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Directed attention alters the temporal activation patterns of back extensors during trunk flexion–extension in individuals with chronic low back pain

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Abstract

In chronic low back pain patients (CLBP), neuromuscular and pain intensity have been identified as contributing factors in the disability of the individual. However, it is unclear whether pain intensity influences neuromuscular activation and if directed attention mediates this relationship. Thus, the purpose of this study was to determine the effect of directed attention in individuals with different pain intensities on back extensor activation profiles. Fifty-four CLBP patients were separated into either high- or low-pain groups. Surface electromyograms were recorded from back muscles while the subjects performed a trunk flexion motion for four different attention conditions. Pattern recognition and repeated measures ANOVAs were used to examine the effect of sex, attention and pain intensity on temporal muscle activation patterns. The results showed that there was a significant sex × attention × pain interaction. The largest changes in muscle timing were observed in the low-pain group when their attention was focused on their pain, but the pattern of muscle activation differed between sexes. For males, a rapid decline in activation at mid-extension occurred, whereas females showed delayed activation at the beginning of extension. Overall, this study demonstrated that directed attention on pain had an effect on trunk muscle temporal recruitment, and that this relationship differed between sexes and pain groups. This suggests that sex-specific mechanisms may alter the neuromuscular control of the spine in CLBP patients for different pain levels.

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References

  1. Astephen JL, Deluzio KJ, Caldwell GE, Dunbar MJ, Hubley-Kozey CL (2008) Gait and neuromuscular pattern changes are associated with differences in knee osteoarthritis severity levels. J Biomech 41:868–876

    Article  PubMed  Google Scholar 

  2. Bingefors K, Isacson D (2004) Epidemiology, co-morbidity, and impact on health-related quality of life of self-reported headache and musculoskeletal pain—a gender perspective. Eur J Pain 8:435–450

    Article  PubMed  Google Scholar 

  3. Burns JW (2006) The role of attentional strategies in moderating links between acute pain induction and subsequent psychological stress: evidence for symptom-specific reactivity among patients with chronic pain versus healthy nonpatients. Emotion 6:180–192

    Article  PubMed  Google Scholar 

  4. Bushnell MC, Villemure C, Duncan GH (2004) Psychophysical and neurophysiological studies of pain modulation by attention. In: Price DD, Bushnell MC (eds) Psychological methods of pain control: basic science and clinical perspectives. IASP Press, Seattle, pp 99–116

    Google Scholar 

  5. Butler HL, Newell R, Hubley-Kozey CL, Kozey JW (2009) The interpretation of abdominal wall muscle recruitment strategies change when the electrocardiogram (ECG) is removed from the electromyogram (EMG). J Electromyogr Kinesiol 19:e102–e113

    Article  PubMed  Google Scholar 

  6. Callaghan JP, Dunk NM (2002) Examination of the flexion relaxation phenomenon in erector spinae muscles during short duration slumped sitting. Clin Biomech 17:353–360

    Article  Google Scholar 

  7. Corbeil P, Blouin JS, Teasdale N (2004) Effects of intensity and locus of painful stimulation on postural stability. Pain 108:43–50

    Article  PubMed  Google Scholar 

  8. Dagenais S, Caro J, Haldeman S (2008) A systematic review of low back pain cost of illness studies in the United States and internationally. Spine J 8:8–20

    Article  PubMed  Google Scholar 

  9. Eccleston C (1995) Chronic pain and distraction: an experimental investigation into the role of sustained and shifting attention in the processing of chronic persistent pain. Behav Res Ther 33:391–405

    Article  CAS  PubMed  Google Scholar 

  10. Falla D, Arendt-Nielsen L, Farina D (2008) Gender-specific adaptations of upper trapezius muscle activity to acute nociceptive stimulation. Pain 138:217–225

    Article  PubMed  Google Scholar 

  11. Falla D, Farina D (2008) Neuromuscular adaptation in experimental and clinical neck pain. J Electromyogr Kinesiol 18:255–261

    Article  PubMed  Google Scholar 

  12. Fillingim RB, King CD, Ribeiro-Dasilva MC, Rahim-Williams B, Riley JL 3rd (2009) Sex, gender, and pain: a review of recent clinical and experimental findings. J Pain 10:447–485

