Highlights
- •Altered decision making processes in CLBP are suggested.
- •Postural strategies with a higher cortical attention-demand are suggested in CLBP.
- •Decreased habituation to painful and auditory stimuli in CLBP was found.
- •Different types of LBP still need to be examined with EEG, besides CLBP.
- •Other functional tasks in LBP still need to be examined with EEG.
Abstract
This systematic review analyzed available literature on functional brain alterations
in low back pain (LBP) measured with electroencephalography (EEG), as until now evidence
thereof was unclear. Four electronic databases were systematically searched the 10th
of March 2018, resulting in 12 included studies. Studies showed a risk of bias of
37.5 to 75% using the Newcastle-Ottawa Scale for case-control studies. Limited evidence
reported higher amplitudes of balance-related potentials and early components of somatosensory
evoked potentials (SEP) to noxious stimuli, and altered feedback-related negativity
and P300 potentials during decision-making in chronic LBP (CLBP). These findings suggest
postural strategies requiring a higher cortical attention-demand, increased sensory-discriminative
processing of noxious input, and altered decision-making in CLBP. However, further
research is warranted as these inferences were based on single studies. Moderate evidence
for unaltered amplitude of late-phase SEPs to noxious stimuli and auditory evoked
potentials in LBP implies that the affective-emotional processing of stimuli might
be unaffected in LBP. Furthermore, moderate evidence indicated disturbed habituation
of somatosensory stimuli in LBP. Most studies examined nonspecific or mixed CLBP populations,
hence EEG-quantified brain activity in (sub)acute or recurrent LBP still needs to
be explored.
Perspective
This review presents an overview of the current understanding of the functional LBP
brain measured with EEG. The limited evidence in current research suggests altered
cortical function regarding balance control, somatosensory processing, and decision
making in LBP, and highlights opportunities for future EEG-research.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of PainAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Cortical responses associated with predictable and unpredictable compensatory balance reactions.Exp Brain Res. 2006; 172: 85-93https://doi.org/10.1007/s00221-005-0310-9
- Mechanisms of low back pain: A guide for diagnosis and therapy.F1000Res. 2016; 5https://doi.org/10.12688/f1000research.8105.2
- Pain and the brain: Specificity and plasticity of the brain in clinical chronic pain.Pain. 2011; 152: S49-S64https://doi.org/10.1016/j.pain.2010.11.010
- The sensory-discriminative and affective-motivational aspects of pain.Neurosci Biobehav Rev. 2010; 34: 214-223https://doi.org/10.1016/j.neubiorev.2008.07.008
- Everyday executive functioning in chronic pain: specific deficits in working memory and emotion control, predicted by mood, medications, and pain interference.Clin J Pain. 2016; 32: 673-680https://doi.org/10.1097/ajp.0000000000000313
- Corticostriatal functional connectivity predicts transition to chronic back pain.Nat Neurosci. 2012; 15: 1117-1119https://doi.org/10.1038/nn.3153
- What we know about the brain structure-function relationship.Behav Sci. 2018; 8: 39https://doi.org/10.3390/bs8040039
- Identification of pain, intensity and P300 components in the pain evoked potential.Electroencephalogr Clin Neurophysiol. 1993; 88: 290-301
- Meta-analysis of cognitive performance in fibromyalgia.J Clin Exp Neuropsychol. 2018; 40: 698-714https://doi.org/10.1080/13803395.2017.1422699
- Do people with chronic pain have impaired executive function? A meta-analytical review.Clin Psychol Rev. 2014; 34: 563-579https://doi.org/10.1016/j.cpr.2014.08.003
- The role of the cerebral cortex in postural responses to externally induced perturbations.Neurosci Biobehav Rev. 2015; 57: 142-155https://doi.org/10.1016/j.neubiorev.2015.08.014
