Unraveling Back Pain Chronicity: an EMG and EEG Study

NCT ID: NCT03705676

Last Updated: 2023-12-18

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

107 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-03-03

Study Completion Date

2018-04-17

Brief Summary

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This study aims at examining the influence of both threat of experimentally induced pain and clinical low back pain (LBP) on trunk motor control on the one hand and brain activity related to movement preparation on the other hand. Therefore, 3 groups are studied: healthy controls, people with recurrent LBP, and people with chronic LBP. A comparison in electromyography (EMG) of the trunk muscles and electroencephalography (EEG) activity between the 3 groups will be made in 2 conditions: a control condition without experimental pain on 1 test day, and a fear condition with experimental pain on another test day. In both conditions a motor control task will be performed and muscle and brain activity will be measured during each motor control task.

It is hypothesised that motor control will be different between the 3 groups in both conditions, i.e. delayed trunk muscle onset in LBP groups compared with controls. With regards to the brain activity, it is expected that preparation for movement will also be delayed in the LBP groups. Furthermore, it is expected that the fear condition will entail differences in both EMG and EEG within each group.

Detailed Description

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March 2017 - April 2018. 30 healthy participants, 30 recurrent and 30 chronic LBP patients all aged 18-45 and of both genders were tested for 2 conditions on 2 separate days, i.e. a control condition (C) on 1 test day; a fear (F) condition consisting out of threat (T) and no threat trials (NT) on another test day. The order of test days was randomized.

1 block of 240 rapid arm movements (RAM) with the dominant arm was performed per condition, while electroencephalography (EEG) of the brain and surface electromyography (sEMG) of the Internal Oblique/Transversus Abdominis, External Oblique, Multifidus and Iliocostalis Lumborum pars Thoracis muscles were measured bilaterally. sEMG of the Anterior Deltoid muscle of the dominant arm was also measured. This RAM was used to induce an internal perturbation to the postural balance of subjects and is an often used task in the study of trunk motor control. Midway the RAM block, the participants got a short intermission of 90 seconds seated rest. Both conditions consisted of a warning cue (colored dot on a screen) followed by a go cue (arrow indicating either an upwards or downwards rapid arm movement) or a no-go cue ('STOP') and 12 seconds rest before the next trial. Harmless vibrotactile stimuli were always administered to the low back region during the appearance of the warning cue. During the C, a white warning cue was presented (safe cue), meaning that the RAM would never be accompanied by a painful electrocutaneous stimulus in that condition. During the F a safe (no threat) or a threatening warning cue could be presented (50-50%); in 25% of the trials after the threatening cue an electrocutaneous stimulus was given to the lower back region; the trials after the no threat cue were never accompanied with painful stimuli.

The intensity of the electrocutaneous stimulus was self-determined by participants through a staircase paradigm and was administered by a digitimer system.

At the beginning of each test day several questionnaires were also administered to control for psychological factors and physical activity, i.e. Central Sensitization Index (CSI), Hospital Anxiety and Depression Scale (HADS), Tampa Scale for Kinesiophobia (TSK), Pain Catastrophizing Scale (PCS), Pain Vigilance and Awareness Questionnaire (PVAQ), Roland-Morris Disability Questionnaire (RMDQ), International Physical Activity Questionnaire (IPAQ) and a general questionnaire regarding socio-demographic information and history of complaints. Furthermore, complaint specific questionnaires were also administered, but only for the clinical populations (RLBP and CLBP)

Statistical analysis will be performed to assess whether and to what extent both threat and LBP might influence motor control as measured with EMG during RAM. Furthermore, the effect of both on cortical movement preparation and somatosensory processing will also be assessed based on the EEG measurements.

Conditions

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Low Back Pain

Keywords

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Sensorimotor control Event-related potentials Cortical movement preparation

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

Each participant will perform both experimental conditions spread out over 2 test days in a randomized order. Between 2 test days a minimum of 5 days has to be present in order to ensure full recuperation from test day 1. Half of the participants will receive the control condition on test day 1 and the fear condition on day 2, the other half vice versa.
Primary Study Purpose

BASIC_SCIENCE

Blinding Strategy

SINGLE

Outcome Assessors
Participants are aware that electrocutaneous stimulation might occur during the fear condition and never during the control condition. This is of paramount importance, as the expectancy of a painful stimulus is the main difference between both conditions.

The researcher that will perform the EMG-analysis, i.e. onset determination of the various muscles that were measured, will be blinded for participant, condition and muscle during that process. EEG-data does not have to be blinded as data processing is computer based and not subjectable to subjective bias of a researcher.

Study Groups

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Healthy controls - control condition

Assesses EMG and EEG activity of healthy controls during a rapid arm task after a warning and go cue. No painful stimuli are administered, only non-painful vibrotactile stimuli.

