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Horsburgh A, Summers SJ, Lewis A, Keegan RJ, Flood A. The Relationship Between Pain and Interoception: A Systematic Review and Meta-Analysis. THE JOURNAL OF PAIN 2024; 25:104476. [PMID: 38244898 DOI: 10.1016/j.jpain.2024.01.341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 01/22/2024]
Abstract
Interoception refers to the ability to sense internal bodily sensations. Research suggests that dysfunctions in interoception may be implicated in the transition to chronic pain, however, little work has examined interoceptive ability in pain states. Therefore, this systematic review aimed to assess whether interoception is altered in individuals experiencing pain. Following a systematic search of 4 electronic databases from inception to February 2023, 28 studies were included. Outcomes of interoceptive accuracy, interoceptive sensibility, and interoceptive awareness were meta-analysed. The risk of bias was assessed, and the certainty of the evidence was evaluated. Meta-analyses indicated that those with chronic pain display reduced interoceptive accuracy and increased interoceptive sensibility. Subgroup analyses indicated that the change in interoceptive sensibility is dependent on the measure used, with those with chronic pain scoring higher on measures focusing on attention to bodily sensations, while also scoring lower on emotional reactivity. No difference in interoceptive awareness was observed between individuals with chronic pain and pain-free controls. Only one study was found that measured interoception in those experiencing acute pain, while another study recruited those experiencing recurrent pain. These findings suggest that while those with chronic pain self-report as more interoceptively aware, they are less accurate at detecting internal bodily signals. Further research investigating domains of interoception in those experiencing acute and recurrent pain is needed. Data should be interpreted with caution as the certainty of evidence was very low for all completed analyses. This review was registered on the PROSPERO International Prospective Register of Systematic Reviews (Registration ID = CRD42022318843). PERSPECTIVE: This review considered the relationship between interoception and pain and found that an individual's ability to accurately sense internal signals is decreased in those with chronic pain, despite them reporting being more aware of internal sensations. However, there remains little research examining interoception in non-chronic pain states.
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Affiliation(s)
- Annabel Horsburgh
- University of Canberra Research Institute for Sport and Exercise, Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia; Discipline of Psychology, Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Simon J Summers
- Brain Stimulation and Rehabilitation (BrainStAR) Lab, School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia; Faculty of Health, School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Aidan Lewis
- University of Canberra Research Institute for Sport and Exercise, Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia; Discipline of Psychology, Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Richard J Keegan
- University of Canberra Research Institute for Sport and Exercise, Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia; Discipline of Sport and Exercise Science, Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Andrew Flood
- University of Canberra Research Institute for Sport and Exercise, Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia; Discipline of Psychology, Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
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Foglia SD, Drapeau CC, Rehsi RS, Ramdeo KR, Shanthanna H, Nelson AJ. Repetitive Transcranial Magnetic Stimulation with Sensorimotor Training for the Treatment of Complex Regional Pain Syndrome Type 2 of the Upper Limb Case Report. A A Pract 2024; 18:e01768. [PMID: 38546353 PMCID: PMC11057489 DOI: 10.1213/xaa.0000000000001768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2024] [Indexed: 05/01/2024]
Abstract
This case report describes the use of repetitive transcranial magnetic stimulation (rTMS) combined with sensorimotor training (SMT) to treat an individual with complex regional pain syndrome (CRPS) type 2 with allodynia of the right hand/wrist. After the 9-week intervention, there was a clinically meaningful reduction in pain intensity which continued to 3 months after intervention. Further, clinically meaningful improvements in wrist and hand function and allodynia were observed. Although the use of rTMS for CRPS has been reported, this unique report provides valuable insight into the clinical utility of rTMS plus SMT for the treatment of CRPS and related symptoms.
