Psychological, social and biological correlates of body perception disturbance in complex regional pain syndrome

Abstract

Body Perception Disturbance (BPD) in Complex Regional Pain Syndrome (CRPS) still represents a poorly understood phenomenon. Research has shown that knowledge about changes in body perception can yield relevant information for understanding and treating the disease. This study addressed possible connections between BPD and psychological and social factors, pain intensity, and disease duration. Sixty patients with chronic CRPS Type I of the hand were recruited. Body Perception Disturbance was assessed using the Galer and Jensen Neurobehavioral Questionnaire (GJ) and the BATH CRPS Body Perception Disturbance Scale (BATH). Depression, anxiety, stress, childhood trauma and other life events were assessed using standardized and validated questionnaires. This study found that BPD in CRPS was significantly correlated with measures of depression, anxiety, current stress, quality of life, and pain intensity, but not with stress experienced in the twelve months preceding onset of illness, childhood trauma, or duration of illness. Future research needs to identify which patients are most likely to develop these psychological conditions of CRPS, so that early, preventive intervention is possible. This study establishes a relationship between depression, anxiety, current stress, quality of life, pain intensity, and BPD severity. It also supports literature suggesting that preexisting stress, childhood trauma, and disease duration have no influence on BPD. The findings suggest that there is a bidirectional influence between brain alterations, psychological symptoms, and illness severity.

Validation of the Bath CRPS Body Perception Disturbance Scale

“…Mixed results have been reported regarding the relationships between body perception disturbance as measured with the B-CRPS-BPDS and disease characteristics in people with CRPS. Positive relationships between body perception disturbance and pain intensity have been found in some studies, 32,51 but not others. 57 One study found positive relationships between body perception disturbances and depression, anxiety, stress, and quality of life.…”

“…1,32 Several studies have evaluated the construct validity of the B-CRPS-BPDS. With regard to other measures that have been related to body perception disturbances, 20,51 B-CRPS-BPDS scores were associated with worse tactile acuity and higher scores on the neurobehavioral questionnaire. 32,36 However, a study using a French translation of the B-CRPS-BPDS (N=13; including fewer items than the original) found no relationship between B-CRPS-BPDS scores and the senses of limb position and movement.…”

“…The two most used questionnaires to measure body perception disturbance in CRPS are the neurobehavioral questionnaire, 14,15 assessing inattention to and disengagement from the affected limb, and the Bath CRPS Body Perception Disturbance Scale ("B-CRPS-BPDS"), 31 covering a broader range of body perception disturbances. 29,31 Although the B-CRPS-BPDS is widely used in different languages, 1,4,32,36,51,57 its psychometric properties have not been fully explored. In two studies (N=22 and 59), the internal consistency of the English B-CRPS-BPDS ranged from poor to good at different time points.…”

“…57 One study found positive relationships between body perception disturbances and depression, anxiety, stress, and quality of life. 51 A prospective study found that body perception disturbance decreased in the first 12 months following the onset of CRPS, along with a decrease of pain, CRPS severity, and disability. 1 However, crosssectional studies found either no effect of disease duration 51,57 or greater body perception disturbance in people with longer disease durations.…”

The Role of Nonmedical Therapeutic Approaches in the Rehabilitation of Complex Regional Pain Syndrome

“…Depression, anxiety and current stress have also been found to be associated with body perception disturbance [51]. Subsequent disengagement and disuse of the affected limb, commonly seen in CRPS [48,52], are thought to be contributing and maintaining factors to the condition and which may lead to cortical changes [53].…”