Group Type ACTIVE_COMPARATOR

Rapid Arm Movements

Intervention Type BEHAVIORAL

240 trials of RAM in either a forward (50%) or backward (50%) shoulder flexion direction and back to neutral as fast as possible, with maintaining extension in the elbow. Visual cues (arrows) indicated the movement direction.

Vibrotactile stimulus

Intervention Type DEVICE

In all trials, during the presentation of the warning cue, a vibrotactile stimulus is administered to the low back region. This stimulus is used to evoke somatosensory evoked potentials (SEP) measured with EEG during the movement-preparation phase.

Healthy controls - fear condition

Assesses EMG and EEG activity of healthy controls during a rapid arm task after a warning and go cue. Half of the trials are no threat trials, the other half are threat trials. A painful stimulus is administered during arm movement in 25% of the threat trials in order to evoke anticipation of pain during the 75% other threat trials.

Group Type EXPERIMENTAL

Rapid Arm Movements

Intervention Type BEHAVIORAL

240 trials of RAM in either a forward (50%) or backward (50%) shoulder flexion direction and back to neutral as fast as possible, with maintaining extension in the elbow. Visual cues (arrows) indicated the movement direction.

Unpleasant stimulus

Intervention Type DEVICE

An unpleasant, but harmless, electrocutaneous stimulus is administered to the low back region in 25% of the threat trials during the fear condition. Due to a conditioning phase before testing, participants know to expect this stimulus after the presentation of a warning cue related to the fear trials (either pink or blue dot dependent on randomization).

Vibrotactile stimulus

Intervention Type DEVICE

In all trials, during the presentation of the warning cue, a vibrotactile stimulus is administered to the low back region. This stimulus is used to evoke somatosensory evoked potentials (SEP) measured with EEG during the movement-preparation phase.

RLBP - control condition

Assesses EMG and EEG activity of RLBP subjects during a rapid arm task after a warning and go cue. No painful stimuli are administered, only non-painful vibrotactile stimuli.

Group Type ACTIVE_COMPARATOR

Rapid Arm Movements

Intervention Type BEHAVIORAL

240 trials of RAM in either a forward (50%) or backward (50%) shoulder flexion direction and back to neutral as fast as possible, with maintaining extension in the elbow. Visual cues (arrows) indicated the movement direction.

Vibrotactile stimulus

Intervention Type DEVICE

In all trials, during the presentation of the warning cue, a vibrotactile stimulus is administered to the low back region. This stimulus is used to evoke somatosensory evoked potentials (SEP) measured with EEG during the movement-preparation phase.

RLBP - fear condition

Assesses EMG and EEG activity of RLBP subjects during a rapid arm task after a warning and go cue. Half of the trials are no threat trials, the other half are threat trials. A painful stimulus is administered during arm movement in 25% of the threat trials in order to evoke anticipation of pain during the 75% other threat trials.

Group Type EXPERIMENTAL

Rapid Arm Movements

Intervention Type BEHAVIORAL

240 trials of RAM in either a forward (50%) or backward (50%) shoulder flexion direction and back to neutral as fast as possible, with maintaining extension in the elbow. Visual cues (arrows) indicated the movement direction.

Unpleasant stimulus

Intervention Type DEVICE

An unpleasant, but harmless, electrocutaneous stimulus is administered to the low back region in 25% of the threat trials during the fear condition. Due to a conditioning phase before testing, participants know to expect this stimulus after the presentation of a warning cue related to the fear trials (either pink or blue dot dependent on randomization).

Vibrotactile stimulus

Intervention Type DEVICE

In all trials, during the presentation of the warning cue, a vibrotactile stimulus is administered to the low back region. This stimulus is used to evoke somatosensory evoked potentials (SEP) measured with EEG during the movement-preparation phase.

CLBP - control condition

Assesses EMG and EEG activity of CLBP subjects during a rapid arm task after a warning and go cue. No painful stimuli are administered, only non-painful vibrotactile stimuli.

Group Type ACTIVE_COMPARATOR

Rapid Arm Movements

Intervention Type BEHAVIORAL

240 trials of RAM in either a forward (50%) or backward (50%) shoulder flexion direction and back to neutral as fast as possible, with maintaining extension in the elbow. Visual cues (arrows) indicated the movement direction.

Vibrotactile stimulus

Intervention Type DEVICE

In all trials, during the presentation of the warning cue, a vibrotactile stimulus is administered to the low back region. This stimulus is used to evoke somatosensory evoked potentials (SEP) measured with EEG during the movement-preparation phase.

CLBP - fear condition

Assesses EMG and EEG activity of CLBP subjects during a rapid arm task after a warning and go cue. Half of the trials are no threat trials, the other half are threat trials. A painful stimulus is administered during arm movement in 25% of the threat trials in order to evoke anticipation of pain during the 75% other threat trials.