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Affiliation(s)
- Stevie D. Foglia
- From the School of Biomedical Engineering, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | - Harsha Shanthanna
- From the School of Biomedical Engineering, McMaster University, Hamilton, Ontario, Canada
- Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Aimee J. Nelson
- From the School of Biomedical Engineering, McMaster University, Hamilton, Ontario, Canada
- Departments of Kinesiology
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3
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Salgues S, Plancher G, Michael GA. Is it really on your hand? Spontaneous sensations are not peripheral sensations - Evidence from able-bodied individuals and a phantom limb syndrome patient. Brain Cogn 2024; 175:106138. [PMID: 38335922 DOI: 10.1016/j.bandc.2024.106138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024]
Abstract
Among other bodily signals, the perception of sensations arising spontaneously on the skin with no external triggers contributes to body awareness. The topic of spontaneous sensations (SPS) being quite recent in the literature, there is still a debate whether this phenomenon is elicited by peripheral cutaneous units' activity underlying tactile perception or originates directly from central mechanisms. In a first experiment, we figured that, if SPS depended on peripheral afferents, their perception on the glabrous hand should relate to the hand tactile sensitivity. On the contrary, we found no relationship at all, which led us to envisage the scenario of SPS in the absence of cutaneous units. In a second experiment, we present the case of Julie, a right-hand amputee that could perceive and report SPS arising on her phantom limb syndrome. We found that SPS distribution on the phantom limb followed the same gradient as that observed in control participants, unlike SPS perceived on the intact left hand. Those findings are crucial to the understanding of neural factors determining body awareness through SPS perception and provide insights into the existence of a precise neural gradient underlying somesthesis.
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Affiliation(s)
- Sara Salgues
- Département de Sciences Cognitives, Psychologie Cognitive & Neuropsychologie, Institut de Psychologie, Unité de Recherche Étude des Mécanismes Cognitifs (EA 3082), Université Lumière Lyon 2, Lyon, France; Laboratoire Mémoire Cerveau et Cognition, Université Paris Cité, Paris, France.
| | - Gaën Plancher
- Département de Sciences Cognitives, Psychologie Cognitive & Neuropsychologie, Institut de Psychologie, Unité de Recherche Étude des Mécanismes Cognitifs (EA 3082), Université Lumière Lyon 2, Lyon, France; Institut Universitaire de France (IUF), France
| | - George A Michael
- Département de Sciences Cognitives, Psychologie Cognitive & Neuropsychologie, Institut de Psychologie, Unité de Recherche Étude des Mécanismes Cognitifs (EA 3082), Université Lumière Lyon 2, Lyon, France
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4
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Moro V, Scandola M, Gobbetto V, Bertagnoli S, Beccherle M, Besharati S, Ponzo S, Fotopoulou A, Jenkinson PM. Examining the role of self-reported somatosensory sensations in body (dis)ownership: A scoping review and empirical study of patients with a disturbed sense of limb ownership. Neuropsychologia 2024; 194:108776. [PMID: 38141962 DOI: 10.1016/j.neuropsychologia.2023.108776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/20/2023] [Accepted: 12/20/2023] [Indexed: 12/25/2023]
Abstract
Patients with a disturbed sense of limb ownership (DSO) offer a unique window of insight into the multisensory processes contributing to the sense of body ownership. A limited amount of past research has examined the role of sensory deficits in DSO, and even less is known regarding the role of patient self-reported somatosensory sensations in the pathogenesis of DSO. To address this lack of knowledge we first conducted a systematic scoping review following PRISMA-SR guidelines, examining current research into somatosensory deficits and patient self-reported somatosensory sensations in patients with DSO. Eighty studies, including 277 DSO patients, were identified. The assessment of sensory deficits was generally limited in scope and quality, and deficits in tactile sensitivity and proprioception were most frequently found. The reporting of somatosensory sensations was even less frequent, with instances of paraesthesia (pins-and-needles), stiffness/rigidity, numbness and warmth, coldness and heaviness amongst the deficits recorded. In a second part of the study, we sought to directly address the lack of evidence concerning the impact of patient self-reported somatosensory sensations in DSO by measuring DSO and self-reported somatosensory sensations in a large (n = 121) sample of right-hemisphere stroke patients including N = 65 with DSO and N = 56 hemiplegic controls. Results show that feelings of coldness and stiffness modulate DSO symptoms. Sense of heaviness and numbness are more frequent in patients with DSO but do not have a clear impact on disownership symptomology. Although preliminary, these results suggest a role of subjective sensations about the felt body in the sense of limb ownership.
