Researchers examine recurrence of low back pain

10/04/04

New $1.5 million study



James Thomas

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ATHENS, Ohio Eight out of 10 adults experience low back pain at some point in their lives, and while the nagging aches usually go away on their own, about half of those people will suffer another episode in the following year. A new Ohio University study will examine who is most at risk for recurrent back pain and what causes it.

A team led by James Thomas, assistant professor of physical therapy in the university's College of Health and Human Services, received a $1.55 million, four-year grant from the National Institute of Health to examine the cause and effect of changes in motor coordination in low back pain sufferers. After experiencing an initial episode of back pain, some individuals may restrict physical movements such as reaching and bending to avoid further discomfort. People who become "stuck" in maladaptive movement patterns may be at greater risk for pain and re-injury, however, when faced with physical challenges that require coordinated movement of their spines.

The study also will explore how psychological behavior impacts motor coordination to either delay or promote recovery from an episode of low back pain. The researchers will question whether an individual's level of kinesiophobia -- fear of movement and re-injury -- actually can impact patterns of physical activity.

"This investigation brings together promising ideas from the motor coordination and health psychology literatures to provide an innovative integration of the best predictors of recurrent low back pain," Thomas said. "Once we have identified the relationship between dysfunctional movement patterns and levels of kinesiophobia, our long-term goal is to provide treatment guidelines based on each patient's unique motor coordination profile and kinesiophobia score."

Back pain can be a big problem for many Americans, as recent reports suggest that 3.7 million people seek medical care each year for an acute episode of low back pain, according to the researchers. The pain can flare up again within the following year in as many as 50 percent of those cases, with 33 percent of sufferers reporting occasional or persistent pain and 20 percent reporting pain that limits physical activity. Between 7 and 10 percent develop a chronic pain disorder that may last for years. Medical expenses and work absenteeism due to back pain disability are estimated at $20 billion to $40 billion per year in the United States, according to the researchers.

To further examine the problem, the Ohio University-led research team will conduct two related studies. In the first phase, 44 participants who currently experience low back pain will perform a series of reaching exercises. Sensors placed on arm, leg, back and trunk muscles will track their movements, and the volunteers will fill out questionnaires designed to gauge their level of kinesiophobia. The research team will follow up with the participants for three months after the initial testing.

In phase two of the study, 96 participants who recently have recovered from a back pain injury will undergo four sets of similar testing exercises in the lab, and then will be monitored for an entire year. Both studies, conducted at laboratories in Athens and Columbus, Ohio, are expected to start in October.

The project builds on previous work by Thomas that developed the standardized reaching protocol used to detect changes in motor coordination in individuals with low back pain. The researchers also will draw on previous studies on fear avoidance, including those that have shown that people who have suffered from back pain fall into two categories: avoiders and confronters. Avoiders, who rate high on the scales of kinesiophobia, are prone to catastrophic thoughts and fear that their pain will grow worse with continued physical exercise. Confronters, who rate low on the scales of kinesiophobia, think they can work through the pain. According to co-investigator Christopher France, professor of psychology, the new Ohio University study will be the first to examine how fear avoidance may impact actual motor behavior, making a significant contribution to the understanding of low back pain.

The researchers hope that the study eventually will provide doctors with a tool for gauging which low back pain patients are at greatest risk of re-injury. Doctors could use the study findings to measure changes in muscle movement and determine if a patient will respond better to psychological or physical interventions.

"We're not trying to come up with the same cookie-cutter way to treat patients, but a way to allow individualized treatments to be developed," Thomas said.

Ohio University collaborators on the study also include Bruce Carlson, associate professor of psychology, and David Eland, an associate professor in the College of Osteopathic Medicine. Daniel Corcos of the University of Illinois at Chicago also will be involved in the project. In addition, the team will be hiring a postdoctoral fellow and two research physical therapists to assist with the study.

Source: Eurekalert & others

Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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