- Single-nucleotide polymorphism in the human mu opioid receptor gene alters beta-endorphin binding and activity: Possible implications for opiate addiction.Proc Natl Acad Sci USA. 1998; 95: 9608-9613
- Pain research and therapy: Past and current status and future needs.in: Ng L.K.Y. Bomca J.J. Pain, Discomfort and Humanitarian Care. Elsevier North Holland, New York1980: 146
- Pain-related components in the cerebral potential, experimental and multivariate statistical approaches.in: Bromm B. Pain measurement in man. Elsevier, Amsterdam1984: 257-290
- Brain images of pain.News Physiol Sci. 2001; 16: 244-249
- CNV and SPN: indices of anticipatory behavior.in: Jahanshahi M. Hallett M. The Bereitschaftspotential: Movement-Related Cortical Potentials. Springer, US, Boston, MA2003: 207-227
- Midlatency auditory evoked responses: Differential effects of a cholinergic agonist and antagonist.Electroencephalogr Clin Neurophysiol. 1991; 80: 303-309
- Primary sensory and motor cortex function in response to acute muscle pain: a systematic review and meta-analysis.Eur J Pain. 2016; 20: 1203-1213https://doi.org/10.1002/ejp.859
- Pain perception: Is there a role for primary somatosensory cortex?.Proc Natl Acad Sci US America. 1999; 96: 7705-7709
- Richtlijnontwikkeling binnen het kwaliteitsinstituut voor de gezondheidszorg CBO, handleiding voor werkgroepleden.Kwaliteitsinstituut voor de Gezondheidszorg CBO, Utrecht2007
- New directions in the understanding and management of pain.Soc Sci Med. 1984; 19: 1261-1277https://doi.org/10.1016/0277-9536(84)90014-5
- Assessment of analgesic states: Can evoked potentials play a role.in: Bromm B. Pain Measurement in Man. Elsevier, Amsterdam1984: 233-256
- Brain evoked potentials are functional correlates of induced pain in man.Pain. 1979; 6: 365-374
- Attentional modulation of somatosensory processing during the anticipation of movements accompanying pain: an event-related potential study.J Pain. 2018; 19: 219-227https://doi.org/10.1016/j.jpain.2017.10.008
- Relations between brain alterations and clinical pain measures in chronic musculoskeletal pain: a systematic review.J Pain. 2016; 17: 949-962https://doi.org/10.1016/j.jpain.2016.04.005
- Neural correlates of uncertain decision making: ERP evidence from the Iowa Gambling Task.Front Hum Neurosci. 2013; 7: 776https://doi.org/10.3389/fnhum.2013.00776
- The auditory event related potentials in episodic and chronic pain sufferers.Eur J Pain. 2002; 6: 239-244https://doi.org/10.1053/eujp.2001.0342
- Repositioning accuracy and movement parameters in low back pain subjects and healthy control subjects.Eur Spine J. 2005; 14: 185-191https://doi.org/10.1007/s00586-004-0833-y
- Wave form and neural mechanism of the decision P350 elicited without pre-stimulus CNV or readiness potential in random sequences of near-threshold auditory clicks and finger stimuli.Electroencephalogr Clin Neurophysiol. 1979; 47: 648-670
- Genetic basis for individual variations in pain perception and the development of a chronic pain condition.Hum Mol Gen. 2005; 14: 135-143https://doi.org/10.1093/hmg/ddi013
- Central processing of acute muscle pain in chronic low back pain patients: An EEG mapping study.J Clin Neurophysiol. 2007; 24: 76-83https://doi.org/10.1097/01.wnp.0000241093.00844.0e
- Is the P300 component a manifestation of context updating?.Behav Brain Sci. 1988; 11: 357-427https://doi.org/10.1017/S0140525X00058027
- Pain-evoked anterior cingulate activity generating the negative difference potential may reflect response selection processes.Psychophysiology. 2002; 39 (10.1017.s0048577201393113): 369-379
- Lumbar spine movement patterns during prolonged sitting differentiate low back pain developers from matched asymptomatic controls.Work. 2010; 35: 3-14https://doi.org/10.3233/wor-2010-0953
- Functional radiographic diagnosis of the lumbar spine. Flexion-extension and lateral bending.Spine. 1991; 16: 562-571https://doi.org/10.1097/00007632-199105000-00014
