Visual illusions modulate body perception disturbance and pain in Complex Regional Pain Syndrome: A randomized trial

ABSTRACTEffective treatment of longstanding Complex Regional Pain Syndrome (CRPS) is a challenge, as causal mechanisms remain elusive. People with CRPS frequently report distorted subjective perceptions of their affected limb. Evidence of pain reduction when the affected limb is visually altered in size, suggests that visual illusions used to target central processing could restore coherence of this disrupted limb representation. We hypothesised that using virtual reality that alters hand image to match the patient’s desired hand appearance, would improve body perception disturbance and pain. Also, repeated exposure would maintain any therapeutic effect.A blinded randomised controlled trial of 45 participants with refractory upper-limb CRPS and body perception disturbance (BPD) viewed a digital image of their affected hand for one minute. The image was digitally altered according to the patient’s description of how they desired their hand to look in the experimental group and unaltered in the control group. BPD and pain were measured pre and post-intervention. A subgroup was followed up two weeks after a course of repeated interventions.BPD (p=0.036, effect size (ES)=0.6) and pain intensity (p = 0.047, ES=0.5) reduced in 23 participants after single exposure compared to controls (n=22). At follow-up the subgroup (experimental n= 21; control n=18) showed sustained pain reduction only (p=0.037 ES=0.7), with an overall 1.2 decrease on an 11-point scale.Visually changing the CRPS hand to a desired appearance modulates BPD and pain suggesting therapeutic potential for those with refractory CRPS. Future detailed studies to optimise this therapeutic effect are required.

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Exploring the Relationships Between Altered Body Perception, Limb Position Sense, and Limb Movement Sense in Complex Regional Pain Syndrome

Journal of Pain ◽

10.1016/j.jpain.2018.07.008 ◽

2019 ◽

Vol 20 (1) ◽

pp. 17-27 ◽

Cited By ~ 5

Author(s):

Clémentine Brun ◽

Nicolas Giorgi ◽

Anne-Marie Pinard ◽

Martin Gagné ◽

Candida S. McCabe ◽

...

Keyword(s):

Complex Regional Pain Syndrome ◽

Pain Syndrome ◽

Position Sense ◽

Limb Movement ◽

Body Perception ◽

Limb Position ◽

Movement Sense

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The effect of virtual body swapping with mental rehearsal on pain intensity and body perception disturbance in complex regional pain syndrome

International Journal of Rehabilitation Research ◽

10.1097/mrr.0000000000000053 ◽

2014 ◽

Vol 37 (2) ◽

pp. 167-172 ◽

Cited By ~ 4

Author(s):

Haesol Hwang ◽

Sungkun Cho ◽

Jang-Han Lee

Keyword(s):

Pain Intensity ◽

Complex Regional Pain Syndrome ◽

Pain Syndrome ◽

Body Perception ◽

Mental Rehearsal ◽

Virtual Body

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Spontaneous sensations reveal distorted body perception in complex regional pain syndrome (CRPS)

Brain and Cognition ◽

10.1016/j.bandc.2020.105568 ◽

2020 ◽

Vol 142 ◽

pp. 105568 ◽

Cited By ~ 2

Author(s):

A. Echalier ◽

C. Borg ◽

C. Creac'h ◽

B. Laurent ◽

G.A. Michael

Keyword(s):

Complex Regional Pain Syndrome ◽

Pain Syndrome ◽

Body Perception

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

Pain ◽

10.1016/j.pain.2007.03.013 ◽

2007 ◽

Vol 133 (1) ◽

pp. 111-119 ◽

Cited By ~ 190

Author(s):

Jennifer S. Lewis ◽

Paula Kersten ◽

Candida S. McCabe ◽

Kathryn M. McPherson ◽

David R. Blake

Keyword(s):

Complex Regional Pain Syndrome ◽

Pain Syndrome ◽

Body Perception

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Impact of Spinal Cord Stimulation on Sensory Characteristics in Complex Regional Pain Syndrome Type I: A Randomized Trial

Survey of Anesthesiology ◽

10.1097/00132586-200204000-00051 ◽

2002 ◽

Vol 46 (2) ◽

pp. 110

Keyword(s):

Spinal Cord ◽

Randomized Trial ◽

Complex Regional Pain Syndrome ◽

Spinal Cord Stimulation ◽

Pain Syndrome ◽

Sensory Characteristics ◽

Type I ◽

Syndrome Type

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Body Perception Disturbance and Pain Reduction in Longstanding Complex Regional Pain Syndrome Following a Multidisciplinary Rehabilitation Program

Pain Medicine ◽

10.1093/pm/pnz176 ◽

2019 ◽

Vol 20 (11) ◽

pp. 2213-2219 ◽

Cited By ~ 2

Author(s):

Jennifer S Lewis ◽

Sara Kellett ◽

Ryan McCullough ◽

Ashley Tapper ◽

Chelsey Tyler ◽

...