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Affiliation(s)
- Valentina Moro
- Npsy-Lab.Vr, Department of Human Sciences, University of Verona, Italy.
| | - Michele Scandola
- Npsy-Lab.Vr, Department of Human Sciences, University of Verona, Italy
| | | | - Sara Bertagnoli
- Social and Cognitive Neuroscience Laboratory, Department of Psychology, University La Sapienza, Roma, Italy
| | | | - Sahba Besharati
- Department of Psychology, University of Witwatersrand, Johannesburg, South Africa
| | | | - Aikaterini Fotopoulou
- Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Paul M Jenkinson
- Research Department of Clinical, Educational and Health Psychology, University College London, UK; ISN Psychology, Institute for Social Neuroscience, Melbourne, Australia.
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Melf-Marzi A, Böhringer B, Wiehle M, Hausteiner-Wiehle C. Modern Principles of Diagnosis and Treatment in Complex Regional Pain Syndrome. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:879-886. [PMID: 36482756 PMCID: PMC10011717 DOI: 10.3238/arztebl.m2022.0358] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 04/21/2022] [Accepted: 10/17/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Background: Complex regional pain syndrome (CRPS) is a relatively common complication, occurring in 5% of cases after injury or surgery, particularly in the limbs. The incidence of CPRS is around 5-26/100 000. The latest revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11) now categorizes CRPS as a primary pain condition of multifactorial origin, rather than a disease of the skeletal system or the autonomic nervous system. METHODS Method: Based on a selective search of the literature, we summarize current principles for the diagnosis and treatment of CRPS. RESULTS Results: Regional findings in CRPS are accompanied by systemic symptoms, especially by neurocognitive disorders of body perception and of symptom processing. The therapeutic focus is shifting from predominantly passive peripheral measures to early active treatments acting both centrally and peripherally. The treatment is centered on physiotherapy and occupational therapy to improve sensory perception, strength, (fine) motor skills, and sensorimotor integration/ body perception. This is supported by stepped psychological interventions to reduce anxiety and avoidance behavior, medication to decrease inflammation and pain, passive physical measures for reduction of edema and of pain, and medical aids to improve functioning in daily life. Interventional procedures should be limited to exceptional cases and only be performed in specialized centers. Spinal cord and dorsal root ganglion stimulation, respectively, are the interventions with the best evidence. CONCLUSION Conclusion: The modern principles for the diagnosis and treatment of CRPS consider both, physiological and psychological mechanisms, with the primary goal of restoring function and participation. More research is needed to strengthen the evidence base in this field.
