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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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Harvey MP, Maher-Bussières S, Emery E, Martel M, Houde F, Tousignant-Laflamme Y, Léonard G. Evidence of motor system reorganization in complex regional pain syndrome type 1: A case report. Can J Pain 2018; 2:21-26. [PMID: 35005361 PMCID: PMC8730548 DOI: 10.1080/24740527.2017.1422116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background Central nervous system reorganization, particularly in networks devoted to somatosensation, is thought to be a significant feature of complex regional pain syndrome (CRPS). Aims In the present case report, we evaluated the corticomotor system of a woman suffering from CRPS, as she started and completed her rehabilitation, in order to explore whether CRPS could also be linked to changes in motor networks. Methods The patient, a 58-year-old woman, was diagnosed with right-hand CRPS. Transcranial magnetic stimulation measures, reflecting the strength of the corticospinal projections, were evaluated before, during, and after an 8-week graded motor imagery (GMI) program. Results Before treatment, the patient reported significant pain and disability, and the strength of the corticospinal projections of the first dorsal interosseous of the affected hand was reduced compared to the healthy, unaffected hand. Pain and disability decreased as the patient completed the GMI program. These changes were paralleled by an increase in the strength of the corticospinal projections. Conclusions These observations suggest that corticomotor changes can be observed in individuals suffering from CRPS and that some of the clinical manifestations observed in these patients (e.g., pain, disability) could possibly be linked to these neurophysiological changes.
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Affiliation(s)
- Marie-Philippe Harvey
- Faculty of Medicine and Health Sciences, University of Sherbrooke , Sherbrooke, Québec, Canada
- Research Centre on Aging, University Institute of Geriatrics of Sherbrooke , Sherbrooke, Québec, Canada
| | - Samuel Maher-Bussières
- Faculty of Medicine and Health Sciences, University of Sherbrooke , Sherbrooke, Québec, Canada
| | - Elysa Emery
- Faculty of Medicine and Health Sciences, University of Sherbrooke , Sherbrooke, Québec, Canada
| | - Marylie Martel
- Faculty of Medicine and Health Sciences, University of Sherbrooke , Sherbrooke, Québec, Canada
- Research Centre on Aging, University Institute of Geriatrics of Sherbrooke , Sherbrooke, Québec, Canada
| | - Francis Houde
- Faculty of Medicine and Health Sciences, University of Sherbrooke , Sherbrooke, Québec, Canada
- Research Centre on Aging, University Institute of Geriatrics of Sherbrooke , Sherbrooke, Québec, Canada
| | - Yannick Tousignant-Laflamme
- Clinical Research Centre Étienne–Le Bel-CHUS , Sherbrooke, Québec, Canada
- School of Rehabilitation, Faculty of Medicine and Health Sciences, University of Sherbrooke , Sherbrooke, Québec, Canada
| | - Guillaume Léonard
- Research Centre on Aging, University Institute of Geriatrics of Sherbrooke , Sherbrooke, Québec, Canada
- School of Rehabilitation, Faculty of Medicine and Health Sciences, University of Sherbrooke , Sherbrooke, Québec, Canada
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Hu X, Ludvig D, Murray WM, Perreault EJ. Using Feedback Control to Reduce Limb Impedance during Forceful Contractions. Sci Rep 2017; 7:9317. [PMID: 28839242 PMCID: PMC5571169 DOI: 10.1038/s41598-017-10181-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 08/04/2017] [Indexed: 11/25/2022] Open
Abstract
Little is known about the ability to precisely regulate forces or torques during unexpected disturbances, as required during numerous tasks. Effective force regulation implies small changes in force responding to externally imposed displacements, a behavior characterized by low limb impedance. This task can be challenging, since the intrinsic impedance of muscles increases when generating volitional forces. The purpose of this study was to examine the ability to voluntarily reduce limb impedance during force regulation, and the neural mechanisms associated with that ability. Small displacement perturbations were used to quantify elbow impedance during the exertion of volitional elbow torques from 0% to 20% of maximum voluntary contraction. Subjects were instructed either to not intervene with the imposed perturbations or to explicitly intervene so as to minimize the influence of the perturbations on the elbow torque. Our results demonstrated that individuals can reduce the low frequency components of elbow impedance by 35%. Electromyographic analysis suggested that this behavior is mediated by volitional and possibly long-latency reflex pathways with delays of at least 120 ms. These results provide a context for understanding how feedback altered by aging or injuries may influence the ability to regulate forces precisely.