Keyword(s):

Complex Regional Pain Syndrome ◽

Rating Scale ◽

Numerical Rating Scale ◽

Pain Syndrome ◽

Rehabilitation Program ◽

Data Sets ◽

Body Perception ◽

Duration Of Symptoms ◽

Multidisciplinary Rehabilitation ◽

Numerical Rating

Abstract Objective Clinical guidelines for the treatment of complex regional pain syndrome recommend multidisciplinary rehabilitation, yet limited evidence exists to support the effectiveness of this approach. Body perception disturbance, a common and debilitating feature of complex regional pain syndrome, is recommended by guidelines as important to treat. However, no study has yet explored whether disturbances change in response to multidisciplinary rehabilitation. We aimed to determine whether there is a change in body perception disturbance and pain following a two-week multidisciplinary rehabilitation program for complex regional pain syndrome. Methods Retrospective clinical data from complex regional pain syndrome patients who completed the program between September 2014 and December 2016 were extracted and anonymized. Data collected pre- and post rehabilitation comprising the Bath Body Perception Disturbance scale and a pain intensity numerical rating scale were analyzed. Results Thirty complete data sets were analyzed from a sample of 50 consecutive patient records. After the program, there was a significant reduction in body perception disturbance (P < 0.0001), strength of negative emotional feelings (P < 0.0001), and pain (P = 0.0038). There was a significant correlation between a change in disturbance and pain (r = 0.44, P = 0.024). No relationship was found between the duration of symptoms and changes in disturbance (r = 0.04, P = 0.82). Conclusions This study provides evidence that both body perception disturbance and pain reduce after rehabilitation. Findings suggest that targeting these disturbances may be important in reducing pain and may be a potentially useful measure for recovery. Controlled trials are required to confirm the effectiveness of rehabilitation and determine what factors are responsible for these reductions.

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

Current Psychology ◽

10.1007/s12144-020-00635-1 ◽

2020 ◽

Cited By ~ 2

Author(s):

H. Schulte-Goecking ◽

M. Azqueta-Gavaldon ◽

C. Storz ◽

M. Woiczinski ◽

P. Fraenkel ◽

...

Keyword(s):

Complex Regional Pain Syndrome ◽

Pain Syndrome ◽

Body Perception

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Virtual Reality-Induced Sensorimotor Conflict Evokes Limb-Specific Sensory Disturbances in Complex Regional Pain Syndrome

Frontiers in Virtual Reality ◽

10.3389/frvir.2021.694293 ◽

2021 ◽

Vol 2 ◽

Author(s):

Clémentine Brun ◽

Anne Marie Pinard ◽

Candida S. McCabe ◽

Catherine Mercier

Keyword(s):

Complex Regional Pain Syndrome ◽

Clinical Characteristics ◽

Sensorimotor Integration ◽

Pain Syndrome ◽

Healthy Controls ◽

Body Perception ◽

Item Questionnaire ◽

Sensory Disturbances ◽

Motor Disturbances ◽

Rule Out

The origin of sensory disturbances in complex regional pain syndrome (CRPS) remains unclear. It has been hypothesized that such disturbances are due to attentional effects and/or sensorimotor integration deficits. If sensory disturbances are explained by sensorimotor integration deficits, they would be expected to be specific in terms of the category of sensation evoked and in terms of localization. Objective 1: To test whether sensory disturbances evoked by a unilateral sensorimotor conflict are specific to the painful limb and differ according to the category of sensory disturbances in individuals with a unilateral CRPS compared to healthy controls (HC). Objective 2: To assess the association between clinical characteristics and conflict-induced sensory disturbances. Objective 3: To assess conflict-induced motor disturbances. Ten adults with upper limb (UL) CRPS and 23 HC were recruited. Sensorimotor conflict was elicited with a KINARM exoskeleton interfaced with a 2D virtual environment allowing the projection of a virtual UL that was moving in either a congruent or incongruent manner relative to the actual UL movement. Participants rated sensory disturbances from 0 (no change) to 3 (high change) on a 8-item questionnaire. Items were classified into two Categories (Category 1: pain, discomfort, the feeling of losing a limb, change in weight and temperature; Category 2: feelings of peculiarity, the impression of gaining a limb and losing control). Motor disturbances were quantified as mediolateral drift and changes in amplitude of UL movement. Clinical characteristics included the intensity and duration of pain, proprioception, and body perception. CRPS participants report higher Category 1 than Category 2 disturbances for the Affected limb (while the reverse was observed for HC and for the Unaffected limb). In addition, no difference was observed between the Unaffected limb in CRPS and the Dominant limb in HC for Category 2 disturbances, while higher conflict sensitivity was observed for Category 1 disturbances. Conflict sensitivity was only related to higher pain for Category 1 disturbances in the Affected limb. Finally, no effect on motor disturbances was observed. While they do not completely rule out the attentional hypothesis, these results support the hypothesis of sensorimotor integration deficits.

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