Clinical models of chronic low back pain (cLBP) highlight the role of excessive attention to pain and kinesiophobia on the origin of disability. At the motor control level, various mechanisms are involved in the impairments observed in patients with cLBP. We aimed to assess the role of maladaptative attentional behaviors by using a complex systems approach and a visual display as a distraction during walking. Sixteen patients with cLBP with no previous surgery or significant leg pain and 16 healthy matched controls were included. Patients walked on a treadmill at preferred walking speed with and without distraction. Stride time (ST) fractal complexity was assessed using detrended fluctuation analysis. A two-way analysis of variance with repeated measures on distraction was performed on fractal exponents. We found a significant group × distraction interaction effect on fractal complexity of ST series (F(1,30) = 9.972, P = 0.004). Post hoc analysis showed that, without distraction, patients with cLBP had significantly lower ST complexity than controls, but when distracted, they regained gait complexity, recovering the level of controls. Our results suggest that excessive attention to pain causes loss of complexity and adaptability in cLBP and explain alterations of motor control with pain. Fractal analysis seems to be a promising method to explore movement variability and individual adaptability in musculoskeletal disorders.

Background/Objectives: Chronic low back pain (CLBP) is a common condition with limited long-term treatment options. Vagus nerve stimulation (VNS) has shown potential for pain improvement, but its use in CLBP remains underexplored. Our aim was to evaluate the efficacy, feasibility and tolerability of transcutaneous auricular vagus nerve stimulation (taVNS) in reducing pain and improving functional outcomes in CLBP patients. Methods: Thirty adults with CLBP (VAS ≥ 40/100) participated in this open-label pilot study (NCT05639270). Patients were treated with a taVNS device on the left ear for 30 min daily over a period of 3 months. The primary outcome was a reduction in pain intensity (VAS) at 1 month. Secondary outcomes included pain intensity at 3 months, disability (Oswestry Disability Index, ODI), quality of life (EQ-5D-5L), catastrophizing and psychological distress. In addition, compliance and adverse events were monitored. Results: After 1 month, 27 patients were evaluated. VAS scores decreased significantly by 16.1 (SD = 17.9) mm (p < 0.001) and by 22.5 (25) mm (p < 0.001) after 3 months (24 patients were analyzed). Functional disability improved with an average reduction in ODI of 11.9 (11.1) points (p < 0.001) after 3 months. Other patient-reported outcomes also improved significantly over the 3-month period. Overall, 51.9% of the patients achieved clinically meaningful pain reduction (≥20 mm), and no serious adverse events were reported. Treatment adherence was good, with half of the patients achieving 80% adherence. Conclusions: This pilot study suggests that taVNS is a feasible, safe and potentially effective treatment for CLBP that warrants further investigation in a randomized controlled trial compared to sham stimulation.

Background: Complex regional pain syndrome (CRPS) is a chronic pain condition characterized by peripheral, central sensory and motor dysfunction. Implicit motor imagery is known to be impaired in CRPS patients, but evidence for explicit motor imagery is still lacking. Using a self-rated questionnaire, this study aims to compare explicit motor imagery abilities between individuals with CRPS, with chronic limb pain (CLP), and healthy controls, and to also examine differences between affected and unaffected limbs. We hypothesize that both CRPS and CLP patients will show a decrease in motor imagery abilities compared to healthy controls and in their affected limb compared to their own contralateral, unaffected side. Patients and Methods: In this single-center observational study, 123 participants were recruited (CRPS = 40, chronic limb pain, CLP = 40, and healthy individuals = 43). Participants completed the Movement Imagery Questionnaire-Revised Second (MIQ-RS) once for each side of the body. The total MIQ-RS score, and the kinesthetic and visual subscores were compared between groups and between the affected and unaffected sides. Results: A high degree of heterogeneity was observed in the explicit motor imagery scores and subscores, regardless of whether the participants were healthy or individuals with chronic pain. The MIQ-RS did not reveal any significant differences in explicit motor imagery abilities, neither between groups nor between the affected and unaffected side. Bayesian testing of the null hypothesis for kinesthetic motor imagery abilities indicated a sevenfold likelihood of no differences between groups and a more than a fivefold likelihood of no differences between sides. Conclusion: Individuals with CRPS and chronic limb pain displayed preserved explicit motor imagery abilities, notably on the pain side. The preservation of these abilities supports the recommendation of mental imagery therapy to improve motor function and relieve pain in chronic pain patients.

Article: Validation of the French version of the Fremantle Back Awareness Questionnaire in patients with chronic low back pain - European Journal of Physical and Rehabilitation Medicine 2025 Mar 10 - Minerva Medica - Journals

Musculoskeletal pain, particularly low back and neck pain, is associated with maladaptive changes in spinal motor behaviour (SMB). Psychological factors such as pain-related fear play a role in driving these adaptations. While previous research found weak associations between general psychological measures and SMB, task-specific measures may provide more precise insights into movement avoidance. This systematic review and meta-analysis aimed to compare the relative associations of general and task-specific pain-related fear measures with SMB. Following PRISMA guidelines, we included 13 studies (651 participants) assessing both general (Tampa Scale of Kinesiophobia and Pain Anxiety Symptoms Scale) and task-specific measures alongside objective spinal motor outcomes (eg, amplitude, velocity, muscle activity, coordination, variability). A three-level meta-analytic model revealed a weak but significant association between general measures and SMB (r = 0.12, 95% CI: 0.04-0.21, P = 0.007), whereas task-specific measures showed a stronger association (r = 0.29, 95% CI: 0.18-0.40, P < 0.001). The difference between these correlations (Δr _{(task-specific – general)} = 0.16, 95% CI: 0.04 to 0.27, P = 0.008) was statistically significant, indicating that task-specific measures better capture the relationship between perceived fear and movement alterations. Despite methodological heterogeneity, our findings highlight the importance of task-specific assessments in understanding motor impairments associated with pain-related fear. These results support the integration of task-specific evaluations in clinical and research settings. To further elucidate the mechanisms linking psychological factors to SMB, future studies should use longitudinal designs, improve the contextual validity of the motor tasks studied, and explore new approaches of movement analysis.