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Introduction
People move differently in the presence of (or in anticipation of) pain. Changes in motor control may play an important role in musculoskeletal pain. In our laboratory, we use a cross-disciplinary approach that combines neuroscience and movement biomechanics to provide new insights into the role of potential interactions between movement behavior, psychological factors and supraspinal mechanisms in the development and maintenance of persistent low back pain.
Additional affiliations
January 2012 - present
Publications
Publications (67)
Methods 20 healthy controls (HC, 8 females, mean age = 32.1, SD = 10.78) and 20 cLBP patients (13 females, mean age = 38.65, SD = 13.01) participated in this fMRI study. To assess the level of FOM, all cLBP patients completed the Tampa Scale of Kinesiophobia (TSK) questionnaire. During fMRI, participants were asked to carefully observe video clips...
Motor control, which relies on constant communication between motor and sensory systems, is crucial for spine
posture, stability and movement. Adaptions of motor control occur in low back pain (LBP) while different motor
adaption strategies exist across individuals, probably to reduce LBP and risk of injury. However, in some individuals
with LBP, a...
There is a long-held belief that physical activities such as lifting with a flexed spine is generally harmful for the back and can cause low back pain (LBP), potentially reinforcing fear avoidance beliefs underlying pain-related fear. In chronic LBP patients, pain-related fear has been shown to be associated with reduced lumbar range of motion duri...
Fear-avoidance beliefs, particularly the fear of lifting with a flexed spine, are associated with reduced spinal motion during object lifting. Low back pain patients thereby also showed potentially clinically relevant changes in the spatial distribution of back muscle activity, but it remains unknown whether such associations are also present in pa...
Musculoskeletal models have the potential to improve diagnosis and optimize clinical treatment by predicting accurate outcomes on an individual basis. However, the subject-specific modeling of spinal alignment is often strongly simplified or is based on radiographic assessments, exposing subjects to unnecessary radiation.
We therefore developed and...
Persistent pain alters brain-body representations, highlighting their potential pathological significance. In chronic low back pain (LBP), sparse evidence points towards a shift of the cortical representation of sensory afferents of the back. However, systematic investigations of the cortical representation of tactile and proprioceptive paraspinal...
The objective of this study was to develop an MR-safe stimulation device (pneumatic vibration device, pneuVID) that can apply vibrotactile stimulation to different thoracolumbar segments and to characterize stimulation parameters such as the amplitude and its stability for two relevant frequencies (20Hz/80Hz). This is the first apparatus specifical...
p>The objective of this study was to develop an MR-safe stimulation device (pneumatic vibration device, pneuVID) that can apply vibrotactile stimulation to different thoracolumbar segments and to characterize stimulation parameters such as the amplitude and its stability for two relevant frequencies (20Hz/80Hz). This is the first apparatus specific...
Lifting up objects from the floor has been identified as a risk factor for low back pain, whereby a flexed spine during lifting is often associated with producing higher loads in the lumbar spine. Even though recent biomechanical studies challenge these assumptions, conclusive evidence is still lacking. This study therefore aimed at comparing lumba...
Fear-avoidance beliefs, particularly the fear of lifting an object with a flexed spine, were shown to be associated with reduced spinal motion during object lifting in both individuals with and without low back pain (LBP). LBP patients thereby also showed potentially clinically relevant changes in the spatial distribution of back muscle activity, b...
To test potential specific and sustained effects of spinal manipulation therapy (SMT) on lumbar proprioceptive function
Lifting up objects from the floor has been identified as a risk factor for low back pain, whereby a flexed spine during lifting is often associated with producing higher loads in the lumbar spine. Even though recent biomechanical studies challenge these assumptions, conclusive evidence is still lacking. This study therefore aimed at comparing lumba...
Persistent low back pain (LBP) is a major health issue, and its treatment remains challenging due to a lack of pathophysiological understanding. A better understanding of LBP pathophysiology has been recognized as a research priority, however research on contributing mechanisms to LBP is often limited by siloed research within different disciplines...
The objective of this study was to determine the response of the lumbar spinal motor control in different gravitational conditions. This was accomplished by measuring indicators of lumbar motor control, specifically lumbar spinal stiffness, activity of lumbar extensor and flexor muscles and lumbar curvature, in hypergravity and microgravity during...
Non-specific chronic low back pain (NSCLBP) is a major health problem, affecting about one fifth of the population worldwide. To avoid further pain or injury, patients with NSCLBP seem to adopt a stiffer movement pattern during everyday living activities. However, it remains unknown how NSCLBP affects the lumbar lordosis angle (LLA) during repetiti...