    Article  PubMed  Google Scholar 

  13. Freburger JK, Holmes GM, Agans RP, Jackman AM, Darter JD, Wallace AS, Castel LD, Kalsbeek WD, Carey TS (2009) The rising prevalence of chronic low back pain. Arch Intern Med 169:251–258

    Article  PubMed  Google Scholar 

  14. Gazerani P, Wang K, Cairns BE, Svensson P, Arendt-Nielsen L (2006) Effects of subcutaneous administration of glutamate on pain, sensitization and vasomotor responses in healthy men and women. Pain 124:338–348

    Article  CAS  PubMed  Google Scholar 

  15. Ge HY, Madeleine P, Arendt-Nielsen L (2004) Sex differences in temporal characteristics of descending inhibitory control: an evaluation using repeated bilateral experimental induction of muscle pain. Pain 110:72–78

    Article  PubMed  Google Scholar 

  16. Ge HY, Arendt-Nielsen L, Farina D, Madeleine P (2005) Gender-specific differences in electromyographic changes and perceived pain induced by experimental muscle pain during sustained contractions of the upper trapezius muscle. Muscle Nerve 32:726–733

    Article  PubMed  Google Scholar 

  17. Ge HY, Madeleine P, Cairns BE, Arendt-Nielsen L (2006) Hypoalgesia in the referred pain areas after bilateral injections of hypertonic saline into the trapezius muscles of men and women: a potential experimental model of gender-specific differences. Clin J Pain 22:37–44

    Article  PubMed  Google Scholar 

  18. George SZ, Wittmer VT, Fillingim RB, Robinson ME (2007) Sex and pain-related psychological variables are associated with thermal pain sensitivity for patients with chronic low back pain. J Pain 8:2–10

    Article  PubMed  Google Scholar 

  19. Goubert L, Crombez G, Eccleston C, Devulder J (2004) Distraction from chronic pain during a pain-inducing activity is associated with greater post-activity pain. Pain 110:220–227

    Article  PubMed  Google Scholar 

  20. Greenspan JD, Craft RM, LeResche L, Arendt-Nielsen L, Berkley KJ, Fillingim RB, Gold MS, Holdcroft A, Lautenbacher S, Mayer EA, Mogil JS, Murphy AZ, Traub RJ, Consensus Working Group of the Sex, Gender, Pain SIG of the IASP (2007) Studying sex and gender differences in pain and analgesia: a consensus report. Pain 132(Suppl 1):S26–S45

    Article  PubMed  Google Scholar 

  21. Hansson GA, Asterland P, Holmer NG, Skerfving S (2001) Validity and reliability of triaxial accelerometers for inclinometry in posture analysis. Med Biol Eng Comput 39:405–413

    Article  CAS  PubMed  Google Scholar 

  22. Hodges PW, Moseley GL, Gabrielsson A, Gandevia SC (2003) Experimental muscle pain changes feedforward postural responses of the trunk muscles. Exp Brain Res 151:262–271

    Article  PubMed  Google Scholar 

  23. Hodges PW, Ervilha UF, Graven-Nielsen T (2008) Changes in motor unit firing rate in synergist muscles cannot explain the maintenance of force during constant force painful contractions. J Pain 9:1169–1174

    Article  PubMed  Google Scholar 

  24. Hubley-Kozey CL, Vezina MJ (2002) Differentiating temporal electromyographic waveforms between those with chronic low back pain and healthy controls. Clin Biomech 17:621–629

    Article  CAS  Google Scholar 

  25. Hubley-Kozey CL, Deluzio KJ, Landry SC, McNutt JS, Stanish WD (2006) Neuromuscular alterations during walking in persons with moderate knee osteoarthritis. J Electromyogr Kinesiol 16:365–378

    Article  CAS  PubMed  Google Scholar 

  26. Hurley RW, Adams MC (2008) Sex, gender, and pain: an overview of a complex field. Anesth Analg 107:309–317

    Article  PubMed  Google Scholar 

  27. Jackson JE (2003) A user’s guide to principal components. Wiley, Hoboken

    Google Scholar 

  28. Kewman DG, Vaishampayan N, Zald D, Han B (1991) Cognitive impairment in musculoskeletal pain patients. Int J Psychiatry Med 21:253–262