- Midlatency auditory evoked responses: Differential effects of sleep in the human.Electroencephalogr Clin Neurophysiol. 1986; 65: 383-392
- The P50 midlatency auditory evoked potential in patients with chronic low back pain (CLBP).Clin Neurophysiol. 2005; 116: 681-689https://doi.org/10.1016/j.clinph.2004.09.026
- A dynamic network perspective of chronic pain.Neurosci Lett. 2012; 520: 197-203https://doi.org/10.1016/j.neulet.2012.05.001
- Age-related changes in processing positive and negative feedback: Is there a positivity effect for older adults?.Biol Psychol. 2013; 94: 235-241https://doi.org/10.1016/j.biopsycho.2013.07.006
- Habituation to pain in "medication overuse headache": A CO2 laser-evoked potential study.Headache. 2012; 52: 792-807https://doi.org/10.1111/j.1526-4610.2012.02151.x
- The A118G single nucleotide polymorphism of the mu-opioid receptor gene (OPRM1) is associated with pressure pain sensitivity in humans.J Pain. 2005; 6: 159-167https://doi.org/10.1016/j.jpain.2004.11.008
- Extensive reorganization of primary somatosensory cortex in chronic back pain patients.Neurosci Lett. 1997; 224: 5-8
- Peripheral and electrocortical responses to painful and non-painful stimulation in chronic pain patients, tension headache patients and healthy controls.Neurosci Lett. 2004; 361: 147-150https://doi.org/10.1016/j.neulet.2003.12.064
- Laser heat hyperalgesia is not a feature of non-specific chronic low back pain.Eur J Pain. 2014; 18: 1501-1508https://doi.org/10.1002/ejp.535
- The use of electroencephalography in language production research: a review.Front Psychol. 2011; 2: 208https://doi.org/10.3389/fpsyg.2011.00208
- Disorders of the reticular activating system.Med Hypotheses. 1997; 49: 379-387
- The sleep state-dependent midlatency auditory evoked P50 potential in various disorders.Thalamus Rel Syst. 2002; 2: 9-19https://doi.org/10.1016/S1472-9288(02)00032-8
- Cortical field potentials associated with hand movements triggered by warning and imperative stimuli in the monkey.Neurosci Lett. 1990; 113: 275-280
- Decision-making cognition in neurodegenerative diseases.Nat Rev Neurol. 2010; 6: 611-623https://doi.org/10.1038/nrneurol.2010.148
- Significance of catechol-O-methyltransferase gene polymorphism in fibromyalgia syndrome.Rheumatol Int. 2003; 23: 104-107https://doi.org/10.1007/s00296-002-0260-5
- Endogenous potentials generated in the human hippocampal formation and amygdala by infrequent events.Science. 1980; 210: 803-805
- Magnetoencephalography: theory, instrumentation, and applications to noninvasive studies of the working human brain.Reviews of Modern Physics. 1993; 65: 413-497
- Peripheral and central sensitization as risk factors of low back pain.in: Hasenbring M.I. Rusu A.C. Turk D.C. From Acute to Chronic Back Pain: Risk Factors, Mechanisms, and Clinical Implications. Oxford University Press, 2012
- Electrical signs of selective attention in the human brain.Science. 1973; 182: 177-180
- Inefficient muscular stabilization of the lumbar spine associated with low back pain. A motor control evaluation of transversus abdominis.Spine. 1996; 21: 2640-2650https://doi.org/10.1097/00007632-199611150-00014
- Changes in the mechanical properties of the trunk in low back pain may be associated with recurrence.J Biomech. 2009; 42: 61-66https://doi.org/10.1016/j.jbiomech.2008.10.001
- Comparison of female geriatric lumbar-extension strength: Asymptotic versus chronic low back pain patients and their response to active rehabilitation.J Spinal Disord. 1996; 9: 17-22https://doi.org/10.1097/00002517-199602000-00003
IASP: IASP Terminology. Available at: http://www.iasp-pain.org/terminology?navItemNumber=576Accessed July 21, 2018
- A history of low back pain associates with altered electromyographic activation patterns in response to perturbations of standing balance.J Neurophysiol. 2011; 106: 2506-2514https://doi.org/10.1152/jn.00296.2011
