Body perception disturbance: A contribution to pain in complex regional pain syndrome (CRPS)

Abstract

12 Abstract 13In spite of pain in the CRPS limb, clinical observations show patients pay little attention to, and fail to care for, their affected 14 limb as if it were not part of their body. Literature describes this phenomenon in terms of neurological neglect-like symptoms. This 15 qualitative study sought to explore the nature of this phenomenon with a view to providing insights into central mechanisms and the 16 relationship with pain. Twenty-seven participants who met the IASP CRPS classification were interviewed using qualitative methods 17 to explore feelings and perceptions about their affected body parts. These semi-structured interviews were analysed utilising princi-18 ples of grounded theory. Participants revealed bizarre perceptions about a part of their body and expressed a desperate desire to 19 amputate this part despite the prospect of further pain and functional loss. A mismatch was experienced between the sensation 20 of the limb and how it looked. Anatomical parts of the CRPS limb were erased in mental representations of the affected area. Pain 21 generated a raised consciousness of the limb yet there was a lack of awareness as to its position. These feelings were about the CRPS 22 limb only as the remaining unaffected body was felt to be normal. Findings suggest that there is a complex interaction between pain, 23 disturbances in body perception and central remapping. Clinically, findings support the use of treatments that target cortical areas, 24 which may reduce body perception disturbance and pain. We propose that body perception disturbance is a more appropriate term 25 than 'neglect-like' symptoms to describe this phenomenon. 26

Imaging and Clinical Evidence of Sensorimotor Problems in CRPS: Utilizing Novel Treatment Approaches

“…Those with CRPS express a sense that the limb no longer belongs to them, referring to the limb in the third person and as foreign or alien (Forderreuther et al 2004;Galer et al 1995;Lewis et al 2007). Some describe hostile thoughts and feelings about the limb and report a strong desire for amputation despite receiving medical advice to the contrary (Lewis et al 2007).…”

“…Some describe hostile thoughts and feelings about the limb and report a strong desire for amputation despite receiving medical advice to the contrary (Lewis et al 2007). Commonly, patients can easily identify the location at which they would like to remove the affected limb which is referred to clinically as the hypothetical amputation line.…”

“…Importantly, aberrant mapping reverses as pain diminishes (Maihofner et al 2004;Pleger et al 2005). In light of this, it is unsurprising that pain seems to have a detrimental influence on thoughts, feelings and how individuals perceive their affected body part (Lewis et al 2007;Lewis et al 2010). Fear of someone knocking the painful limb, the unpredictability of symptoms and the patients disordered body perception may lead to social isolation and broken personal relationships which can reduce the patients' capacity to cope with their condition (Bruehl & Chung 2006).…”

“…Furthermore, other signs and symptoms quite quickly develop in the affected limb that would not commonly occur with an inflammatory response, such as dramatic changes in hair and nail growth (Harden et al 2010), significant problems with motor control (Van Hilten et al 2005), neglect and perceived lack of ownership of that limb (Galer et al 1995(Galer et al , 1999Lewis et al 2007; Lewis & McCabe 2010). In addition, recent imaging studies have demonstrated that the motor and sensory cortical maps representing the painful limb become altered (Maihöfner et al 2003;2004) and the magnitude of those changes appears to closely correlate to the intensity of perceived pain and a reduction in tactile acuity.…”

Inconsistency of response to conscious and unconscious motor imagery in complex regional pain syndrome: Comment on the article by Moseley et al

“…With regard to pain provocation, we agree that this may reflect the enhanced sensitivity of the neural mechanisms underpinning pain. Another possibility is that a change in cardiovascular or respiratory function, both of which can be evoked by imagined exercise (8), causes the effect. Alternatively, McCabe et al have reported that patients with CRPS are vulnerable to situations that involve incongruence between motor commands and sensory feedback (6); perhaps that is the mechanism.…”