Altered updating of bodily and spatial representations after tool-use in complex regional pain syndrome

Vitterso, Axel; Buckingham, Gavin; Halicka, Monika; Proulx, Michael J.; Bultitude, Janet

doi:10.1097/j.pain.0000000000001845

Cited by 17 publications

(15 citation statements)

References 116 publications

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“…In addition, the condition can be accompanied by neuropsychological changes (for reviews, see Halicka, Vittersø, Proulx, & Bultitude, 2020a; Kuttikat et al, 2016), including distorted representations of the body (e.g. Lewis, Kersten, McCabe, McPherson, & Blake, 2007; Moseley, 2005; Peltz, Seifert, Lanz, Müller, & Maihöfner, 2011), and altered updating of such representations (Vittersø, Buckingham, Halicka, Proulx, & Bultitude, 2020). Sensorimotor processing might also be affected by altered sensory experiences and motor deficits (Harden et al, 2010; Harden et al, 2007).…”

Section: Introduction1mentioning

confidence: 99%

Characterising sensorimotor adaptation in Complex Regional Pain Syndrome

Vitterso

Buckingham²,

Halicka

et al. 2019

Preprint

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Distorted representations of the body and peripersonal space are common in Complex Regional Pain Syndrome (CRPS), and might modulate its symptoms (e.g. asymmetric limb temperature). In pain-free people, such representations are malleable, and update when we interact with objects in our environment (e.g. during tool-use). Distortions are also common after immobilisation, but quickly normalise once movement is regained. We tested the hypothesis that people with CRPS have problems updating bodily and spatial representations, which contributes to the maintenance of their distorted representations by preventing normalization. We also explored spatially defined modulations of hand temperature asymmetries, and any influence of updating bodily and spatial representations on this effect. Thirty-six people with unilateral CRPS (18 upper limb, 18 lower limb) and 36 pain-free controls completed tool-use tasks considered to alter body and peripersonal space representations (measured using tactile distance judgements and a visuotactile crossmodal congruency task, respectively). We also tested how the arrangement (crossed, uncrossed) of the hands and tools affected hand temperature. In upper limb CRPS the non-affected arm representation updated normally, but the affected arm representation updated in the opposite to normal direction. A similar pattern was seen in lower limbs CRPS, although not significant. Furthermore, people with CRPS showed more pronounced updating of peripersonal space than the controls. We did not observe any modulation of hand temperature asymmetries by the arrangement of hands or tools. Our findings suggest enhanced malleability of bodily and spatial representations in CRPS, potentially implicating central mechanisms in the aetiology of this condition.

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Section: Introduction1mentioning

confidence: 99%

Characterising sensorimotor adaptation in Complex Regional Pain Syndrome

Vitterso

Buckingham²,

Halicka

et al. 2019

Preprint

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“…More pronounced sensorimotor realignment in the affected hand could relate to lower stability of representations of the body and space. In a previous study, we showed that following tool use, people with upper limb CRPS had more pronounced changes in their arm and peripersonal space representations compared to matched controls (Vittersø et al, 2020). Furthermore, in people with upper limb CRPS, representations of the affected and non-affected arms updated differently.…”

Section: Sensorimotor Realignmentmentioning

confidence: 78%

“…These changes include distorted representations of the body (e.g. Lewis, Kersten, McCabe, McPherson, & Blake, 2007;Moseley, 2005;Peltz, Seifert, Lanz, Müller, & Maihöfner, 2011), and altered updating of such representations (Vittersø, Buckingham, Halicka, Proulx, & Bultitude, 2020). Sensorimotor processing might also be affected by altered sensory experiences and motor deficits (Harden et al, 2010;Harden et al, 2007).…”

Section: Introductionmentioning

confidence: 99%

No evidence of impaired sensorimotor adaptation in Complex Regional Pain Syndrome

