Chapter

The Psychophysiology of Chronic Back Pain Patients

Kati Thieme and Richard H. Gracely

in From Acute to Chronic Back Pain

Published on behalf of Oxford University Press

Published in print January 2012 | ISBN: 9780199558902
Published online November 2012 | e-ISBN: 9780191753343 | DOI: http://dx.doi.org/10.1093/med/9780199558902.003.0040
The Psychophysiology of Chronic Back Pain Patients

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Psychophysiological studies have disproved the biomechanical model of CBP that proposed that pain may result from physically demonstrable CBP disease and from poor posture caused by reflex spasm connected with high muscle tension. Studies that tested static and dynamic postures found only 29% of the CBP patients with significantly higher sEMG-responses during dynamic postures in comparison with pain-free controls. Only one study could report a connection between higher sEMG responses and pain perception.

Studies of anticipatory postural adjustments of trunk-stabilizing muscles showed that postural changes are connected with expectations that lead to an earlier centrally mediated activation of abdominal muscle activity caused by fear of pain and movement.

In contrast to the myogenic model, psychophysiological studies showed an important influence of stress on the aetiopathogenesis of CBP. Classical and operant conditioning as well as cognitions are relevant factors that play an important role in stress at work and in the partnership. According to the symptom-specific response pattern, increased muscle tension has also been proposed to be responsible for maintenance of CBP. However, only 30% of psychophysiological studies could confirm the assumption of higher muscle tension in CBP. Personally important situations provoke a symptom-specific psychophysiological response. The results suggest that social and emotional factors at work exert a much greater influence on maintenance of CBP symptoms than the level of work intensity.

Studies that reported higher SCL, HR or BP instead of higher EMG suggest psychophysiological heterogeneity. Higher SCL suggests an increased arousal response influenced by anger, fear, and comorbidity. A further individual-specific stress responses can be related to higher BP responses that propose an interaction between cardiovascular and pain system. An inverse relationship between BP and pain based on diminished baroreceptor sensitivity in CBP patients is assumed as a further psychophysiological response pattern besides sudomotor (SCL) and muscular response pattern.

The heterogeneity of the psychophysiological studies with CBP patients is determined by different groups of characteristics. physical characteristics such as diagnosis, association, and non-association between physical changes and pain allow the definition of physical subgroups. Varying levels of muscle activity and psychophysiological response pattern may similarly contribute to the determination of psychophysiological subgroups. The role of personal relevant stressors, comorbidity, and close relationships in learned pain behaviour are consistent with previously described psychosocial subgroups (Turk et al. 1996).

Chapter.  19403 words.  Illustrated.

Subjects: Neuroscience ; Pain Medicine

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