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Affiliation(s)
- Alexandra Melf-Marzi
- Department for BG Rehabilitation; Outpatient CRPS Clinic; BG Trauma Center Murnau; Department for Anesthesiology, Intensive Care Medicine and Pain Therapy; Multimodal Pain Therapy; BG Trauma Center Murnau; Department for Neurology, Clinical Neurophysiology and Stroke Unit; BG Trauma Center Murnau; Clinic and Polyclinic for Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich
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Michael GA, Salgues S, Plancher G, Duran G. Cues to body-related distortions and hallucinations? Spontaneous sensations correlate with EEG oscillatory activity recorded at rest in the somatosensory cortices. Psychiatry Res Neuroimaging 2022; 324:111506. [PMID: 35688045 DOI: 10.1016/j.pscychresns.2022.111506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 09/18/2021] [Accepted: 05/29/2022] [Indexed: 11/17/2022]
Abstract
Body awareness may arise in the total absence of sensory input, as suggested by the spontaneous occurrence of normal and pathological (i.e., hallucinatory) bodily sensations. These phenomena may arise due to back-projections from higher-order cortical areas to the primary (SI) and secondary (SII) somatosensory cortices, and would appear to be reflected in cortical oscillatory activity in both SI and SII. Here, we set to investigate the relationship of SI and SII in SPS. Healthy participants underwent an EEG recording session at rest, and then completed an experiment on the perception of spontaneous sensations occurring on the hands. Cortical oscillatory activity was extracted from specified ROIs in the somatosensory cortices. The findings showed that (i) SPS perceived in the fingers correlated positively with alpha-band oscillations recorded in SI, and that (ii) SPS perceived in the palm correlated positively with gamma-band oscillations and negatively with beta-band oscillations recorded in SII. Apart from supporting the idea that the somatosensory cortices are involved in bodily awareness even in the absence of sensory input, these findings also suggest that default oscillatory activity in the somatosensory cortices reflects individual differences in bodily awareness. The results are interpreted in terms of neural and cognitive processes that may give rise to bodily awareness and modulate it, and their importance in understanding body perception distortions and bodily delusions and hallucinations is discussed.
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Affiliation(s)
- George A Michael
- Université de Lyon, Lyon, France; Université Lyon 2, Unité de Recherche EMC, Lyon, France; Université Lyon 2, Institut de Psychologie, Lyon, France.
| | - Sara Salgues
- Université de Lyon, Lyon, France; Université Lyon 2, Unité de Recherche EMC, Lyon, France; Université Lyon 2, Institut de Psychologie, Lyon, France
| | - Gaën Plancher
- Université de Lyon, Lyon, France; Université Lyon 2, Unité de Recherche EMC, Lyon, France; Université Lyon 2, Institut de Psychologie, Lyon, France
| | - Geoffrey Duran
- Université de Lyon, Lyon, France; Université Lyon 2, Unité de Recherche EMC, Lyon, France; Université Lyon 2, Institut de Psychologie, Lyon, France
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7
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Biran I, Book A, Aviram L, Bregman N, Bahagali E, Tripto A. Body Structural Description Impairment in Complex Regional Pain Syndrome Type I. Front Psychol 2022; 13:853641. [PMID: 35756256 PMCID: PMC9226898 DOI: 10.3389/fpsyg.2022.853641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background Complex Regional Pain Syndrome (CRPS) is a clinical syndrome composed of chronic pain, motor impairment, and autonomic dysfunction, usually affecting a limb. Although CRPS seems to be a peripheral disorder, it is accompanied by parietal alterations leading to body schema impairments (the online representations of the body). Impairments to body structural description (the topographical bodily map) were not assessed systematically in CRPS. A patient we encountered with severe disruption to her bodily structural description led us to study this domain further. Aims To document aberrant body structural description in subjects with CRPS using an object assembly task. Methods Body Schema Study: 6 subjects with CRPS-I and six age and sex-matched healthy controls completed visual puzzles taken from WAIS-III and WAIS-R. The puzzles were either related to the human body or non-human body objects. Mann–Whitney U-tests were performed to compare groups’ performances. Results The CRPS group received relatively lower scores compared to controls for human body objects (u = 3, p < 0.05), whereas the non-human object scoring did not reveal significant differences between groups (u = 9, p > 0.05). Conclusion CRPS subjects suffer from impaired body structural description, taking the form of body parts disassembly and body parts discontinuity. This impairment can serve as a nidus for aberrant psychological representation of the body.
