Differences in Low Back Pain Behavior Are Reflected in the Cerebral Response to Tactile Stimulation of the Lower Back

Lloyd, David T.; Findlay, G.; Roberts, Neil; Nurmikko, Turo

doi:10.1097/brs.0b013e3181734a8a

Cited by 96 publications

(87 citation statements)

References 24 publications

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“…Background and Aims: Evidence indicates that chronic non-specific low back pain (CNSLBP) is associated with alteration in the brain's cortical representation of the back, resulting in body perception disturbance and contributing to the condition [1,2]. This study investigated perception via 'cortical' sensory tests, in this case two-point discrimination and graphaesthesia-whose results partly depend on the integrity of cortical representation [2].…”

Section: Tactile Thresholds Are Preserved Yet Complex Sensory Functiomentioning

confidence: 99%

Tactile thresholds are preserved yet complex sensory function is impaired over the lumbar spine of chronic non-specific low back pain patients: a preliminary investigation

et al. 2010

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Section: Tactile Thresholds Are Preserved Yet Complex Sensory Functiomentioning

confidence: 99%

Tactile thresholds are preserved yet complex sensory function is impaired over the lumbar spine of chronic non-specific low back pain patients: a preliminary investigation

et al. 2010

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“…In addition to CLBP, cortical abnormalities occur in a wide variety of other chronic pain conditions, such as chronic headache, arthritis, and fibromyalgia (for review, see . Several studies have also indicated abnormal cortical function in people with CLBP (Giesecke et al, 2004;Baliki et al, 2008;Lloyd et al, 2008;Kobayashi et al, 2009;Tagliazucchi et al, 2010). Evidence from pain neuroimaging and transcranial magnetic stimulation studies has linked the DLPFC to pain modulation (Lorenz et al, 2003;Brighina et al, 2004;Fierro et al, 2010), placebo analgesia (Wager et al, 2004;Krummenacher et al, 2010), perceived control of pain (Pariente et al, 2005;Wiech et al, 2006), and pain catastrophizing (Seminowicz and Davis, 2006).…”

Section: Introductionmentioning

confidence: 99%

Effective Treatment of Chronic Low Back Pain in Humans Reverses Abnormal Brain Anatomy and Function

et al. 2011

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Chronic pain is associated with reduced brain gray matter and impaired cognitive ability. In this longitudinal study, we assessed whether neuroanatomical and functional abnormalities were reversible and dependent on treatment outcomes. We acquired MRI scans from chronic low back pain (CLBP) patients before (n ϭ 18) and 6 months after (spine surgery or facet joint injections; n ϭ 14) treatment. In addition, we scanned 16 healthy controls, 10 of which returned 6 months after the first visit. We performed cortical thickness analysis on structural MRI scans, and subjects performed a cognitive task during the functional MRI. We compared patients and controls, as well as patients before versus after treatment. After treatment, patients had increased cortical thickness in the left dorsolateral prefrontal cortex (DLPFC), which was thinner before treatment compared with controls. Increased DLPFC thickness correlated with the reduction of both pain and physical disability. Additionally, increased thickness in primary motor cortex was associated specifically with reduced physical disability, and right anterior insula was associated specifically with reduced pain. Left DLPFC activity during an attention-demanding cognitive task was abnormal before treatment, but normalized following treatment. These data indicate that functional and structural brain abnormalities-specifically in the left DLPFC-are reversible, suggesting that treating chronic pain can restore normal brain function in humans.

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“…Finally, it is possible that WS are, at least in part, reflections of central sensitization, and the fMRI differences between the WS-H and WS-L groups are a manifestation of neurological changes associated with central sensitization. We have shown previously that there is some cortical re-organisation in response to differences in WS 35 . However, it is impossible to demonstrate 'cause and effect' with our current cross-sectional design.…”

Section: Discussionmentioning

confidence: 99%

Brain Areas Involved in Anticipation of Clinically Relevant Pain in Low Back Pain Populations With High Levels of Pain Behavior

Lloyd

Helbig

Findlay

et al. 2016

The Journal of Pain

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The purpose of this study was to identify neural correlates of pain anticipation in people with non-specific low back pain (NSLBP) that correlated with pain-related distress and disability, thus providing evidence for mechanisms underlying pain behaviour in this population. Thirty NSLBP sufferers, with either high levels of pain behaviour (WS-H) or low levels (WS-L) based on Waddell Signs (WS), were scanned with functional Magnetic Resonance Imaging (fMRI) whilst a straight-leg raise (of the side deemed to cause moderate pain in the lower back) was performed. On each trial coloured stimuli were presented and used to indicate when the leg definitely would be raised (Green; 100% certainty), might be raised (Yellow; 50% certainty) or would definitely not be raised (Red; 100% certainty). In response to expected vs. unexpected pain the group difference in activation between WS-H and WS-L co-varied as a function of anxiety scores in right insula and pregenual anterior cingulate cortex and as a function of catastrophizing in prefrontal and parietal cortex and hippocampus. The results suggest NSLBP populations with the highest levels of pain-related distress are more likely to attend to and infer threat from innocuous cues, which may contribute to the maintenance of pain behaviour associated with some chronic pain states.Perspective: This article demonstrates a likely neural network for exacerbating pain anticipation in NSLBP contributing to high levels of pain behaviour in some people. This information could potentially help clinicians and patients to understand how anticipation of pain may contribute to patient pain and disability.

show abstract

Differences in Low Back Pain Behavior Are Reflected in the Cerebral Response to Tactile Stimulation of the Lower Back

Cited by 96 publications

References 24 publications

Tactile thresholds are preserved yet complex sensory function is impaired over the lumbar spine of chronic non-specific low back pain patients: a preliminary investigation

Tactile thresholds are preserved yet complex sensory function is impaired over the lumbar spine of chronic non-specific low back pain patients: a preliminary investigation

Effective Treatment of Chronic Low Back Pain in Humans Reverses Abnormal Brain Anatomy and Function

Brain Areas Involved in Anticipation of Clinically Relevant Pain in Low Back Pain Populations With High Levels of Pain Behavior

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