- Low back pain associates with altered activity of the cerebral cortex prior to arm movements that require postural adjustment.Clin Neurophysiol. 2010; 121: 431-440https://doi.org/10.1016/j.clinph.2009.11.076
- Neural mechanisms and functional correlates of altered postural responses to perturbed standing balance with chronic low back pain.Neuroscience. 2016; 339: 511-524https://doi.org/10.1016/j.neuroscience.2016.10.032
- Movement-related potentials associated with self-paced, cued and imagined arm movements.Exp Brain Res. 2002; 147: 98-107https://doi.org/10.1007/s00221-002-1220-8
- The amplitude of the P300 component of the event-related potential: Review and synthesis.Adv Psychophysiol. 1988; 3: 69-137
- Decreased response to novel stimuli after prefrontal lesions in man.Electroencephalogr Clin Neurophysiol. 1984; 59: 9-20
- Learned maintenance of pain: Muscle tension reduces central nervous system processing of painful stimulation in chronic and subchronic pain patients.Psychophysiology. 1999; 36: 755-764
- Structural and functional brain abnormalities in chronic low back pain: a systematic review.Semin Arthritis Rheum. 2015; 45: 229-237https://doi.org/10.1016/j.semarthrit.2015.05.002
- Attention to pain localization and unpleasantness discriminates the functions of the medial and lateral pain systems.Eur J Neurosci. 2005; 21: 3133-3142https://doi.org/10.1111/j.1460-9568.2005.04098.x
- Intracerebral recordings of slow potentials in a contingent negative variation paradigm: An exploration in epileptic patients.Electroencephalogr Clin Neurophysiol. 1995; 95: 268-276
- Classifying different emotional states by means of EEG-based functional connectivity patterns.PloS One. 2014; 9: e95415https://doi.org/10.1371/journal.pone.0095415
- Nociceptive local field potentials recorded from the human insula are not specific for nociception.PLoS Biol. 2016; 14e1002345https://doi.org/10.1371/journal.pbio.1002345
- Monte Carlo simulation studies of EEG and MEG localization accuracy.Hum Brain Mapp. 2002; 16: 47-62
- The human mu-opioid receptor gene polymorphism 118A >G decreases cortical activation in response to specific nociceptive stimulation.Behav Neurosci. 2006; 120: 1218-1224https://doi.org/10.1037/0735-7044.120.6.1218
- Non-specific low back pain.Lancet. 2017; 389: 736-747https://doi.org/10.1016/s0140-6736(16)30970-9
- What harm – pain behavior? Psychological and physical factors in the development of chronicity.Bull: Hosp Joint Dis. 1996; 55: 210-212
- Differences in brain structure in patients with distinct sites of chronic pain: A voxel-based morphometric analysis.Neural Regener Res. 2013; 8: 2981-2990
- Quality assessment of observational studies in a drug-safety systematic review, comparison of two tools: The Newcastle-Ottawa Scale and the RTI item bank.Clin Epidemiol. 2014; 6: 359-368https://doi.org/10.2147/clep.s66677
- Localizing evoked cortical activity associated with balance reactions: Does the anterior cingulate play a role?.J Neurophysiol. 2014; 111: 2634-2643https://doi.org/10.1152/jn.00511.2013
- Response inhibition, set shifting, and complex executive function in patients with chronic lower back pain.Medicina. 2017; 53: 26-33https://doi.org/10.1016/j.medici.2016.12.001
- Closing the quality gap: Revisiting the state of the science (vol. 3: quality improvement interventions to address health disparities).Evid Rep/Technol Assess. 2012; 3: 1-475
- Health Literacy. From Reference to Review.2016 (Leuven (Belgium)/Den Haag (The Netherlands))
- Pain and the neuromatrix in the brain.J Dent Educ. 2001; 65: 1378-1382
- Pain mechanism: A new theory.Science. 1965; 150: 971-979https://doi.org/10.1016/S1082-3174(96)80062-6
- Changes in cortical activity associated with adaptive behavior during repeated balance perturbation of unpredictable timing.Front Behav Neurosci. 2015; 9: 272https://doi.org/10.3389/fnbeh.2015.00272