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Affiliation(s)
- Iftah Biran
- Neurological Institute, Tel Aviv Medical Center, Tel Aviv-Yafo, Israel.,Division of Psychiatry, Tel Aviv Medical Center, Tel Aviv-Yafo, Israel.,The Rehabilitation Hospital, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Andrea Book
- The Rehabilitation Hospital, Chaim Sheba Medical Center, Ramat Gan, Israel.,Department of Psychology, Ari'el University, Ari'el, Israel
| | - Liron Aviram
- Department of Psychology, The Academic College of Tel Aviv - Yaffo, Tel Aviv-Yafo, Israel
| | - Noa Bregman
- Neurological Institute, Tel Aviv Medical Center, Tel Aviv-Yafo, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Einat Bahagali
- Department of Psychology, Ari'el University, Ari'el, Israel
| | - Assaf Tripto
- The Rehabilitation Hospital, Chaim Sheba Medical Center, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel.,Be'eri Clinic, Clalit Health Services, Bnei Brak, Israel
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8
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Vittersø AD, Halicka M, Buckingham G, Proulx MJ, Bultitude JH. The sensorimotor theory of pathological pain revisited. Neurosci Biobehav Rev 2022; 139:104735. [PMID: 35705110 DOI: 10.1016/j.neubiorev.2022.104735] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/13/2022] [Accepted: 06/07/2022] [Indexed: 01/31/2023]
Abstract
Harris (1999) proposed that pain can arise in the absence of tissue damage because changes in the cortical representation of the painful body part lead to incongruences between motor intention and sensory feedback. This idea, subsequently termed the sensorimotor theory of pain, has formed the basis for novel treatments for pathological pain. Here we review the evidence that people with pathological pain have changes to processes contributing to sensorimotor function: motor function, sensory feedback, cognitive representations of the body and its surrounding space, multisensory processing, and sensorimotor integration. Changes to sensorimotor processing are most evident in the form of motor deficits, sensory changes, and body representations distortions, and for Complex Regional Pain Syndrome (CRPS), fibromyalgia, and low back pain. Many sensorimotor changes are related to cortical processing, pain, and other clinical characteristics. However, there is very limited evidence that changes in sensorimotor processing actually lead to pain. We therefore propose that the theory is more appropriate for understanding why pain persists rather than how it arises.
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Affiliation(s)
- Axel D Vittersø
- Centre for Pain Research, University of Bath, Bath, Somerset, United Kingdom; Department of Psychology, University of Bath, Bath, Somerset, United Kingdom; Department of Sport & Health Sciences, University of Exeter, Exeter, Devon, United Kingdom; Department of Psychology, Oslo New University College, Oslo, Norway.
| | - Monika Halicka
- Centre for Pain Research, University of Bath, Bath, Somerset, United Kingdom; Department of Psychology, University of Bath, Bath, Somerset, United Kingdom
| | - Gavin Buckingham
- Department of Sport & Health Sciences, University of Exeter, Exeter, Devon, United Kingdom
| | - Michael J Proulx
- Department of Psychology, University of Bath, Bath, Somerset, United Kingdom; Centre for Real and Virtual Environments Augmentation Labs, Department of Computer Science, University of Bath, Bath, Somerset, United Kingdom
| | - Janet H Bultitude
- Centre for Pain Research, University of Bath, Bath, Somerset, United Kingdom; Department of Psychology, University of Bath, Bath, Somerset, United Kingdom
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Vastano R, Costantini M, Widerstrom-Noga E. Maladaptive reorganization following SCI: The role of body representation and multisensory integration. Prog Neurobiol 2021; 208:102179. [PMID: 34600947 DOI: 10.1016/j.pneurobio.2021.102179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 09/08/2021] [Accepted: 09/24/2021] [Indexed: 10/20/2022]
Abstract
In this review we focus on maladaptive brain reorganization after spinal cord injury (SCI), including the development of neuropathic pain, and its relationship with impairments in body representation and multisensory integration. We will discuss the implications of altered sensorimotor interactions after SCI with and without neuropathic pain and possible deficits in multisensory integration and body representation. Within this framework we will examine published research findings focused on the use of bodily illusions to manipulate multisensory body representation to induce analgesic effects in heterogeneous chronic pain populations and in SCI-related neuropathic pain. We propose that the development and intensification of neuropathic pain after SCI is partly dependent on brain reorganization associated with dysfunctional multisensory integration processes and distorted body representation. We conclude this review by suggesting future research avenues that may lead to a better understanding of the complex mechanisms underlying the sense of the body after SCI, with a focus on cortical changes.
