Fear of movement disturbs inter-limb coupling in complex regional pain syndrome

Effect of Painful Electrical Stimuli on Readiness Potential in the Human Brain

The readiness potential (RP), which is a slow negative electrical brain potential that occurs before voluntary movement, can be interpreted as a measure of intrinsic brain activity originating from self-regulating mechanisms. Early and late components of the RP may indicate clinical-neurophysiological features such as motivation, preparation, intention, and initiation of voluntary movements. In the present study, we hypothesized that electrical pain stimuli modulate the preparatory brain activity for movement. The grand average evoked potentials were measured at sensory motor regions with EEG during an experimental protocol consisting of painful and nonpainful stimuli. Our results demonstrated that painful stimuli were preceded by an enhanced RP when compared to non-painful stimuli at the Cz channel (p < 0.05). Furthermore, the mean amplitude of the RP at the early phase was significantly higher for the painful stimuli when compared to the non-painful stimuli (p < 0.05). Our results indicate that electrical painful stimuli, which can be considered as an unpleasant and stressful condition, modulate the motor preparation at sensory motor regions to a different extent when compared to non-painful electrical stimuli. Since early component of the RP represents cortical activation due to anticipation of the stimuli and the allocation of attentional resources, our results suggest that painful stimuli may affect the motor preparation processes and the prediction of the movement at the cortical level.

Fear of movement-related pain disturbs cortical preparatory activity after becoming aware of motor intention

Fear of movement-related pain is known to disturb the process of motor preparation in patients with chronic pain. In the present study, we aimed to clarify the neural mechanisms underlying the influence of fear movement-related pain on motor preparatory brain activity using Libet's clock and electroencephalography (EEG). Healthy participants were asked to press a button while watching a rotating Libet's clock-hand, and report the number on the clock ("W time") when they made the "decision" to press the button with their right index finger. Immediately after pressing the button, a painful electrical stimulus was delivered to the dorsum of the left hand, causing participants to feel fear of movement (button press-related pain). We found that fear of movement-related pain caused the W time to be early, and that the amplitudes of readiness potentials (RPs) increased after awareness of motor intention emerged. In addition, fear of movement-related pain caused over-activation of the medial frontal cortex, supplementary motor area, cingulate motor area, and primary motor cortex after participants became aware of their motor intention. Such over-activation might result from conflict between the unrealized desire to escape from a painful experience and motivation to perform a required motor task.