Not my body, not my pain? Pain perception and placebo analgesia in individuals with body integrity dysphoria

Is it really on your hand? Spontaneous sensations are not peripheral sensations - Evidence from able-bodied individuals and a phantom limb syndrome patient

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.

Sensorimotor Uncertainty of Immersive Virtual Reality Environments for People in Pain: Scoping Review

INTRODUCTION

Decision making and action execution both rely on sensory information, and their primary objective is to minimise uncertainty. Virtual reality (VR) introduces uncertainty due to the imprecision of perceptual information. The concept of "sensorimotor uncertainty" is a pivotal element in the interplay between perception and action within the VR environment. The role of immersive VR in the four stages of motor behaviour decision making in people with pain has been previously discussed. These four processing levels are the basis to understand the uncertainty that a patient experiences when using VR: sensory information, current state, transition rules, and the outcome obtained.

METHODS

This review examines the different types of uncertainty that a patient may experience when they are immersed in a virtual reality environment in a context of pain. Randomised clinical trials, a secondary analysis of randomised clinical trials, and pilot randomised clinical trials related to the scope of Sensorimotor Uncertainty in Immersive Virtual Reality were included after searching.

RESULTS

Fifty studies were included in this review. They were divided into four categories regarding the type of uncertainty the intervention created and the stage of the decision-making model.

CONCLUSIONS

Immersive virtual reality makes it possible to alter sensorimotor uncertainty, but studies of higher methodological quality are needed on this topic, as well as an exploration into the patient profile for pain management using immersive VR.

Ownership of the affected leg is further reduced following deceptive behaviors in body integrity dysphoria

Although predicted by the notion of embodied morality, it remains unknown whether a reduced sense of body ownership (SoO) is associated with increased or decreased dishonesty. To clarify this issue, we tested patients with body integrity dysphoria (BID), a clinical condition characterized by chronic reductions of SoO toward one leg that patients persistently desire to have amputated. Participants with BID played a card game in which they could voluntarily tell the truth or cheat an opponent, and thus either steal or give them money. To assess whether SoO toward the effector limb influences (im)moral decisions, responses were communicated with the affected or the unaffected leg. We found that a higher number of self-gain lies was followed by further reductions of SoO toward the affected leg. Our result supports the idea that reductions of SoO may follow immoral behaviors to distance from unwanted characteristics of the self, like one's own dishonesty.

An illusion of disownership over one's own limb is associated with pain perception

Viewing one's body and even a fake/virtual body experienced as one's own has been suggested to modulate pain perception. However, what happens to pain perception when one's own body part is felt as not belonging to one? We designed a paradigm to induce an illusory feeling of disownership regarding one's limb, investigating whether the feeling affects pain threshold. Participants observed right-side images of their bodies from a third-person perspective via a head-mounted display in real-time. Following instructions, they moved their left hand while keeping their left elbow behind the upper body, so that the connection of their arm to the torso was not visible (test condition), or in front of it, so they could see the arm being part of them (control condition). Then, pain threshold was tested with a thermal stimulator. We found a significantly higher strength of disownership in the test condition than in the control condition. While there was no pain modulation within and between conditions, disownership ratings negatively correlated with pain-threshold changes, where the participants reporting explicit disownership showed lower pain-threshold changes than the others. The finding suggests that while multisensory disintegration had no modulatory effect, the individual sense of disownership was associated with pain perception.

Influence of bodily states on cognition: A web-based study in individuals with body integrity dysphoria

There is a constant reciprocal flow of information between the malleable sensorimotor states of the body and cognitive functions, and some embodied cognition approaches argue that many cognitive-affective mechanisms depend on the physical characteristics of the body. To examine such influences of bodily state, the current study compared patients with body integrity dysphoria (BID) with an amputation desire of the lower limb to a healthy control group on an Implicit Association Test for self-identity and self-esteem, and a pain evaluation task. Patients with BID completed the tasks once while emulating their desired bodily state and once while simulating their undesired bodily state, while healthy controls were split into two groups: one control group completed the experiment once while either sitting on one leg and once while sitting in a normal position, whereas the other control group completed both experiments while sitting in a normal position. Results demonstrate that patients with BID implicitly identify more strongly with an amputated body, whereas healthy controls demonstrate stronger identification with a complete body, independent of bodily state. Furthermore, implicit self-esteem did not differ between the groups and was also not modulated by bodily state manipulation in any of the groups. Pain evaluation ratings were not influenced by bodily state manipulation, perspective, or consistency. Pain forced choice response times, however, revealed that individuals with BID were faster to judge whether the stimulus depicted was painful when simulating their desired bodily state. These results provide insightful information to how both the subjective sense of body, as well as more transient alterations of objective sensorimotor states of the physical body may exert selective pressure on certain cognitive tasks.