Participants with mildly-disabling chronic neck pain perform differently during explicit compared to implicit motor learning of a reaching task

Abstract

Chronic musculoskeletal (CMSK) pain associated with musculoskeletal disorders like low back pain or neck pain are the leading causes of disability. While CMSK pain has the potential to negatively influence motor learning, there is limited research to understand the impact of CMSK on motor learning. In order to examine differences in motor learning between individuals with and without CMSK we modified a serial reaction time task to assess motor learning of a repetitive reaching task. The paradigm was used to assess both explicit and implicit motor learning. In a cross-sectional study design, seventeen participants with chronic neck pain (CNP) (5 males) and 21 controls (8 males) were recruited. In addition, physical, cognitive, sensorimotor, disability and pain assessments were used to examine differences between individuals with and without CNP. All participants with CNP were categorized as having mild disability. There was no difference in cognitive assessments and minimal differences in physical measures between groups. Examining motor learning, groups with and without CNP demonstrated similar outcomes in both explicit and implicit motor learning. There was one notable performance difference between groups in the reaching task, the group with CNP demonstrated slower reaching movements outward and inward during blocks without explicit information. This may suggest a cautious approach to movement with reduced explicit information. Findings from this study provide insight on motor learning in individuals with mildly-disabling CNP, further research is necessary to examine how instruction can impact peak performance in people with CMSK pain.

Exploring pain interference with motor skill learning in humans: A systematic review

“…The three studies exploring the impact of; SCNP on a visuomotor learning task, [ 46 ] and OA of the thumb [ 42 ] and CTTH [ 43 ] on repeated ballistic movement tasks were judged to be at ‘serious risk of bias’ and therefore omitted from the analysis. The remaining two studies [ 44 , 45 ] were judged to have ‘moderate risk of bias’ and their findings are discussed below. No studies explored the impact of clinical pain on ecological learning.…”

“…Motor sequence learning. One study [ 44 ] explored the impact of CNP on learning during a motor sequence learning task involving reaching for targets on a screen. In addition, the study’s aims stated the authors wished to explore the different impact of clinical pain on implicit and explicit learning paradigms.…”

“…Brown et al [ 44 ] reported clinical pain impeded ‘time to target’ during all learning blocks in implicit motor learning but not explicit learning. The authors hypothesise that participants with chronic pain may approach tasks with increased caution in the absence of explicit information pertaining to the task.…”

“…Five clinical pain studies [42][43][44][45][46] were included in this review. The three studies exploring the impact of; SCNP on a visuomotor learning task, [46] and OA of the thumb [42] and CTTH [43] on repeated ballistic movement tasks were judged to be at 'serious risk of bias' and therefore omitted from the analysis.…”

“…The two clinical pain studies [44,45] included in this review investigated the impact of clinical pain on task performance measures only. Both studies included participants with chronic pain PLOS ONE only, defined as those experiencing symptoms for more than 3 months.…”