Embodied pain in fibromyalgia: Disturbed somatorepresentations and increased plasticity of the body schema

Abstract

Fibromyalgia syndrome (FMS) is a highly prevalent, chronic musculoskeletal condition characterized by widespread pain and evoked pain at tender points. This study evaluated various aspects of body awareness in a sample of 14 women with FMS and 13 healthy controls, such as plasticity of the body schema, body esteem, and interoceptive awareness. To this end, the Rubber Hand Illusion (RHI), the Body Esteem Scale (BES), and the Body Perception Questionnaire (BPQ) were used, respectively. Consistent with increased plasticity of the body schema, FMS patients scored higher, with large or very large effect sizes, across all three domains evaluated in the RHI paradigm, namely proprioceptive drift and perceived ownership and motor control over the rubber hand. Scores on all items addressed by the BES were consistently lower among FMS subjects (2.52, SEM .19 vs 3.89, SEM .16, respectively, p < .01, Cohen’s d = .38-.66). In the FMS sample, BES scores assigned to most painful regions also were lower than those assigned to the remaining body sites (1.58, SEM .19 vs 2.87, SEM .18, respectively, p < .01). Significantly higher scores (p < .01, Cohen’s d = .51-.87) were found in the FMS sample across awareness (3.57 SEM .15 vs 1.87 SEM .11), stress response (3.76 SEM .11 vs 1.78 SEM .11), autonomic nervous system reactivity (2.59 SEM .17 vs 1.35 SEM .07), and stress style 2 (2.73 SEM .27 vs 1.13 SEM .04) subscales of the BPQ. Intensity of ongoing clinical pain was found to be strongly correlated with interoceptive awareness (r = .75, p = .002). The results suggest a disturbed embodiment in FMS, characterized by instability of the body schema, negatively biased cognitions regarding one’s own body, and increased vigilance to internal bodily cues. These manifestations may be interpreted as related with the inability of incoming sensory inputs to adequately update negatively biased off-line somatorepresentations stored as long-term memory.

Explicit and Implicit Own's Body and Space Perception in Painful Musculoskeletal Disorders and Rheumatic Diseases: A Systematic Scoping Review

“…Inclusion and exclusion criteria have been poorly documented in 29/38 studies (76%) (Figures 7, 8): the selection of the target population may have been not adequately performed, potentially biasing the validity of results. Sixteen percent of all included studies were conducted in an experimental setting (Grod and Diakow, 2002;Wand et al, 2010;Docherty et al, 2012;Gilpin et al, 2015;Treleaven and Takasaki, 2015;Martínez et al, 2018), limiting the applicability of methodologies proposed in clinical practice.…”

“…A graphical distribution of included studies grouped by clinical conditions examined is shown in Figure 3. Twenty-five studies (Grod and Diakow, 2002;Moseley, 2008;Wand et al, 2010Wand et al, , 2013bWand et al, , 2014Wand et al, , 2016Docherty et al, 2012;Lauche et al, 2012a;Valenzuela-Moguillansky, 2013;Hirakawa et al, 2014;Gilpin et al, 2015;Mibu et al, 2015;Nishigami et al, 2015Nishigami et al, , 2017Nishigami et al, , 2018Treleaven and Takasaki, 2015;Beales et al, 2016;Janssens et al, 2017;Moreira et al, 2017;Adamczyk et al, 2018a,b;Ehrenbrusthoff et al, 2018;Magni et al, 2018;Martínez et al, 2018) studies concerned the assessment of SoP dysfunctions, while twelve interventional studies (Barker et al, 2008;Preston and Newport, 2011;Wand et al, 2011Wand et al, , 2013aMorone et al, 2012;Paolucci et al, 2012;Diers et al, 2013;Vetrano et al, 2013;Ryan et al, 2014;Louw et al, 2017;Stanton et al, 2018;Nishigami et al, 2019) investigated the effects of perception-based intervention to reduce pain or to correct perceptual distortions. One study, (Lauche et al, 2012a) was included both in assessment and in intervention studies: it is a qualitative study i...…”

“…For neck pain, was considered 3.5 to 5 U on the 50-U Neck Pain Disability Index or 7 to 10% change (Pool et al, 2007;Stratford et al, 2009) for function and 2.5 on an 10-U NRS (25% change) for pain (Pool et al, 2007). 2015; Treleaven and Takasaki, 2015;Martínez et al, 2018), while the remaining 19 studies were clinical investigations (Moseley, 2008;Wand et al, 2010Wand et al, , 2013aWand et al, ,b, 2014Wand et al, , 2016Lauche et al, 2012a;Valenzuela-Moguillansky, 2013;Hirakawa et al, 2014;Mibu et al, 2015;Nishigami et al, 2015Nishigami et al, , 2017Nishigami et al, , 2018Beales et al, 2016;Janssens et al, 2017;Adamczyk et al, 2018a,b;Ehrenbrusthoff et al, 2018;Magni et al, 2018).…”

“…The majority of selected assessment studies evaluated the explicit SoP: five studies adopted the Body Image Drawing (BID) task (Moseley, 2008;Lauche et al, 2012a;Mibu et al, 2015;Nishigami et al, 2015;Moreira et al, 2017), eight studies used the FreBAQ (Wand et al, 2014Wand et al, 2013a;Beales et al, 2016;Janssens et al, 2017;Nishigami et al, 2017Nishigami et al, , 2018Ehrenbrusthoff et al, 2018) or the FreKAQ (Nishigami et al, 2017), two studies used the Neglect-Like Symptoms Questionnaire (NLSQ) (Hirakawa et al, 2014;Magni et al, 2018), one study investigate the visual size estimation in an experimental setting (Gilpin et al, 2015), one study investigated the rubber hand illusion (RHI) (Martínez et al, 2018), and one was a qualitative study on subjectively referred body perception (Valenzuela-Moguillansky, 2013).…”

“…The study of Martínez et al (2018) is the only one to analyse body ownership through the RHI paradigm. They found that fibromyalgic patients were more susceptible to experience the illusion compared to healthy controls, scoring significantly (p < 0.05) higher both in proprioceptive drift sub-scale and in 4 out 5 items of the agency scale.…”