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Affiliation(s)
- Roberta Vastano
- University of Miami, Department of Neurological Surgery, The Miami Project to Cure Paralysis, Miami, FL, USA.
| | - Marcello Costantini
- Department of Psychological, Health and Territorial Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy; Institute for Advanced Biomedical Technologies, ITAB, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy.
| | - Eva Widerstrom-Noga
- University of Miami, Department of Neurological Surgery, The Miami Project to Cure Paralysis, Miami, FL, USA.
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10
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Lewis JS, Newport R, Taylor G, Smith M, McCabe CS. Visual illusions modulate body perception disturbance and pain in Complex Regional Pain Syndrome: A randomized trial. Eur J Pain 2021; 25:1551-1563. [PMID: 33759278 DOI: 10.1002/ejp.1766] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/14/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Effective treatment of longstanding Complex Regional Pain Syndrome (CRPS) is a challenge, as causal mechanisms remain elusive. People with CRPS frequently report distorted subjective perceptions of their affected limb. Evidence of pain reduction when the affected limb is visually altered in size suggests that visual illusions used to target central processing could restore coherence of this disrupted limb representation. We hypothesized that using virtual reality that alters hand image to match the patient's desired hand appearance would improve body perception disturbance and pain. Also, repeated exposure would maintain any therapeutic effect. METHODS A blinded randomized controlled trial of 45 participants with refractory upper-limb CRPS and body perception disturbance (BPD) viewed a digital image of their affected hand for 1 min. The image was digitally altered according to the patient's description of how they desired their hand to look in the experimental group and unaltered in the control group. BPD and pain were measured pre- and post-intervention. A subgroup was followed up 2 weeks after a course of repeated interventions. RESULTS BPD (mean-6, ±SD 7.9, p = 0.036, effect size [ES] = 0.6) and pain intensity (mean-0.43, ±SD 1.3, p = 0.047, ES = 0.5) reduced in 23 participants after single exposure compared to controls (n = 22). At follow-up, the subgroup (experimental n = 21; control n = 18) showed sustained pain reduction only (p = 0.037, ±SD 1.9, ES = 0.7), with an overall 1.2 decrease on an 11-point scale. CONCLUSIONS Visually changing the CRPS hand to a desired appearance modulates BPD and pain suggesting therapeutic potential for those with refractory CRPS. Further research to optimize this therapeutic effect is required. SIGNIFICANCE Visual bodily illusions that change the shape and appearance of the painful CRPS hand to that desired by the patient result in a rapid amelioration of pain and body perception disturbance in people with longstanding CRPS. These findings highlight the future potential of this drug-free approach in the treatment of refractory CRPS.