Non-specific chronic low back pain (NSCLBP) is a major health problem, affecting about one fifth of the population worldwide. To avoid further pain or injury, patients with NSCLBP seem to adopt a stiffer movement pattern during everyday living activities. However, it remains unknown how NSCLBP affects the lumbar lordosis angle (LLA) during repetiti...
Background and aims
“Lifting an object with a round back is dangerous!” This is a widespread belief among the general public, which might influence an individual’s lifting technique. We therefore aimed at investigating the relationship between the perceived threat value of lifting with a round back and lumbar spine motion during repetitive lifting...
Background
Quantification of dentin hypersensitivity (DH) is challenging and requires standardized, graded stimulation by natural‐like stimuli.
Objective
The present study aimed at identifying DH subjects and longitudinally monitoring their pain thresholds by cold air quantitative sensory testing (QST).
Methods
Subject recruitment started with an...
Fear of pain demonstrates significant prognostic value regarding the development of persistent musculoskeletal pain and disability. Its assessment often relies on self-report measures of pain-related fear by a variety of questionnaires. However, based either on “fear of movement/(re)injury/kinesiophobia”, “fear avoidance beliefs” or “pain anxiety”,...
INTRODUCTION:
The purpose of this study was to analyze posterior-to-anterior spinal stiffness in Earth, hyper-, and microgravity conditions during both prone and upright postures.
CASE REPORT:
During parabolic flight, the spinal stiffness of the L3 vertebra of a healthy 37-yr-old man was measured in normal Earth gravity (1.0 g), hypergravity (...
Pain-related fear (PRF) is considered important for pain chronification and disability (Vlaeyen, 1996). Several scales are used to assess PRF, including the Tampa Scale for Kinesiophobia (TSK) and the Fear Avoidance Belief Questionnaire (FABQ). However, Lundberg et al. (2011) concluded that `[…] the weak construct validity (of PRF questionnaires) i...
Introduction:. Pain-related fear plays a substantial role in chronic low back pain (LBP) by amplifying the experienced disability. Related dysfunctional emotions and cognitions may also affect sensory aspects of pain through a modulatory pathway in which the periaqueductal gray (PAG) and the amygdala play key roles.
Objectives:. We therefore hypoth...
In this study we investigated sensorimotor processing of painful pressure stimulation on the lower back of patients with chronic lower back pain (CLBP) by using functional near-infrared spectroscopy (fNIRS) to measure changes in cerebral hemodynamics and oxygenation. The main objectives were whether patients with CLBP show different relative change...
Converging lines of evidence indicate that the pain experience emerges from distributed cortical nodes that share nociceptive information. While the theory of a single pain center is still not falsifiable by current neuroimaging technology, the validation of distinct brain mechanisms for acute pain and its relief is ongoing and strongly dependent o...
![Figure 2: Probe array (A) and its sensitivity profile [per mm]...](profile/Andrea-Vrana/publication/309162315/figure/fig2/AS:417451931127810@1476539704410/Probe-array-A-and-its-sensitivity-profile-per-mm-calculated-using-AtlasViewer-as_Q320.jpg)
Background and Objectives
This study aimed at investigating the feasibility of functional near‐infrared spectroscopy (fNIRS) to measure changes in cerebral hemodynamics and oxygenation evoked by painful and nonpainful mechanosensory stimulation on the lower back. The main objectives were to investigate whether cortical activity can be (1) detected...
Fear of movement (FOM) can be acquired by a direct aversive experience such as pain or by social learning through observation and instruction. Excessive FOM results in heightened disability and is an obstacle for recovery from acute, subacute, and chronic low back pain (cLBP). FOM has further been identified as a significant explanatory factor in t...
The advent of neuroimaging in dental research provides exciting opportunities for relating excitation of trigeminal neurons to human somatosensory perceptions. Cold air sensitivity is one of the most frequent causes of dental discomfort or pain. Up to date, devices capable of delivering controlled cold air in an MR-environment are unavailable for q...
Objectives Dentine hypersensitivity (DH) is commonly evoked by cold temperatures. This study aimed at clarifying the following two questions: Is the DH pain threshold stable across a four week time period? What are the brain responses during cold stimulation?
Objectives Dentine hypersensitivity (DH) is commonly evoked by cold temperatures. This study aimed at clarifying the following two questions: Is the DH pain threshold stable across a four week time period? What are the brain responses during cold stimulation?
Drug effects of loco-regional anesthetics are commonly measured by unidimensional pain rating scales. These scales require subjects to transform their perceptual correlates of stimulus intensities onto a visual, verbal or numeric construct that uses a unitless cognitive reference frame. The conceptual understanding and execution of this magnitude e...
Study design:
A cross-sectional comparative study between chronic low back pain (CLBP) patients and healthy control subjects.
