Understanding Chronic Non-Specific Low Back Pain through Postural, Respiratory, and Emotional Processes

Abstract

Chronic, non-specific low back pain (CNSLBP) is a complex, multifactorial condition. Gaining insight into its underlying mechanisms could enhance mechanistic understanding of CNSLBP and improve clinical practice, thereby limiting the actual and projected burden on societal and healthcare systems. In this doctoral thesis, we focused on postural behavior, respiration, and psychological factors as possible underlying mechanisms of CNSLBP and how they relate to each other within this population.

Our findings in Chapter 2 reveal that postural behavior and psychological factors are only weakly associated with each other in individuals with CNSLBP. In Chapter 3, we demonstrated that individuals with CNSLBP exhibit subnormal PetCO2 values at rest and slower recovery of PetCO2 following a respiratory challenge compared to healthy individuals. In addition, individuals with CNSLBP reported higher levels of difficulties in identifying feelings and sensitivity towards neutral bodily sensations compared to healthy individuals. In Chapter 4, we revealed that body position (sitting vs standing) had minimal effects on the emotional imagery paradigm in healthy individuals and concluded that the emotional imagery paradigm could be used in a standing position. Thereafter, in Chapter 5, we showed that emotional imagery did not affect postural behavior in healthy individuals. This served as a premise for Chapter 6, in which we showed that although postural behavior and respiration were not affected by emotional imagery, symptom perception did. Individuals with CNSLBP reported more bodily complaints during the hostile-resistance script compared to the acceptance and relaxation script. Ultimately, in Chapter 7, we demonstrated that different types of breathing interventions could be of value in clinical practice, as they resulted in decreases in pain and disability levels in individuals with CNSLBP. Taken together, our findings underscore the relevance of adopting a biopsychosocial approach to CNSLBP, with particular emphasis on symptom perception processes, respiration, and psychological factors.