Abstract
Aim of investigation: Fear of movement (avoidance) has been implicated as an obstacle to recovery in back pain. We have argued that the concept of fear-avoidance needs clarifying, to identify sub-groups of avoiders. This study explored the patterns of activation during exposure to previously reported feared movement in patients with chronic back pain. The aim was to explore activation in areas associated with catasrophizing.
Method: 13 chronic back pain patients, who scored above a cut-point on the Tampa Scale of Kinesiophobia selected photographic images representing 5 movements they feared most and five movements they hadno concerns with carrying out. Stimuli were therefore individually selected. Two other sets of stimuli included generally threatening images, and neutral images. These four stimulus types were presented in blocks in a fMRI scanner in random order. Ratings of pain were taken after the presentation of each block.
Results: Analysis of contrasts-of-interest showed that the highly feared movements caused selective activation in areas related to preparation for action, and attentional modulation. The canonical ‘pain matrix’, and areas associated with catasrophizing was not activated.
Conclusion: The activation seen may indicate the involvement of heightened attentional processing and/or response processes (bracing and protecting) when viewing pictures of feared movements. The absence of activity in affective pain areas in the contrast analysis will be discussed in reference to theoretical developments and methodological limitations.
Correspondence should be addressed to SBPR at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE, England.
