CHROniC LOW BACk PAin
It is also possible that the observed
degeneration within the DLPFC may
contribute directly to greater catastrophic
interpretation of pain. The DLPFC
seems to be important in emotional
disengagement from pain
25,41
and there is
evidence that DLPFC activity is negatively
correlated with catastrophic thinking
about pain.
43
When CLBP patients
and healthy controls are exposed to a
stimulus to induce the same intensity
of pain, the unpleasantness associated
with this same intensity is significantly
greater in patients, most notably at high
intensities of pain.
23
CLBP is frequently
associated with depressive symptoms
[30]
and distress/depressive mood is cited
as an important psychological factor
in the transition from acute to chronic
LBP.
38
There is significant overlap in the
neural circuitries of the brain in both
depression and CLBP,
19
notably DLPFC
degeneration seems to be a feature of
both conditions.
2 42,19, 37
Finally, the reorganisation
11,24
and
degeneration
42
evident in the primary
somatosensory cortex (S1) of CLBP
patients may represent a disruption in
the central representation of the back,
potentially producing a distortion in
body perception. There is growing data
that CLBP patients demonstrate clinical
findings consistent with a distortion of Benedict M Wand is Associate Professor at the School of Health
body image. Patients exhibit deficits in Sciences, The University of Notre Dame Australia, Fremantle,
proprioception
16,7,36
have poorer tactile W Australia
acuity than healthy controls,
35,22,48
are
impaired at recognising letters that are Neil E O’Connell is Lecturer in Physiotherapy at the Centre for Research
drawn on their back
48
and find it difficult in Rehabilitation, School of Health Sciences and Social Care, Brunel
to delineate the outline of their back, University, Uxbridge, Middlesex, UK
consistently representing the back to be
smaller than it really is.
35
Furthermore, it G Lorimer Moseley is an NHMRC Senior Research Fellow at the Prince
is possible that the varied alterations in of Wales Medical Research Institute and University of New South Wales,
muscle recruitment patterns observed in Sydney, NSW, Australia
CLBP patients
21
may be a manifestation
of poor awareness and perception of
the lumbar spine, or the result of the when body perception is disturbed. approaches that attempt to restore
anticipation of pain,
31
an idea supported by Harris
20
suggests that altered cortical integration of somatosensory and motor
the close association between tactile acuity representation of somatic input may processing within the brain appear to be
and performance on motor control tests.
22
falsely signal incongruence between successful in managing other chronic pain
motor intention and actual movement. problems such as complex regional pain
The role of distorted body perception in If there is conflict between motor output syndrome
32,33,34
and phantom limb pain.
34,12
long standing pain problems has received and sensory feedback, it is hypothesised
considerable attention recently.
26,45,28
It that pain is produced as a warning signal The data on brain dysfunction is
has been proposed that pain may be to alert the individual to abnormalities cross-sectional and as such no firm
generated within the motor control system within information processing.
29
Treatment conclusions may be drawn on whether
The Backcare Journal 9
backcare Winter 2009/10.indd 9 8/1/10 11:18:48
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