    Article  CAS  PubMed  Google Scholar 

  29. Kori SH, Miller RP, Todd DD (1990) Kinisophobia: a new view of chronic pain behavior. Pain Manage 3:35–43

    Google Scholar 

  30. Kovacs FM, Abraira V, Zamora J, Fernandez C, Spanish Back Pain Research Network (2005) The transition from acute to subacute and chronic low back pain: a study based on determinants of quality of life and prediction of chronic disability. Spine 30:1786–1792

    Article  PubMed  Google Scholar 

  31. Lamoth CJ, Stins JF, Pont M, Kerckhoff F, Beek PJ (2008) Effects of attention on the control of locomotion in individuals with chronic low back pain. J Neuroeng Rehabil 5:13

    Article  PubMed  Google Scholar 

  32. Lariviere C, Arsenault AB, Gravel D, Gagnon D, Loisel P (2001) Median frequency of the electromyographic signal: effect of time-window location on brief step contractions. J Electromyogr Kinesiol 11:65–71

    Article  CAS  PubMed  Google Scholar 

  33. Lotters F, Burdorf A (2006) Prognostic factors for duration of sickness absence due to musculoskeletal disorders. Clin J Pain 22:212–221

    Article  PubMed  Google Scholar 

  34. Marras WS, Davis KG, Heaney CA, Maronitis AB, Allread WG (2000) The influence of psychosocial stress, gender, and personality on mechanical loading of the lumbar spine. Spine 25:3045–3054

    Article  CAS  PubMed  Google Scholar 

  35. Moseley GL, Nicholas MK, Hodges PW (2004) Pain differs from non-painful attention-demanding or stressful tasks in its effect on postural control patterns of trunk muscles. Exp Brain Res 156:64–71

    Article  PubMed  Google Scholar 

  36. Moseley GL, Hodges PW (2006) Reduced variability of postural strategy prevents normalization of motor changes induced by back pain: a risk factor for chronic trouble? Behav Neurosci 120:474–476

    Article  PubMed  Google Scholar 

  37. Nouwen A, Cloutier C, Kappas A, Warbrick T, Sheffield D (2006) Effects of focusing and distraction on cold pressor-induced pain in chronic back pain patients and control subjects. J Pain 7:62–71

    Article  PubMed  Google Scholar 

  38. Ostelo RW, Deyo RA, Stratford P, Waddell G, Croft P, Von Korff M, Bouter LM, de Vet HC (2008) Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change. Spine 33:90–94

    Article  PubMed  Google Scholar 

  39. O’Sullivan P, Dankaerts W, Burnett A, Chen D, Booth R, Carlsen C, Schultz A (2006) Evaluation of the flexion relaxation phenomenon of the trunk muscles in sitting. Spine 31:2009–2016

    Article  PubMed  Google Scholar 

  40. Panjabi MM (2006) A hypothesis of chronic back pain: ligament subfailure injuries lead to muscle control dysfunction. Eur Spine J 15:668–676

    Article  PubMed  Google Scholar 

  41. Passatore M, Roatta S (2006) Influence of sympathetic nervous system on sensorimotor function: whiplash associated disorders (WAD) as a model. Eur J Appl Physiol 98:423–449

    Article  PubMed  Google Scholar 

  42. Quiton RL, Greenspan JD (2007) Sex differences in endogenous pain modulation by distracting and painful conditioning stimulation. Pain 132(Suppl 1):S134–S149

    Article  PubMed  Google Scholar 

  43. Roland M, Morris R (1983) A study of the natural history of back pain. Part I: development of a reliable and sensitive measure of disability in low-back pain. Spine 8:141–144

    Article  CAS  PubMed  Google Scholar 

  44. Rollman GB, Lautenbacher S (2001) Sex differences in musculoskeletal pain. Clin J Pain 17:20–24

    Article  CAS  PubMed  Google Scholar 

  45. Schneider S, Randoll D, Buchner M (2006) Why do women have back pain more than men? A representative prevalence study in the federal republic of Germany. Clin J Pain 22:738–747

