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Fear-avoidance beliefs or insomnia relate to pain intensity with chronic lower back pain.

Fear avoidance

Goal of the Study?

In this open-access paper, published in Frontiers in Psychiatry by Arnold Y.L. Wong et al.1, these group of researchers were curious about the deep muscles of the lower back and sleep and how this relates to pain intensity of chronic lower back pain.


Why are they doing this study?

Back pain is a chronic planetary problem. Also, sleep deficiencies are likely just as common. What has been looked at as a cause of lower back pain is the atrophy of a particular number of deep core muscles called the lumbar multifidus. These are muscles thought of as essential stabilizers to the lumbar spine. Weakness or atrophy of these is believed to contribute to the chronicity of ongoing lower back pain. These researchers got to work collecting data to get a handle on the association of sleep and the possible relationship between the multifidus size and shape with chronic lower back pain.


What was done?

Volunteers (with and without chronic lower back pain) were recruited to participate in this research study. All volunteers provided a measure of the level of pain they were in (11-point numeric scale), plus they filled out a Roland-Morris disability questionnaire. In addition, they also completed questionnaires for depression, anxiety, pain catastrophizing, fear-avoidance and degree of insomnia. Furthermore, resting and contracted lower back muscles were measured for thickness. Each of these variables was analyzed with each other using univariate and multivariate analyses.


What did they find?

Those with chronic lower back pain demonstrated significantly higher low back pain intensity, disability, fear-avoidance behaviour, pain catastrophizing and insomnia scores. Interestingly, lumbar multifidus muscle morphology did not present to be any less in the chronic low back pain group.


Why do these findings matter?

Learning about the contributors of chronic lower back pain patients can be helpful in sub classifying treatment targets for those that suffer.  Clinicians have a monumental task to screen for maladaptive sleep and fear behaviours and work to match associated treatments.


At Dynamic Disc Designs, we have worked to create anatomical human models to help clinicians explain to low back patients the mechanistic causes and associated factors. Building trust between doctors and patients through clinical confidence is at the heart of what we do. When it is time to educate patients about biological or inflammatory contributors to chronic lower back pain, our anatomical spine models can be a clinical asset.

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  1. […] argue that it leads to over-medicalization and unneeded surgeries. Some others believe it may cause catastrophizing and instill fear in […]

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