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Affiliation(s)
- Xiao Hu
- Departement of Biomedical Engineering, Northwestern University, Evanston, IL, USA. .,Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL, USA.
| | - Daniel Ludvig
- Departement of Biomedical Engineering, Northwestern University, Evanston, IL, USA.,Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL, USA.,Departement of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Wendy M Murray
- Departement of Biomedical Engineering, Northwestern University, Evanston, IL, USA.,Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL, USA.,Departement of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA.,Research Service, Edward Hines, Jr. VA Hospital, Hines, IL, USA
| | - Eric J Perreault
- Departement of Biomedical Engineering, Northwestern University, Evanston, IL, USA.,Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL, USA.,Departement of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
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Azqueta-Gavaldon M, Schulte-Göcking H, Storz C, Azad S, Reiners A, Borsook D, Becerra L, Kraft E. Basal ganglia dysfunction in complex regional pain syndrome - A valid hypothesis? Eur J Pain 2016; 21:415-424. [DOI: 10.1002/ejp.975] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2016] [Indexed: 01/27/2023]
Affiliation(s)
- M. Azqueta-Gavaldon
- Interdisciplinary Pain Unit; Medical Centre of University of Munich; Germany
- Department of Orthopaedics, Physical Medicine and Rehabilitation; Medical Centre of University of Munich; Germany
| | - H. Schulte-Göcking
- Interdisciplinary Pain Unit; Medical Centre of University of Munich; Germany
- Department of Orthopaedics, Physical Medicine and Rehabilitation; Medical Centre of University of Munich; Germany
| | - C. Storz
- Department of Orthopaedics, Physical Medicine and Rehabilitation; Medical Centre of University of Munich; Germany
| | - S. Azad
- Interdisciplinary Pain Unit; Medical Centre of University of Munich; Germany
- Department of Anaesthesia; Medical Centre of University of Munich; Germany
| | - A. Reiners
- Department of Rehabilitation; City Hospital Bogenhausen; Munich Germany
| | - D. Borsook
- Centre for Pain and the Brain; Boston Children's Hospital; Harvard Medical School; Boston USA
| | - L. Becerra
- Centre for Pain and the Brain; Boston Children's Hospital; Harvard Medical School; Boston USA
| | - E. Kraft
- Interdisciplinary Pain Unit; Medical Centre of University of Munich; Germany
- Department of Orthopaedics, Physical Medicine and Rehabilitation; Medical Centre of University of Munich; Germany
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Mugge W, Schouten AC, van Hilten JJ, van der Helm FCT. Impaired Inhibitory Force Feedback in Fixed Dystonia. IEEE Trans Neural Syst Rehabil Eng 2015; 24:475-84. [PMID: 25955788 DOI: 10.1109/tnsre.2015.2422892] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Complex regional pain syndrome (CRPS) is a multifactorial disorder associated with an aberrant host response to tissue injury. About 25% of CRPS patients suffer poorly understood involuntary sustained muscle contractions associated with dysfunctional reflexes that result in abnormal postures (fixed dystonia). A recent modeling study simulated fixed dystonia (FD) caused by aberrant force feedback. The current study aims to validate this hypothesis by experimentally recording the modulation of reflexive force feedback in patients with FD. CRPS patients with and without FD, patients with FD but without CRPS, as well as healthy controls participated in the experiment. Three task instructions and three perturbation characteristics were used to evoke a wide range of responses to force perturbations. During position tasks ("maintain posture"), healthy subjects as well as patients resisted the perturbations, becoming more stiff than when being relaxed (i.e., the relax task). Healthy subjects and CRPS patients without FD were both more compliant during force tasks ("maintain force") than during relax tasks, meaning they actively gave way to the imposed forces. Remarkably, the patients with FD failed to do so. A neuromuscular model was fitted to the experimental data to separate the distinct contributions of position, velocity and force feedback, as well as co-contraction to the motor behavior. The neuromuscular modeling indicated that inhibitory force feedback is deregulated in patients with FD, for both CRPS and non-CRPS patients. From previously published simulation results and the present experimental study, it is concluded that aberrant force feedback plays a role in fixed dystonia.
