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

Barke, Antoniaa,*; Baudewig, Jürgenb; Schmidt-Samoa, Carstenc; Dechent, Peterc; Kröner-Herwig, Birgita

doi: 10.1016/j.pain.2011.11.012

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.

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.

aGeorg-Elias-Müller-Institute of Psychology, Department of Clinical Psychology and Psychotherapy, University of Göttingen, Göttingen, Germany

bDahlem Institute for Neuroimaging of Emotion (D.I.N.E.), Freie Universität Berlin, Berlin, Germany

cDepartment of Cognitive Neurology, University Medicine 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.


Submitted March 8, 2011; revised September 8, 2011; accepted November 8, 2011.

© 2012 Lippincott Williams & Wilkins, Inc.
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