Studies show emotion plays role in chronic low back pain

Sin-Ki Ng is a PhD student at the
Monash Alfred Psychiatry research
centre

by Anne Crawford

Chronic low back pain (CLBP) is a debilitating disease, adversely affecting quality of life and wellbeing, potentially leading to depression, long-term disability, time off work due to pain and reduced productivity. Yet its underlying mechanisms remain unclear.

Now a review of available data by Central Clinical School PhD student Sin-Ki Ng and others at the Monash Alfred Psychiatry Research Centre (MAPrc) suggests that emotional and cognitive processes may be the core contributor to it.

The systematic review, published in the ‘Clinical Journal of Pain’ in July, surveyed 55 studies that recruited adults with chronic low back pain and which had used magnetic resonance imaging (MRI), aiming to identify MRI brain changes and examine their potential relationship with emotional and cognitive processes.

The majority of studies found that the brain changes in CLBP groups were mainly observed in areas and networks important in emotion and cognition rather than those typically associated with pain.

“What’s really interesting is that in the majority of chronic back pain patients if you take an X-ray and MRI a lot of them have perfect backs – there’s nothing that can be identified that says ‘yes, this is the cause of lower back pain’,” Sin-Ki said.

“But the pain is real to the patients. We can’t just simplify it as being psychological. Nor can we just rule out the sensory aspect of chronic pain. It’s more complex,” she said.

Sin-Ki, who is being supervised mainly by Dr Bernadette Fitzgibbon, said that while the results of the paper were preliminary and future studies were needed to further explore these processes, they pointed researchers in the right direction.

She said that most people, including clinicians, didn’t usually associate pain with brain processes but rather a localised physiological cause so bringing this to light may assist in future approaches to treatment.

“There’s not really an effective treatment that is beneficial so understanding the underlying processes that may be contributing to the chronic pain could steer research towards other ways of developing treatments in the future,” she said.

“Cognitive Behavioural Therapy or something as simple as re-educating, which has been found to be somewhat effective, used in addition to current therapies might help solve the mystery of CLBP,” she said. “Re-educating” means changing beliefs about the disease to be more positive in order to increase the chances of recovery. “Emotional self-regulation” was another option.

“Even if these approaches help the patients manage their pain it’s good.”

Said Dr Fitzgibbon, “The study contributes to a growing appreciation of the psychological and cognitive factors in the development and maintenance of pain.”

The paper is one in a series investigating factors potentially involved in CLBP.

Another recently published paper followed a group of 192 people over two years probing the effect of negative beliefs about low back pain on the pain itself. It found that those people with persistent pain at two years were more likely to have held negative beliefs about the pain at baseline, whereas those with positive beliefs at baseline who had similar levels of pain then were more likely to experience recovery after two years.

The researchers are seeking participants participants who are female with chronic low back pain or healthy controls to participate in an MRI study looking at emotion regulation. For more details, please contact Sin-Ki on 0401 760 481 or email on sinki.ng@monash.edu.


Ng SK, Urquhart DM, Fitzgerald PB, Cicuttini FM, Hussain SM, Fitzgibbon BM. The Relationship between Structural and Functional Brain Changes and Altered Emotion and Cognition in Chronic Low Back Pain: A Systematic Review of MRI and fMRI Studies. Clin J Pain. 2017 Jul 17. doi: 10.1097/AJP.0000000000000534. [Epub ahead of print]

Ng SK, Cicuttini FM, Wang Y, Wluka AE, Fitzgibbon B, Urquhart DM. Negative beliefs about low back pain are associated with persistent high intensity low back pain. Psychol Health Med. 2017 Aug;22(7):790-799. doi: 10.1080/13548506.2016.1220602. Epub 2016 Aug 12.