Disputing space-based biases in unilateral complex regional pain syndrome

Halicka, Monika; Vitterso, Axel; McCullough, Hayley; Göebel, Andreas; Heelas, L.; Proulx, Michael J.; Bultitude, Janet

doi:10.1016/j.cortex.2020.02.018

Cited by 17 publications

(14 citation statements)

References 83 publications

(190 reference statements)

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“…In contrast to potential biases in VSA pointing [ 10 – 15 ], our study corroborates past research showing no directional bias in MSA pointing in CRPS [ 17 , 27 , 28 ]. This finding complements recent findings that show no visuospatial attention bias in people with CRPS [ 8 , 9 , 47 ] by showing that egocentric spatial representations are also unaffected. The inconsistent findings of spatial biases in CRPS could relate to the different reference frames, regions of space, and/or qualities of the space being tested [ 3 ].…”

Section: Discussionsupporting

confidence: 90%

“…This condition can also be accompanied by neuropsychological changes [for reviews, see 3 , 4 ], such as changes in spatial perception, which might be considered neglect-like [ 3 , 5 ], although alternative interpretations exist [ 6 – 8 ]. Recently we showed that people with CRPS do not show a consistent visuospatial attention bias [ 8 , 9 ]. However, some studies that have suggested biases in the representations of space (i.e.…”

Section: Introductionmentioning

confidence: 99%

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Normal manual straight ahead pointing in Complex Regional Pain Syndrome

et al. 2021

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There is evidence to suggest that people with Complex Regional Pain Syndrome (CRPS) can have altered body representations and spatial cognition. One way of studying these cognitive functions is through manual straight ahead (MSA) pointing, in which participants are required to point straight ahead of their perceived body midline without visual feedback of the hand. We therefore compared endpoint errors from MSA pointing between people with CRPS (n = 17) and matched controls (n = 18), and examined the effect of the arm used (Side of Body; affected/non-dominant, non-affected/dominant). For all participants, pointing errors were biased towards the hand being used. We found moderate evidence of no difference between Groups on endpoint errors, and moderate evidence of no interaction with Side of Body. The differences in variability between Groups were non-significant/inconclusive. Correlational analyses showed no evidence of a relationship between MSA endpoint errors and clinical parameters (e.g. CRPS severity, duration, pain) or questionnaire measures (e.g. body representation, “neglect-like symptoms”, upper limb disability). This study is consistent with earlier findings of no difference between people with CRPS and controls on MSA endpoint errors, and is the first to provide statistical evidence of similar performance of these two groups. Our results do not support a relationship between clinical or self-reported measures (e.g. “neglect-like symptoms”) and any directional biases in MSA. Our findings may have implications for understanding neurocognitive changes in CRPS.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Normal manual straight ahead pointing in Complex Regional Pain Syndrome

et al. 2021

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“…It should be stressed that motor and cognitive neglect-like symptoms in CRPS differ from hemispatial neglect after stroke [ 8–10 ], which most often manifests as a visuospatial bias. Typically, people with CRPS perform normally on classic “pen-and-paper” neglect tasks (e.g., line bisection), which capture a combination of perceptual and motor biases that stroke patients generally are not aware of ([ 1 , 2 , 14 , 27 , 28 ], although see [ 29 , 30 ]), and people with CRPS show no visuospatial attention bias towards one side of space ([ 31 , 32 ], although see [ 33 , 34 ]). Motor and cognitive neglect-like symptoms in CRPS more closely resemble a less common manifestation of post-stroke neglect called “personal neglect” (e.g., failure to dress or groom the contralesional side of the body), which might be primarily a disorder of body perception rather than attention [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Predictors of Self-Reported Neglect-like Symptoms and Involuntary Movements in Complex Regional Pain Syndrome Compared to Other Chronic Limb Pain Conditions