Group Type EXPERIMENTAL

Rapid Arm Movements

Intervention Type BEHAVIORAL

240 trials of RAM in either a forward (50%) or backward (50%) shoulder flexion direction and back to neutral as fast as possible, with maintaining extension in the elbow. Visual cues (arrows) indicated the movement direction.

Unpleasant stimulus

Intervention Type DEVICE

An unpleasant, but harmless, electrocutaneous stimulus is administered to the low back region in 25% of the threat trials during the fear condition. Due to a conditioning phase before testing, participants know to expect this stimulus after the presentation of a warning cue related to the fear trials (either pink or blue dot dependent on randomization).

Vibrotactile stimulus

Intervention Type DEVICE

In all trials, during the presentation of the warning cue, a vibrotactile stimulus is administered to the low back region. This stimulus is used to evoke somatosensory evoked potentials (SEP) measured with EEG during the movement-preparation phase.

Interventions

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Rapid Arm Movements

240 trials of RAM in either a forward (50%) or backward (50%) shoulder flexion direction and back to neutral as fast as possible, with maintaining extension in the elbow. Visual cues (arrows) indicated the movement direction.

Intervention Type BEHAVIORAL

Unpleasant stimulus

An unpleasant, but harmless, electrocutaneous stimulus is administered to the low back region in 25% of the threat trials during the fear condition. Due to a conditioning phase before testing, participants know to expect this stimulus after the presentation of a warning cue related to the fear trials (either pink or blue dot dependent on randomization).

Intervention Type DEVICE

Vibrotactile stimulus

In all trials, during the presentation of the warning cue, a vibrotactile stimulus is administered to the low back region. This stimulus is used to evoke somatosensory evoked potentials (SEP) measured with EEG during the movement-preparation phase.

Intervention Type DEVICE

Other Intervention Names

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Electrocutaneous stimulus

Eligibility Criteria

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Inclusion Criteria

* Healthy adult subjects.


* People with non-specific recurrent LBP for at least 2 episodes last year. (1 episode = \>24h complaints; 2 episodes are separated by a painfree period of at least 1 month)


* People with non-specific chronic LBP for at least 3 days a week and this for at least 3 months on a row.

Exclusion Criteria

* People with a history of pain or current pain
* severe pathologies
* traumata
* cardiorespiratory disorders
* neurological disorders
* vestibular disorders
* endocrinologic disorders
* psychiatric and cognitive disorders
* colour blindness
* sleeping disorders
* psychological disorders or major depressions
* major surgery to the spine or upper limbs
* clinically relevant malalignments and deformities
* malignancies
* substance abuse of alcohol or drugs
* consumption of analgesics without prescription 24 hours or with prescription two weeks before testing
* use of psychotropic medication
* extreme physical activities two days before testing
* professional athletes
* pregnant women or women \< 1 year postnatally

RLBP


* specific reason for LBP (e.g. herniation \<2y, fracture, rheumatic disease,...)
* severe pathologies
* traumata
* cardiorespiratory disorders
* neurological disorders
* vestibular disorders
* endocrinologic disorders
* psychiatric and cognitive disorders
* colour blindness
* sleeping disorders
* psychological disorders or major depressions
* major surgery to the spine or upper limbs
* clinically relevant malalignments and deformities
* malignancies
* substance abuse of alcohol or drugs
* consumption of analgesics without prescription 24 hours or with prescription two weeks before testing
* use of psychotropic medication
* extreme physical activities two days before testing
* professional athletes
* pregnant women or women \< 1 year postnatally

CLBP


* specific reason for LBP (e.g. herniation \<2y, fracture, rheumatic disease,...)
* severe pathologies
* traumata
* cardiorespiratory disorders
* neurological disorders
* vestibular disorders
* endocrinologic disorders
* psychiatric and cognitive disorders
* colour blindness
* sleeping disorders
* psychological disorders or major depressions
* major surgery to the spine or upper limbs
* clinically relevant malalignments and deformities
* malignancies
* substance abuse of alcohol or drugs
* consumption of analgesics without prescription 24 hours or with prescription two weeks before testing
* use of psychotropic medication
* extreme physical activities two days before testing
* professional athletes
* pregnant women or women \< 1 year postnatally
Minimum Eligible Age

18 Years

Maximum Eligible Age

45 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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University Ghent

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Lieven Danneels, PT, PhD

Role: PRINCIPAL_INVESTIGATOR

University Ghent

Locations

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Vakgroep REVAKI (Ghent University - Ghent University Hospital)

Ghent, , Belgium

Site Status

Countries

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Belgium

Other Identifiers

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2016/0186

Identifier Type: -

Identifier Source: org_study_id