear of movement, 60 women (30 CLBP patients, 15 healthy controls, and 15 women with spider phobia; mean age 46.8±9.8 years) participated. The CLBP patients were divided into a high and low fear-avoidant group on the basis of the Tampa Scale of Kinesiophobia. The participants viewed photographs depicting neutral and aversive (back-stressing) movements, generally fear-inducing and neutral pictures from the International Affective Picture System, and pictures of spiders while fMRI data were acquired. It was hypothesized that the high fear-avoidant CLBP patients would show fear-related activations when viewing the aversive movements and that they would differ from CLBP patients with low fear-avoidance and controls in this regard. No such activations were found for high or low fear-avoidant CLBP patients. The random-effects analysis showed no differences between high and low fear-avoidant CLBP patients or high fear-avoidant CLBP patients and controls. Normal fear-related activations were present in the high fear-avoidant CLBP patients for the generally fear-inducing pictures, demonstrating the validity of the stimulation paradigm and a generally unimpaired fear processing of the high fear-avoidant CLBP patients. Our findings do not support the fear component of the fear avoidance model.