Vitterso

Buckingham²,

Brink

et al. 2020

Preprint

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Sensorimotor conflict is theorised to contribute to the maintenance of some pathological pain conditions, such as Complex Regional Pain Syndrome (CRPS). We therefore tested whether sensorimotor adaptation is impaired in people with CRPS by characterising their adaption to lateral prismatic shifts in vision. People with unilateral upper limb CRPS Type I (n = 17), and pain-free individuals (n = 18; matched for age, sex, and handedness) completed prism adaptation with their affected/non-dominant and non-affected/dominant arm, in a counterbalanced order. We examined 1) the rate at which participants compensated for the optical shift during prism exposure (i.e. strategic recalibration), 2) endpoint errors made directly after prism adaptation (sensorimotor realignment) and their retention, and 3) kinematic markers associated with feedforward motor control and sensorimotor realignment. We found no evidence that strategic recalibration was different between people with CRPS and controls, including no evidence for differences in a kinematic marker associated with trial-by-trial changes in movement plans. Participants made significant endpoint errors in the prism adaptation after-effect phase, which are indicative of sensorimotor realignment. Overall, the magnitude of this realignment was not found to differ between people with CRPS and pain-free controls. However, people with CRPS made greater endpoint errors when using their affected hand than their non-affected hand, whereas no such difference was seen in controls. Taken together, these findings suggest that strategic control and sensorimotor realignment were not impaired for either arm in people with CRPS. In contrast, they provide some evidence that there is a greater propensity for sensorimotor realignment in CRPS, consistent with more flexible representations of the body and peripersonal space. Our study challenges the theory that sensorimotor conflict might underlie pathological pain that is maintained in the absence of tissue pathology.

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“…One possible explanation is that persistent pain may affect the perception of painless sensations and result in the distortion of the body schema [ 8 ], which is consistent with evidence of an altered functional organization of the S1 in patients with CRPS [ 13 , 14 ] (cf [ 15 , 16 ]). Alternatively, the distortion of the body schema may be attributed to reduced sensory input to the somatosensory cortex [ 17 ], underuse of a limb [ 18 , 19 ], or problems with updating body representations [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

“…However, no studies have conducted within-group comparisons. Given that the body schema can be updated and this process might be different between the affected and unaffected limb [ 2 , 20 ], there would be different patterns in mental rotation of hands vs feet as well as left vs right according to the region of pain.…”

Section: Introductionmentioning

confidence: 99%

Impaired Performance in Mental Rotation of Hands and Feet and Its Association with Social Cognition in Patients with Complex Regional Pain Syndrome

Lee¹,

Choi

Noh

et al. 2021

Pain Medicine

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Objectives. So far, dysfunction in mental rotation has been assessed in relation to the left- or right-sided CRPS. Here we examined mental rotation in patients with upper or lower limb CRPS. Considering the potential role of socio-emotional functioning on the perception of body image, we further investigated the association between performance on mental rotation and socio-emotional characteristics. Methods. We examined the performance of 36 patients with upper or lower limb CRPS on the limb laterality recognition. Accuracy and response times for pictures of hands and feet at 4 rotation angles were evaluated. Socio-emotional functioning was measured by the Interpersonal Reactivity Scale and the Toronto Alexithymia Scale. Results. Patients with upper limb pain showed longer RTs to recognize the laterality of hands than feet (P = 0.002), whereas patients with lower limb pain showed longer RTs for feet than hands (P = 0.039). Exploratory correlation analyses revealed that RTs for feet were negatively correlated with the levels of empathic ability to take another’s perspective (P = 0.006) and positively correlated with the level of emotional difficulty in identifying feelings (P = 0.006). Conclusions. This study is the first to report selectively impaired mental rotation of hands vs feet in patients with upper or lower limb CRPS. The findings suggest that impaired mental rotation derives from relative deficits in the representation of the affected limb. Correlations between impaired mental rotation and socio-emotional inability indicate that an altered body schema may be closely associated with impaired social cognitive aspects in CRPS patients.

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Altered updating of bodily and spatial representations after tool-use in complex regional pain syndrome

Abstract: The results of this study were presented at European Somatosensation & Body Representation meeting (2019); Scandinavian Association for the Study if Pain's congress (2019); and Federation of the European Societies of Neuropsychology's 7 th scientific meeting (2019).

Cited by 17 publications

References 116 publications

Characterising sensorimotor adaptation in Complex Regional Pain Syndrome

Characterising sensorimotor adaptation in Complex Regional Pain Syndrome

No evidence of impaired sensorimotor adaptation in Complex Regional Pain Syndrome

Impaired Performance in Mental Rotation of Hands and Feet and Its Association with Social Cognition in Patients with Complex Regional Pain Syndrome

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