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Affiliation(s)
- Jennifer S Lewis
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Trust, Bath, UK
- University of the West of England, Bristol, UK
| | - Roger Newport
- University of Nottingham, Nottingham, UK
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | | | - Mike Smith
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Trust, Bath, UK
| | - Candida S McCabe
- University of the West of England, Bristol, UK
- Florence Nightingale Foundation, London, UK
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11
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Salgues S, Plancher G, Michael GA. Visuospatial working memory abilities and spontaneous sensations perception. Somatosens Mot Res 2021; 38:164-177. [PMID: 34180338 DOI: 10.1080/08990220.2021.1914018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Aim: Body awareness arises when attending to and maintaining awareness of visuospatial body representations. By the same token, focussing on representations transfers them to working memory. Body awareness and working memory seemingly rely on similar processes and recruit common parietal areas involved in perception. Therefore, we asked whether visuospatial working memory abilities would define individual differences in the perception of spontaneous sensations (SPS), i.e., bodily sensations perceived in the absence of triggers (e.g., tactile stimulation or movement), when attending to the body.Method: Participants completed two visuospatial working memory tasks to assess various mechanisms: (i) the decay of representations was assessed through a Brown-Peterson task in which the delay between the memorandum presentation and its recall was manipulated, and (ii) the impact of distractors' interference and cognitive load (i.e., complexity) on recall performances were assessed through a complex span task that required the processing of distractors while maintaining a memorandum. A standard SPS task involving localization and characterization of SPS perceived on the hands was completed afterwards.Results: Low performance due to decay, distractors' interference and cognitive load in visuospatial working memory was associated with a decrease in the frequency of SPS. Additionally, low performance due to distractors' cognitive load predicted a decrease in the perception of surface-type sensations, and high performance despite distractors' interference led to a better perception of SPS on less sensitive areas of the hand.Conclusion: We discuss how visuospatial working memory processes might contribute to body awareness and perceptual distortions of the body.
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Affiliation(s)
- Sara Salgues
- Université de Lyon, Lyon, France.,Département de Sciences Cognitives, Psychologie Cognitive et Neuropsychologie, Laboratoire d'Étude des Mécanismes Cognitifs (EA 3082), Institut de Psychologie, Université Lyon 2, Lyon, France
| | - Gaën Plancher
- Université de Lyon, Lyon, France.,Département de Sciences Cognitives, Psychologie Cognitive et Neuropsychologie, Laboratoire d'Étude des Mécanismes Cognitifs (EA 3082), Institut de Psychologie, Université Lyon 2, Lyon, France
| | - George A Michael
- Université de Lyon, Lyon, France.,Département de Sciences Cognitives, Psychologie Cognitive et Neuropsychologie, Laboratoire d'Étude des Mécanismes Cognitifs (EA 3082), Institut de Psychologie, Université Lyon 2, Lyon, France
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12
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Michael GA, Guyot D, Tarroux E, Comte M, Salgues S. Feeling Oneself Requires Embodiment: Insights From the Relationship Between Own-Body Transformations, Schizotypal Personality Traits, and Spontaneous Bodily Sensations. Front Psychol 2021; 11:578237. [PMID: 33424690 PMCID: PMC7786119 DOI: 10.3389/fpsyg.2020.578237] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 12/07/2020] [Indexed: 12/25/2022] Open
Abstract
Subtle bodily sensations such as itching or fluttering that occur in the absence of any external trigger (i.e., spontaneous sensations, or SPS) may serve to locate the spatial boundaries of the body. They may constitute the normal counterpart of extreme conditions in which body-related hallucinations and perceptual aberrations are experienced. Previous investigations have suggested that situations in which the body is spontaneously experienced as being deformed are related to the ability to perform own-body transformations, i.e., mental rotations of the body requiring disembodiment. We therefore decided to consider whether the perception of SPS might relate to embodiment as assessed through (i) the ability to perform own-body transformations (OBT task) and (ii) schizotypal traits (Schizotypal Personality Questionnaire, or SPQ), since high degrees of schizotypy in the general population have been associated with more vivid perceptions and aberrant perceptual experiences. Then participants completed a standard SPS task. Our analysis revealed that the slower the response time in the OBT task, the more frequent the perception of SPS. This suggests that difficulties in disembodying and mentally transforming one's own body facilitate feeling oneself. Furthermore, a greater number of correct responses in the OBT task was associated with less frequent perception of SPS. This suggests that finding it easier to disembody and perform mental own-body transformations interferes with the ability to sense oneself. The results also show that higher schizotypal traits, as assessed through the SPQ, are associated with more frequent perception of SPS. Taken together, these results provide a coherent picture and suggest that embodiment is required in order to correctly feel oneself, as expressed through the perception of SPS. The ability to easily experience disembodiment reduces the sense of feeling oneself, and proneness to schizotypal traits produces body misperceptions that enhance and amplify this feeling. The results are discussed in the light of current knowledge and theories about body representations, taking into account attention and interoception as factors that influence body awareness. We offer explanations for perceptual aberrations, body-related delusions, and hallucinations based on misperceived or misinterpreted SPS, and we discuss possible mechanisms that may contribute to feeling and misperceiving oneself.