Objective:
The aim of this study was to investigate reorganization in the sensory cortex by comparing cortical activity due to mechanosensory stimulation of the lumbar spine in CLBP patients versus a control group by usin...
Aim of Investigation While some cortical pain matrix areas have been investigated in order to understand their pain related neuro-chemical characteristics, the human brainstem is still a terra incognita in this perspective. By combining a robust dental pain paradigm together with 1H-Magnetic Resonance Spectroscopy (1H-MRS), this initial study measu...
Chronic low back pain (chronic LBP) is both debilitating for patients but also a major burden on the health care system. Previous studies reported various maladaptive structural and functional changes among chronic LBP patients on spine- and supraspinal levels including behavioral alterations. However, evidence for cortical reorganization in the se...
In most individuals suffering from chronic low back pain, psychosocial factors, specifically fear avoidance beliefs (FABs), play central roles in the absence of identifiable organic pathology. On a neurobiological level, encouraging research has shown brain system correlates of somatic and psychological factors during the transition from (sub) acut...
Local anesthesia has made dental treatment more comfortable since 1884, but little is known about associated brain mechanisms. Functional magnetic resonance imaging is a modern neuroimaging tool widely used for investigating human brain activity related to sensory perceptions, including pain. Most brain regions that respond to experimental noxious...
Aim of Investigation
The resting human brain is engaged in spontaneous, yet vectored activity not attributable to specific inputs nor to the generation of specific outputs. Thus, the brain is never idle. Specific signatures of temporally correlated low-frequency activities between different brain areas characterize the functional cortical architec...
Eight decades after Penfield's discovery of the homunculus only sparse evidence exists on the cortical representation of the lumbar spine. The aim of our investigation was the description of the lumbar spine's cortical representation in healthy subjects during the application of measured manual pressure. Twenty participants in the prone position we...
Experimental fear conditioning in humans is widely used as a model to investigate the neural basis of fear learning and to unravel the pathogenesis of anxiety disorders. It has been observed that fear conditioning depends on stimulus salience and subject vulnerability to fear. It is further known that the prevalence of dental-related fear and phobi...
Objective:
Drug efficacy of local anesthetics is commonly assessed using pain scales. These are dimensionless constructs with virtual intangible ankers, making it difficult to accurately assess and quantify changes of sensory/pain perceptions. To circumvent inherent shortcomings of pain scales, this study aimed at using a perceptual reference app...
Objective:
Dentine hypersensitivity (DH) pain can be provoked by diverse modalities including thermal, tactile, chemical stimuli. Recent investigations analysed brain responses to dental air blasts at room temperatures by means of functional magnetic resonance imaging (fMRI). To more closely imitate the natural stimulus that evokes pain in DH sub...
The aim was to investigate the effect of mechanical pain stimulation at the lower back on hemodynamic and oxygenation changes in the prefrontal cortex (PFC) assessed by functional near-infrared spectroscopy (fNIRS) and on the partial pressure of end-tidal carbon dioxide ( PetCO 2) measured by capnography. 13 healthy subjects underwent three measure...
The purpose of this study was to develop and test a clinically relevant method to mechanically stimulate lumbar functional spinal units while recording brain activity by means of functional magnetic resonance imaging (MRI).
Subjects were investigated in the prone position with their face lying on a modified stabilization pillow. To minimize head mo...
Objective:
Creatine (Cre) is a neuro-metabolite found in all human brain regions. Its concentration is considered evenly distributed among cortical areas and is believed to represent a "healthy neuronal state" uninfluenced by brief experimental manipulations. It therefore commonly serves as reference spectrum in magnetic resonance spectroscopy (M...
Objective:
Painless somatosensory and nociceptive signals from dental primary afferents relay in trigeminal brainstem nuclei. This report analyzed brainstem fMRI signal activity in response to 5 different electric current intensities applied to the maxillary right canine
Method:
13 right handed male volunteers (aged 22-49 yrs; mean 33.6yrs) w...
Objective:
The origin of dental phobia is generally attributed to conditioning experiences in dental offices. Yet, people who never had (or cannot recall) traumatic dental experiences also report being afraid of visiting dentists. In search of new explanations, we hypothesized to find differences in fear vulnerability between conditioned dental s...
Wound healing is an important aspect of oral and maxillofacial surgery. Positive sensory signs (allodynia, hyperalgesia) and negative sensory signs (hypoesthesia, hypoalgesia) may be encountered. Quantitative sensory testing (QST) has moved from bench to bedside for the detection, therapy selection and monitoring the recovery of individuals with se...
Dentine hypersensitivity (DH) is characterized by a short, sharp pain arising from exposed dentin. Most published literature reports on peripheral neural aspects of this pain condition. The current investigation focused on differential cerebral activity elicited by stimulation of sensitive and insensitive teeth by means of natural air stimuli.