Brink

Bultitude

2021

Pain Medicine

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Objective In addition to pain, people with complex regional pain syndrome (CRPS) often report inattention to and disengagement from their affected limb (i.e., “neglect-like symptoms”). Understanding how these symptoms relate to other characteristics of CRPS, and chronic pain generally, could provide insights for preventing and treating CRPS. Methods We administered an online survey to people who received a diagnosis of CRPS (n = 335) and other chronic limb pain (n = 407). Neglect-like symptoms were assessed using the Neurobehavioral questionnaire. Results A principal component analysis identified two components: motor and cognitive neglect-like symptoms, and involuntary movements. Internal consistency of the components was acceptable. We conducted regression analyses with these as outcomes. Having CRPS, a painful lower limb, higher pain intensity, and somatic symptoms were associated with more motor and cognitive neglect-like symptoms. Having CRPS, higher pain intensity, depression, and somatic symptoms were associated with more involuntary movements. Age, gender, anxiety, disease duration, hours of pain per day, affected side, whether the limb was the most painful body part, and number of pain-related medical diagnoses were no predictors. Finally, motor and cognitive neglect-like symptoms were related to tremor; and involuntary movements to changes in skin color, swelling, sweating, toenails, weakness, and tremor. Conclusions This study confirms the specificity of inattention to and disengagement from the affected limb in CRPS, independent of other factors. Furthermore, two components of the Neurobehavioral questionnaire were disentangled: motor and cognitive neglect-like symptoms, and involuntary movements. Results could potentially help clinicians to better assess neglect-like symptoms in chronic pain.

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“…The copyright holder for this this version posted March 20, 2020. . https://doi.org/10.1101/2020.03.18.20038109 doi: medRxiv preprint attention and spatial representations, no systematic slowing of movements directed towards the affected side, and unimpaired laterality recognition of images of affected hands at baseline (see Table 6 and [29]). In healthy individuals, cognitive after-effects depend on baseline spatial bias [13,26,41].…”

Section: Crpsmentioning

confidence: 99%

Prism adaptation treatment for upper-limb Complex Regional Pain Syndrome: a double-blind randomized controlled trial

Halicka

Vitterso

McCullough

et al. 2020

Preprint

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Initial evidence suggested that people with Complex Regional Pain Syndrome (CRPS) have reduced attention to the affected side of their body and the surrounding space, which might be related to pain and other clinical symptoms. Three previous unblinded, uncontrolled studies showed pain relief following treatment with prism adaptation, an intervention that has been used to counter lateralised attention bias in brain-lesioned patients. To provide a robust test of its effectiveness for CRPS, we conducted a double-blind randomized controlled trial of prism adaptation for unilateral upper-limb CRPS-I. Forty-nine eligible adults with CRPS were randomized to undergo two-weeks of twice-daily home-based prism adaptation treatment (n = 23) or sham treatment (n = 26). Outcomes were assessed in person four weeks prior to and immediately before treatment, and immediately after and four weeks post-treatment. Long-term postal follow-ups were conducted three and six months after treatment. We examined the effects of prism adaptation versus sham treatment on current pain intensity and CRPS symptom severity score (primary outcomes); as well as sensory, motor, and autonomic functions, self-reported psychological functioning, and experimentally tested neuropsychological functions (secondary outcomes). We found no evidence that primary or secondary outcomes differed between the prism adaptation and sham treatment groups when tested at either time point following treatment. Overall, CRPS severity significantly decreased over time for both groups, but we found no benefits of prism adaptation beyond sham treatment. Our findings do not support the efficacy of prism adaptation treatment for relieving upper-limb CRPS-I. This trial was prospectively registered (ISRCTN46828292).

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Disputing space-based biases in unilateral complex regional pain syndrome

Cited by 17 publications

References 83 publications

Normal manual straight ahead pointing in Complex Regional Pain Syndrome

Normal manual straight ahead pointing in Complex Regional Pain Syndrome

Predictors of Self-Reported Neglect-like Symptoms and Involuntary Movements in Complex Regional Pain Syndrome Compared to Other Chronic Limb Pain Conditions

Prism adaptation treatment for upper-limb Complex Regional Pain Syndrome: a double-blind randomized controlled trial

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