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Affiliation(s)
- George A Michael
- University of Lyon, Lyon, France.,University Lyon 2, Laboratoire EMC (Cognitive Mechanisms Research Laboratory) (EA 3082), Lyon, France.,University Lyon 2, Institute of Psychology, Lyon, France
| | - Deborah Guyot
- University of Lyon, Lyon, France.,University Lyon 2, Laboratoire EMC (Cognitive Mechanisms Research Laboratory) (EA 3082), Lyon, France.,University Lyon 2, Institute of Psychology, Lyon, France
| | - Emilie Tarroux
- University of Lyon, Lyon, France.,University Lyon 2, Laboratoire EMC (Cognitive Mechanisms Research Laboratory) (EA 3082), Lyon, France.,University Lyon 2, Institute of Psychology, Lyon, France
| | - Mylène Comte
- University of Lyon, Lyon, France.,University Lyon 2, Laboratoire EMC (Cognitive Mechanisms Research Laboratory) (EA 3082), Lyon, France.,University Lyon 2, Institute of Psychology, Lyon, France
| | - Sara Salgues
- University of Lyon, Lyon, France.,University Lyon 2, Laboratoire EMC (Cognitive Mechanisms Research Laboratory) (EA 3082), Lyon, France.,University Lyon 2, Institute of Psychology, Lyon, France
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Hirakawa Y, Imai R, Shigetoh H, Morioka S. Intervention Using Body Shadow to Evoke Loading Imagery in a Patient with Complex Regional Pain Syndrome in the Foot: A Case Report. Brain Sci 2020; 10:brainsci10100718. [PMID: 33050227 PMCID: PMC7600743 DOI: 10.3390/brainsci10100718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 11/30/2022] Open
Abstract
We present the case of a female patient who developed complex regional pain syndrome (CRPS) after a right-foot injury. The patient had pain from the right knee to the toes and showed severe disgust at the appearance of the affected limb. Consequently, the affected limb was not fully loaded, and the patient had difficulty walking. General interventions, such as mirror therapy, were attempted, but the effect was limited. We hypothesized that this was due to the disgust toward the affected limb, and we implemented a body-shadow intervention that we developed. This reduced the disgust for the affected limb and improved pain, but neither changed the anticipated pain of loading the affected limb nor improved the patient’s walking ability. The reason for this was considered to be that the previous interventions using the body shadow utilized the third-person perspective, denoting that the image of the load sensation on the sole of the foot during walking was insufficient; therefore, we attempted a first-person body-shadow intervention. The results showed improvement in the patient’s walking ability. In CRPS of the foot, it is important to use interventions that evoke images of loading without causing anticipatory pain, pointing to the effectiveness of body-shadow interventions.
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Affiliation(s)
- Yoshiyuki Hirakawa
- Department of Rehabilitation, Fukuoka Rehabilitation Hospital, Fukuoka City, Fukuoka 819-8551, Japan
- Correspondence: ; Tel.: +81-(092)-812-1555
| | - Ryota Imai
- School of Rehabilitation Osaka Kawasaki Rehabilitation University, Kaizuka City, Osaka 597-0104, Japan;
| | - Hayato Shigetoh
- Miura Internal Medicine Michiko Pediatrics Clinic, Kagawa 763-0082, Japan;
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, Nara City, Nara 635-0832, Japan;
| | - Shu Morioka
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, Nara City, Nara 635-0832, Japan;
- Neurorehabilitation Research Centre, Kio University, Nara City, Nara 635-0832, Japan
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