    Article  PubMed  Google Scholar 

  46. Seminowicz DA, Davis KD (2007) A re-examination of pain-cognition interactions: implications for neuroimaging. Pain 130:8–13. doi:10.1016/j.pain.2007.03.036

    Article  PubMed  Google Scholar 

  47. Solomonow M (2009) Ligaments: a source of musculoskeletal disorders. J Bodyw Mov Ther 13:136–154

    Article  PubMed  Google Scholar 

  48. Spitzer WO, LeBlanc F, Dupuis M (1987) A scientific approach to the assessment and management of activity-related spinal disorders: a monograph for clinicians. Spine 12(Supp 75):S3–S59

    Google Scholar 

  49. Suissa S (2003) Risk factors of poor prognosis after whiplash injury. Pain Res Manage 8:69–75

    Google Scholar 

  50. Sullivan MJ, Bishop S, Pivik J (1995) The pain catastrophizing scale: development and validation. Psychol Assess 7:524–532

    Google Scholar 

  51. Sullivan MJ, Thibault P, Savard A, Catchlove R, Kozey J, Stanish WD (2006) The influence of communication goals and physical demands on different dimensions of pain behavior. Pain 125:270–277

    Article  PubMed  Google Scholar 

  52. Sullivan MJ (2008) Toward a biopsychomotor conceptualization of pain: implications for research and intervention. Clin J Pain 24:281–290

    Article  PubMed  Google Scholar 

  53. Thomas E, Silman AJ, Croft PR, Papageorgiou AC, Jayson MI, Macfarlane GJ (1999) Predicting who develops chronic low back pain in primary care: a prospective study. BMJ 318:1662–1667

    CAS  PubMed  Google Scholar 

  54. Van Dieen JH (2007) Low-back pain and motor behavior: contingent adaptations, a common goal. Sixth interdisciplinary world congress on low back and pelvic pain, Barcelona, pp 3–14

  55. van Dieen JH, Cholewicki J, Radebold A (2003) Trunk muscle recruitment patterns in patients with low back pain enhance the stability of the lumbar spine. Spine 28:834–841

    Article  PubMed  Google Scholar 

  56. Von Korff M, Miglioretti DL (2005) A prognostic approach to defining chronic pain. Pain 117:304–313

    Article  Google Scholar 

  57. Waddell G, Somerville D, Henderson I, Newton M (1992) Objective clinical evaluation of physical impairment in chronic low back pain. Spine 17:617–628

    Article  CAS  PubMed  Google Scholar 

  58. Waersted M (2000) Human muscle activity related to non-biomechanical factors in the workplace. Eur J Appl Physiol 83:151–158

    Article  CAS  PubMed  Google Scholar 

  59. Walker J (1971) Pain and distraction in athletes and non-athletes. Percept Mot Skills 33:1187–1190

    CAS  PubMed  Google Scholar 

  60. Winter DA (2005) Biomechanics and motor control of human movement. Wiley, Hoboken

    Google Scholar 

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Acknowledgments

We wish to thank the Quebec Rehabilitation Research Network and the Occupational Health and Safety Research Institute Robert-Sauvé for their financial support.

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Authors and Affiliations

  1. Department of Psychology, McGill University, 1205 Dr. Penfield, Montreal, QC, Canada

    Heather L. Butler & Michael J. L. Sullivan

  2. Occupational Health and Safety Research Institute Robert-Sauvé, Montreal, QC, Canada

    Christian Lariviere

  3. School of Physiotherapy, Dalhousie University, Halifax, NS, Canada

    Cheryl L. Hubley-Kozey

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  1. Heather L. Butler
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  2. Christian Lariviere
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  3. Cheryl L. Hubley-Kozey
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  4. Michael J. L. Sullivan
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Correspondence to Heather L. Butler.

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Butler, H.L., Lariviere, C., Hubley-Kozey, C.L. et al. Directed attention alters the temporal activation patterns of back extensors during trunk flexion–extension in individuals with chronic low back pain. Eur Spine J 19, 1508–1516 (2010). https://doi.org/10.1007/s00586-010-1403-0

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  • DOI: https://doi.org/10.1007/s00586-010-1403-0

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