In early CRPS (type 1), visual input from a moving, unaffected limb re-establishes the pain-free relationship between sensory feedback and motor execution. Trophic changes and a less plastic neural pathway preclude this in chronic disease.

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

In the first ever controlled trial of a CBM in RA, a significant analgesic effect was observed and disease activity was significantly suppressed following Sativex treatment. Whilst the differences are small and variable across the population, they represent benefits of clinical relevance and show the need for more detailed investigation in this indication.

Our findings support the hypothesis that motor-sensory conflict can induce pain and sensory disturbances in some normal individuals. We propose that prolonged sensory-motor conflict may induce long-term symptoms in some vulnerable subjects.

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In this pilot study, we roughly classified the pain descriptor items into two types for evaluating the qualities of deafferentation pain. We found that visually induced motor imagery by MVF was more effective for reducing deep pain than superficial pain. This suggests that the analgesic effect of MVF treatment does depend on the qualities of the pain. Further research will be required to confirm that this effect is a specific consequence of MVF.

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Our findings support the hypothesis that motor-sensory conflict can exacerbate pain and sensory perceptions in those with FMS to a greater extent than in HVs.