- Biofeedback of somatosensory event-related potentials: Can individual pain sensations be modified by biofeedback-induced self-control of event-related potentials?.Pain. 1988; 35: 205-213
- Generalizability of perturbation-evoked cortical potentials: Independence from sensory, motor and overall postural state.Neurosci Lett. 2009; 451: 40-44https://doi.org/10.1016/j.neulet.2008.12.020
- Cortical responses associated with the preparation and reaction to full-body perturbations to upright stability.Clin Neurophysiol. 2008; 119: 1626-1637https://doi.org/10.1016/j.clinph.2008.03.020
- Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement.Int J Surg. 2010; 8: 336-341https://doi.org/10.1016/j.ijsu.2010.02.007
- A multisensory investigation of the functional significance of the "pain matrix".NeuroImage. 2011; 54: 2237-2249https://doi.org/10.1016/j.neuroimage.2010.09.084
- Association between chronic musculoskeletal pain and executive function in community-dwelling older adults.Eur J Pain. 2017; 21: 1717-1722https://doi.org/10.1002/ejp.1083
- Human catechol-O-methyltransferase haplotypes modulate protein expression by altering mRNA secondary structure.Science. 2006; 314: 1930-1933https://doi.org/10.1126/science.1131262
- The clinical effects of intensive, specific exercise on chronic low back pain: A controlled study of 895 consecutive patients with 1-year follow up.Orthopedics. 1995; 18: 971-981
- The relationship between structural and functional brain changes and altered emotion and cognition in chronic low back pain brain changes: a systematic review of MRI and fMRI studies.Clin J Pain. 2018; 34: 237-261https://doi.org/10.1097/ajp.0000000000000534
- The hippocampal formation as a source of the slow endogenous potentials.Electroencephalogr Clin Neurophysiol. 1983; 55: 417-426
- Pain catastrophizing and trunk muscle activation during walking in patients with chronic low back pain.Gait Posture. 2016; 49: 73-77https://doi.org/10.1016/j.gaitpost.2016.06.025
- Diagnosis and management of acute low back pain.Am Fam Phys. 2000; 61 (1789-1790): 1779-1786
- The effect of low-back pain on lumbar spinal movements measured by three-dimensional X-ray analysis.Spine. 1985; 10: 150-153https://doi.org/10.1097/00007632-198503000-00007
- Central pain mechanisms in chronic pain states–maybe it is all in their head. Best practice & research.Clin Rheumatol. 2011; 25: 141-154https://doi.org/10.1016/j.berh.2011.02.005
- Psychological and Neural Mechanisms of Pain.Raven Press, New York1988: 1-18
- Cortical activation following a balance disturbance.Exp Brain Res. 2004; 155: 393-400https://doi.org/10.1007/s00221-003-1744-6
- Effect of age on sensory gating of the sleep state-dependent P1/P50 midlatency auditory evoked potential.Sleep Res Online: SRO. 2000; 3: 97-105
- The pain inhibiting pain effect: An electrophysiological study in humans.Brain Res. 2000; 862: 103-110
- Central sensitization and altered central pain processing in chronic low back pain: Fact or myth?.Clin J Pain. 2013; 29: 625-638https://doi.org/10.1097/AJP.0b013e31826f9a71
- Preparatory brain activity and anticipatory postural adjustments accompanied by externally cued weighted-rapid arm rise task in non-specific chronic low back pain patients and healthy subjects.SpringerPlus. 2016; 5: 674https://doi.org/10.1186/s40064-016-2342-y
- The “pain matrix” in pain-free individuals.JAMA Neurol. 2016; 73: 755-756https://doi.org/10.1001/jamaneurol.2016.0653
- Impaired decision making and feedback evaluation in borderline personality disorder.Psychol Med. 2011; 41: 1917-1927https://doi.org/10.1017/s003329171000262x
- Serum brain-derived neurotrophic factor, depression, and antidepressant medications: Meta-analyses and implications.Biol Psychiatr. 2008; 64: 527-532https://doi.org/10.1016/j.biopsych.2008.05.005
- What is the Bereitschaftspotential?.Clin Neurophysiol. 2006; 117: 2341-2356https://doi.org/10.1016/j.clinph.2006.04.025