Five...
Identification of brain regions that differentially respond to pain intensity may improve our understanding of trigeminally mediated nociception. This report analyzed cortical responses to painless and painful electrical stimulation of a right human maxillary canine tooth. Functional magnetic resonance images were obtained during the application of...
Objectives: The functional role of secondary somatosensory cortex (SII) in processing innocuous and noxious somatosensory stimuli has been documented in a variety of stimulation paradigms. In functional imaging studies of the human brain, usually the entire parietal operculum is labelled SII. Based on cytoarchitectonic analysis, the parietal opercu...
Objectives: The Insular Cortex (originally termed "isle of reil") is an anatomically and functionally diverse brain structure. Its key role in cortical processing of non-noxious and noxious stimuli is increasingly recognized. Experimental and clinical observations indicate that subdividing the Insula into anterior, medial and posterior part may enh...
The current fMRI study investigated cortical processing of electrically induced painful tooth stimulation of both maxillary canines and central incisors in 21 healthy, right-handed volunteers. A constant current, 150% above tooth specific pain perception thresholds was applied and corresponding online ratings of perceived pain intensity were record...
To evaluate whether induced dental pain leads to quantitative changes in brain metabolites within the left insular cortex after stimulation of the right maxillary canine and to examine whether these metabolic changes and the subjective pain intensity perception correlate.
Ten male volunteers were included in the pain group and compared with a contr...
Objectives: Patients qualitatively describe the pain associated with dentin hypersensitivity as rapid in onset, sharp in character and short in duration. Clinical research and in particular the evaluation of therapeutic interventions is largely based on measures that focus on the underlying peripheral biology of the condition. The aim of this study...
Projects
Projects (3)
To evaluate whether and which neuro-imaging method can really contribute to elucidate pain chronicity and which one is optimally suited for this purpose.
We will firstly focus on 1H-MRS in pain related functional homogenous brain areas to distinguish neurochemical differences between healthy, experimental pain and chronic pain states.
We further think about a pain related neurochemical diversity-index within and across the crucial brain areas coupled with an acute-pain-signature and chronic-pain-signature.
Depending on the project's growth, we could envisage to be able objectifying the transmit zone from acute to chronic pain, at least neurochemically. Combined with concise behavioral analysis, chronic pain might someday better understood and patients offered alternative and more comprehensive treatment options.
Background: Low back pain (LBP) is a major health issue. Treatment of chronic LBP is still a major challenge due to a lack of pathophysiological understanding. Thus, understanding LBP pathophysiology is a research priority. Adaptions of motor control likely play a significant role in chronic or recurrent LBP because motor control is crucial for spine posture, stability and movement. Different motor adaption strategies exist across individuals with LBP and two phenotypes representing the opposite ends of a spectrum have been suggested; i.e. "tight" control and "loose" control over trunk movement. The former would be associated with reduced trunk motor variability, the later with increased trunk motor variability. This conceptual framework is very useful to explain maintenance and aggravating of LBP because motor control adaptations are expected to have long-term consequences, such as increased spinal tissue loading, associated with degeneration of intervertebral discs and other tissues. Several knowledge gaps need to be addressed to test the validity of this framework: 1) Do loose/tight control phenotypes indeed exist and/or do other motor control adaption strategies exist? 2) Is reduced/altered paraspinal proprioceptive input associated with LBP related to neuroplastic cortical changes, thereby affecting the organizational structure in sensorimotor cortices and top-down trunk motor control? 3) Do psychological factors such as pain-related fear influence the organizational structure in sensorimotor cortices and motor control strategies?
To address these knowledge gaps, the objectives of the current project are: I) To establish motor control phenotypes in LBP. Proprioceptive weighting and biomechanical assessment of dynamic movement tasks, including subject-specific spine kinematic variability and its relationship to pain duration, negative pain-related cognitions, segmental loadings and paraspinal muscle forces, will be performed. II) To test whether cortical proprioceptive maps differ between healthy subjects and patients with LBP. Brain activation in response to thoracolumbar vibrotactile stimulation will be interrogated using functional magnetic resonance imaging data and univariate and multivariate analysis based on machine learning. III) To test whether proprioceptive maps demonstrate a relationship to spine kinematic patterns, pain duration and negative pain-related cognitions in LBP patients.
P3 SNF link: http://p3.snf.ch/project-185123
Posterior-to-anterior spinal stiffness plays an important role in diagnostics and treatment in patients with low back pain. The purpose of this study is to analyze posterior-to-anterior spinal stiffness in earth, hyper-, and microgravity conditions. Results of this study may help us to better understand the influence of gravity on spinal stiffness and in turn lead to a more precise clinical evaluation as well as future ideas to enhance chiropractic treatment in patients with low back pain.