Implicit evaluations and physiological threat responses in people with persistent low back pain and fear of bending
Implicit evaluations and physiological threat responses in people with persistent low back pain and fear of bending
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DOI：
10.1016/j.sjpain.2017.09.012
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发表时间：
2017-10-01
影响因子：
1.6
通讯作者：
Lipp, Ottmar V.
中科院分区：
文献类型：
--
作者：
Caneiro, J. P.;O'Sullivan, Peter;Lipp, Ottmar V.
背景和目的：疼痛和保护行为取决于对身体危险的隐含评估。然而，目前对感知危险的评估依赖于自我报告，即个人意识到并愿意披露的信息。为了克服这一局限性，人们尝试调查患有持续性腰痛（PLBP）和疼痛相关恐惧的人对运动相关威胁图像的内隐评估。样本和刺激缺乏特异性限制了这些探索。这项研究调查了 PLBP 患者对通常被认为具有威胁性的任务图像的内隐评估和生理反应：弯腰和举重。我们假设，自我报告的对弯曲腰椎的恐惧（对弯曲的恐惧）的不同的人在内隐评估和生理反应上也会有所不同。 方法：本研究使用了 44 名 PLBP 患者（54% 女性）的方便样本，他们对自我报告的对弯曲的恐惧有所不同。参与者完成了一个图片观看范例，其中包括令人愉快、中性和不愉快的图像，以及人们弯曲和抬起腰椎（“圆背”）的图像，以评估生理反应（眨眼惊吓调节、皮肤电导）。他们还完成了内隐联想测试（IAT）和情感启动任务（APT）。两者都评估了（i）人们以弯曲腰椎姿势（“圆背”姿势）弯腰/举重或以直腰椎姿势（“直背”姿势）弯腰/举重的图像与（ii）感知威胁（安全与危险）之间的隐含关联。结果：“危险”和“圆背”弯腰/举重之间的隐性关联在所有参与者中都很明显（IAT） （0.5，CI [0.3；0.6]；p < 0.001）和 APT（24.2，CI [4.2；44.3]；p = 0.019）），与自我报告的对弯曲的恐惧无关（IAT（r = -0.24，95% CI [-0.5，0.04]，p = 0.117）和 APT（r = -0.00，95% CI [-0.3， 0.3]，p = 0.985))。自我报告的对弯腰的恐惧程度与眨眼惊吓 (F(3, 114) = 0.7, p = 0.548) 或对弯腰/举起图片的皮肤电导反应 (F(3, 126) = 0.4, p = 0.780) 无关。结论：与我们的预期相反，自我报告的对弯腰的恐惧与生理惊吓反应或隐含测量无关。患有 PLBP 的人作为一个群体（无论恐惧程度如何）表现出弓背弯曲/举起姿势的图像与危险之间的隐含关联，但并未对这些图像表现出升高的生理反应。这些结果有助于理解疼痛和运动恐惧之间的关系。 (C) 2017 年斯堪的纳维亚疼痛研究协会。由 Elsevier B.V. 出版。保留所有权利。
Background and aims: Pain and protective behaviour are dependent on implicit evaluations of danger to the body. However, current assessment of perceived danger relies on self-report, on information of which the person is aware and willing to disclose. To overcome this limitation, attempts have been made to investigate implicit evaluation of movement-related threatening images in people with persistent low back pain (PLBP) and pain-related fear. Lack of specificity of the sample and stimuli limited those explorations. This study investigated implicit evaluations and physiological responses to images of tasks commonly reported as threatening by people with PLBP: bending and lifting. We hypothesized that people who differ in self-reported fear of bending with a flexed lumbar spine (fear of bending) would also differ in implicit evaluations and physiological responses.Methods: This study used a convenience sample of 44 people (54% female) with PLBP, who differed in self-reported fear of bending. Participants completed a picture-viewing paradigm with pleasant, neutral and unpleasant images, and images of people bending and lifting with a flexed lumbar spine ('round-back') to assess physiological responses (eye-blink startle modulation, skin conductance). They also completed an implicit association test (IAT) and an affective priming task (APT). Both assessed implicit associations between (i) images of people bending/lifting with a flexed lumbar spine posture ('round-back' posture) or bending/lifting with a straight lumbar spine posture ('straight-back' posture), and (ii) perceived threat (safe vs. dangerous).Results: An implicit association between 'danger' and 'round-back' bending/lifting was evident in all participants (IAT (0.5, CI [0.3; 0.6]; p < 0.001) and APT (24.2, CI [4.2; 44.3]; p = 0.019)), and unrelated to self-reported fear of bending (IAT (r = -0.24, 95% CI [-0.5, 0.04], p = 0.117) and APT (r = -0.00, 95% CI [-0.3, 0.3], p = 0.985)). Levels of self-reported fear of bending were not associated with eye-blink startle (F(3, 114) = 0.7, p = 0.548) or skin conductance responses (F(3, 126) = 0.4, p = 0.780) to pictures of bending/lifting.Conclusions: Contrary to our expectation, self-reported fear of bending was not related to physiological startle response or implicit measures. People with PLBP as a group (irrespective of fear levels) showed an implicit association between images of a round-back bending/lifting posture and danger, but did not display elevated physiological responses to these images. These results provide insight to the understanding of the relationship between pain and fear of movement. (C) 2017 Scandinavian Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.