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Hotta J, Harno H, Nummenmaa L, Kalso E, Hari R, Forss N. Patients with complex regional pain syndrome overestimate applied force in observed hand actions. Eur J Pain 2015; 19:1372-81. [DOI: 10.1002/ejp.669] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2014] [Indexed: 02/02/2023]
Affiliation(s)
- J. Hotta
- Department of Neuroscience and Biomedical Engineering; Aalto University; Espoo Finland
- Clinical Neurosciences, Neurology; University of Helsinki and Helsinki University Hospital; Finland
| | - H. Harno
- Clinical Neurosciences, Neurology; University of Helsinki and Helsinki University Hospital; Finland
- Pain Clinic; Department of Anaesthesiology, Intensive Care and Pain Medicine; University of Helsinki and Helsinki University Hospital; Finland
| | - L. Nummenmaa
- Department of Neuroscience and Biomedical Engineering; Aalto University; Espoo Finland
- Turku PET Centre; University of Turku; Finland
| | - E. Kalso
- Pain Clinic; Department of Anaesthesiology, Intensive Care and Pain Medicine; University of Helsinki and Helsinki University Hospital; Finland
| | - R. Hari
- Department of Neuroscience and Biomedical Engineering; Aalto University; Espoo Finland
| | - N. Forss
- Department of Neuroscience and Biomedical Engineering; Aalto University; Espoo Finland
- Clinical Neurosciences, Neurology; University of Helsinki and Helsinki University Hospital; Finland
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Bank P, van Rooijen D, Marinus J, Reilmann R, van Hilten J. Force modulation deficits in complex regional pain syndrome: A potential role for impaired sense of force production. Eur J Pain 2014; 18:1013-23. [DOI: 10.1002/j.1532-2149.2013.00446.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2013] [Indexed: 11/10/2022]
Affiliation(s)
- P.J.M. Bank
- Department of Neurology; Leiden University Medical Center; The Netherlands
- Research Institute MOVE, Faculty of Human Movement Sciences; VU University Amsterdam; The Netherlands
| | - D.E. van Rooijen
- Department of Neurology; Leiden University Medical Center; The Netherlands
| | - J. Marinus
- Department of Neurology; Leiden University Medical Center; The Netherlands
| | - R. Reilmann
- Department of Neurology; University Clinic Muenster (UKM), Westfaelische-Wilhelms-University Muenster; Germany
- George-Huntington-Institute; Muenster Germany
| | - J.J. van Hilten
- Department of Neurology; Leiden University Medical Center; The Netherlands
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Bleton JP, Teremetz M, Vidailhet M, Mesure S, Maier MA, Lindberg PG. Impaired force control in writer's cramp showing a bilateral deficit in sensorimotor integration. Mov Disord 2013; 29:130-4. [DOI: 10.1002/mds.25690] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 07/11/2013] [Accepted: 09/10/2013] [Indexed: 11/09/2022] Open
Affiliation(s)
- Jean-Pierre Bleton
- INSERM U894; Université Paris Descartes, Service de Neurologie, Hôpital Sainte-Anne; Paris France
- CNRS UMR 7287; Aix-Marseille Université; Marseille France
| | - Maxime Teremetz
- CNRS UMR 8194; Université Paris Descartes, Sorbonne Paris Cité; Paris France
| | - Marie Vidailhet
- INSERM UMR S 975/CNRS UMR 7225/Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière (CRICM); Paris France
- UPMC Université Pierre et Marie Curie, and AP-HP; Department of Neurology, Hôpital Pitié-Salpêtrière; Paris France
| | - Serge Mesure
- CNRS UMR 7287; Aix-Marseille Université; Marseille France
| | - Marc A. Maier
- CNRS UMR 8194; Université Paris Descartes, Sorbonne Paris Cité; Paris France
- Université Paris Diderot; Sorbonne Paris Cité; Paris France
| | - Påvel G. Lindberg
- CNRS UMR 8194; Université Paris Descartes, Sorbonne Paris Cité; Paris France
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