Neuromuscular adaptations predict functional disability independently of clinical pain and psychological factors in patients with chronic non-specific low back pain |
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| Institution: | 1. Injury Prevention Centre, School of Public Health, University of Alberta, Canada;2. Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Belgium;3. Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium;4. Pain in Motion Research Group (www.paininmotion.be), Belgium;5. Amsterdam Rehabilitation Research Centre Reade, Amsterdam, The Netherlands;6. MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, The Netherlands;7. VU University Medical Center, Department of Rheumatology, Amsterdam, The Netherlands;8. VU University Medical Center, Department of Rehabilitation Medicine, Amsterdam, The Netherlands;9. Skeletal Biology & Engineering Research Center, Faculty of Medicine, KU Leuven, Belgium;1. Department of Physical Therapy, Central Michigan University, United States;2. The BioCAT, Inc., Santa Clarita, CA, United States |
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| Abstract: | Patients with chronic low back pain exhibit characteristics such as clinical pain, psychological symptoms and neuromuscular adaptations. The purpose of this study was to determine the independent contribution of clinical pain, psychological factors and neuromuscular adaptations to disability in patients with chronic low back pain. Clinical pain intensity, pain catastrophizing, fear-avoidance beliefs, anxiety, neuromuscular adaptations to chronic pain and neuromuscular responses to experimental pain were assessed in 52 patients with chronic low back pain. Lumbar muscle electromyographic activity was assessed during a flexion–extension task (flexion relaxation phenomenon) to assess both chronic neuromuscular adaptations and neuromuscular responses to experimental pain during the task. Multiple regressions showed that independent predictors of disability included neuromuscular adaptations to chronic pain (β = 0.25, p = 0.006, sr2 = 0.06), neuromuscular responses to experimental pain (β = −0.24, p = 0.011, sr2 = 0.05), clinical pain intensity (β = 0.28, p = 0.002, sr2 = 0.08) and psychological factors (β = 0.58, p < 0.001, sr2 = 0.32). Together, these predictors accounted for 65% of variance in disability (R2 = 0.65 p < 0.001). The current investigation revealed that neuromuscular adaptations are independent from clinical pain intensity and psychological factors, and contribute to inter-individual differences in patients’ disability. This suggests that disability, in chronic low back pain patients, is determined by a combination of factors, including clinical pain, psychological factors and neuromuscular adaptations. |
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| Keywords: | Chronic low back pain Fear-avoidance model Functional disability Neuromuscular adaptations Experimental pain |
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