- Reduced sensory gating of the P1 potential in rape victims and combat veterans with posttraumatic stress disorder.Depression Anxiety. 1999; 9: 122-130
- Cognition and emotional decision-making in chronic low back pain: An ERPs study during Iowa gambling task.Front Psychol. 2014; 5: 1350https://doi.org/10.3389/fpsyg.2014.01350
- Equivalent electrical source analysis of pain-related somatosensory evoked potentials elicited by a CO2 laser.J Clin Neurophysiol. 1993; 10: 513-519
- How neuroimaging studies have challenged us to rethink: is chronic pain a disease?.J Pain. 2009; 10: 1113-1120https://doi.org/10.1016/j.jpain.2009.09.001
- The cortical representation of pain.Pain. 1999; 79: 105-111
- Decrease in postural sway and trunk stiffness during cognitive dual-task in nonspecific chronic low back pain patients, performance compared to healthy control subjects.Spine. 2010; 35: 583-589https://doi.org/10.1097/BRS.0b013e3181b4fe4d
- Back muscle activation patterns in chronic low back pain during walking: A "guarding" hypothesis.Clin J Pain. 2010; 26: 30-37https://doi.org/10.1097/AJP.0b013e3181b40eca
- Trunk muscle recruitment patterns in patients with low back pain enhance the stability of the lumbar spine.Spine. 2003; 28: 834-841https://doi.org/10.1097/01.BRS.0000058939.51147.55
- Trunk muscle activation in low-back pain patients, an analysis of the literature.J Electromyogr Kinesiol. 2003; 13: 333-351
- Catechol-O-methyltransferase gene haplotypes in Mexican and Spanish patients with fibromyalgia.Arthritis Res Ther. 2007; 9: R110https://doi.org/10.1186/ar2316
- Does habituation differ in chronic low back pain subjects compared to pain-free controls? A cross-sectional pain rating ERP study reanalyzed with the ERFIA multilevel method.Medicine. 2015; 94: e865https://doi.org/10.1097/md.0000000000000865
- The genetic influence on the cortical processing of experimental pain and the moderating effect of pain status.PloS one. 2010; 5https://doi.org/10.1371/journal.pone.0013641
- Pain in the ACC?.in: Proceedings of the National Academy of Sciences of the United States of America. 113. 2016: E2474-E2475https://doi.org/10.1073/pnas.1600282113
- The effect of chronic low back pain on size and contraction of the lumbar multifidus muscle.Manual Ther. 2009; 14: 496-500https://doi.org/10.1016/j.math.2008.09.006
Wells G, Shea B, O'Connell D, Peterson J, Welch V, Losos M, Tugwell P: The Newcastle–Ottawa Scale (NOS) for assessing the quality of non-randomized studies in meta-analysis, Available at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Accessed July 21, 2018.
- The subjective experience of pain: An FMRI study of percept-related models and functional connectivity.Pain Med. 2015; 16: 2121-2133https://doi.org/10.1111/pme.12785
- A comparison of the effects of two sitting postures on back and referred pain.Spine. 1991; 16: 1185-1191
- Attention and the control of posture and gait: A review of an emerging area of research.Gait Posture. 2002; 16: 1-14
- A subcortical correlate of P300 in man.Electroencephalogr Clin Neurophysiol. 1984; 59: 72-76
Article info
Publication history
Published online: June 28, 2019
The Journal of Pain – Reference number: JPAIN_2018_399Footnotes
Funding: This study was funded by an interdisciplinary grant from the Special Research Fund/Bijzonder Onderzoeksfonds (BOF) at Ghent University (grant number BOF14/IOP/067). Jessica Van Oosterwijck is a Postdoctoral Fellow funded by the Research Foundation – Flanders (FWO) (grant number 12L5616N). Sophie Van Oosterwijck is a PhD researcher supported by a research project grant from the Research Foundation – Flanders (FWO) received by Lieven Danneels and Jessica Van Oosterwijck (G0B3718N).
Disclosures: No other potential conflict of interest was reported by the authors. The authors have no conflicts of interests to declare.
Identification
Copyright
© Published by Elsevier Inc. on behalf of United States Association for the Study of Pain, Inc.
