Impaired visual perception of hurtful actions in patients with chronic low back pain.

Visually presented biological motion stimuli activate regions in the brain that are also related to musculo-skeletal pain. We therefore hypothesized that chronic pain impairs the perception of visually presented actions that involve body parts that hurt. In the first experiment, chronic back pain (CLBP) patients and healthy controls judged the lifted weight from point-light biological motion displays. An actor either lifted an invisible container (5, 10, or 15 kg) from the floor, or lifted and manipulated it from the right to the left. The latter involved twisting of the lower back and would be very painful for CLBP patients. All participants recognized the displayed actions, but CLBP patients were impaired in judging the difference in handled weights, especially for the trunk rotation. The second experiment involved discrimination between forward and backward walking. Here the patients were just as good as the controls, showing that the main result of the first experiment was indeed specific to the sensory aspects of the task, and not to general impairments or attentional deficits. The results thus indicate that the judgment of sensorimotor aspects of a visually displayed movement is specifically affected by chronic low back pain.