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

Brun, Clémentine; Giorgi, Nicolas; Pinard, Anne-Marie; Gagné, Martin; McCabe, Candida; Mercier, Catherine

doi:10.1016/j.jpain.2018.07.008

Cited by 30 publications

(48 citation statements)

References 34 publications

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“…People with CRPS both under-and overestimated the extent of their movements relative to healthy controls [44]. Both this impaired sense of movement of the affected limb and the previous findings of more variable positioning performance for the affected and unaffected limbs provide evidence of impaired proprioception, since participants could not see their limbs and thus were forced to rely on proprioception for these tasks [44,[52][53][54]. However, these deficits are not consistently found [38,55].…”

Section: Estimation Of Limb Size Position and Movement Frommentioning

confidence: 77%

“…Brun et al [44], N = 13; Bultitude et al [45], N = 24; Kotiuk et al [46], N = 50; Lewis and Schweinhardt [47], N = 22, HC; Tajadura-Jiménez et al [48], N = 12…”

Section: Behavioural Neurologymentioning

confidence: 99%

“…Perceived lengthening of the unaffected arm and shortening of the affected arm Vittersø et al [51], N = 36, HC, BL Limb position sense Limb position matching Reduced accuracy in both limbs Brun et al [44], N = 13, HC, BL; Lewis et al [52], N = 20, HC, BL…”

Section: Tactile Distance Judgements Following Tool Usementioning

confidence: 99%

“…In Lewis et al's [52] study, participants were required to match the position of their affected and unaffected arm to specified targets that were external to their body (i.e., point their arms as though they were the hour hand on a clock showing a particular time). In Brun et al's [44] study, they were required to match the position of the affected or unaffected arm to the mirrorreverse position of their other arm, which had been passively moved by a robot. In both of these studies, people with CRPS made more errors and were less precise than healthy controls when positioning both arms when they did not have vision of their limbs.…”

Section: Estimation Of Limb Size Position and Movement Frommentioning

confidence: 99%

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Neuropsychological Changes in Complex Regional Pain Syndrome (CRPS)

Halicka

Vitterso

Proulx

et al. 2020

Behavioural Neurology

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Complex Regional Pain Syndrome (CRPS) is a poorly understood chronic pain condition of multifactorial origin. CRPS involves sensory, motor, and autonomic symptoms primarily affecting one extremity. Patients can also present with neuropsychological changes such as reduced attention to the CRPS-affected extremity, reminiscent of hemispatial neglect, yet in the absence of any brain lesions. However, this “neglect-like” framework is not sufficient to characterise the range of higher cognitive functions that can be altered in CRPS. This comprehensive literature review synthesises evidence of neuropsychological changes in CRPS in the context of potential central mechanisms of the disorder. The affected neuropsychological functions constitute three distinct but not independent groups: distorted body representation, deficits in lateralised spatial cognition, and impairment of non-spatially-lateralised higher cognitive functions. We suggest that many of these symptoms appear to be consistent with a broader disruption to parietal function beyond merely what could be considered “neglect-like.” Moreover, the extent of neuropsychological symptoms might be related to the clinical signs of CRPS, and rehabilitation methods that target the neuropsychological changes can improve clinical outcomes in CRPS and other chronic pain conditions. Based on the limitations and gaps in the reviewed literature, we provide several suggestions to improve further research on neuropsychological changes in chronic pain.

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Section: Estimation Of Limb Size Position and Movement Frommentioning

confidence: 77%

“…Brun et al [44], N = 13; Bultitude et al [45], N = 24; Kotiuk et al [46], N = 50; Lewis and Schweinhardt [47], N = 22, HC; Tajadura-Jiménez et al [48], N = 12…”

Section: Behavioural Neurologymentioning

confidence: 99%

Section: Tactile Distance Judgements Following Tool Usementioning

confidence: 99%

Section: Estimation Of Limb Size Position and Movement Frommentioning

confidence: 99%

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Neuropsychological Changes in Complex Regional Pain Syndrome (CRPS)

Halicka

Vitterso

Proulx

et al. 2020

Behavioural Neurology

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“…Higher scores on the neglect-like symptoms questionnaire (which, like the BPDS, also regards disownership of the affected limb; Frettlöh et al, 2006) were previously linked to greater motor impairment and disability in individuals with CRPS (Kolb et al, 2012). While these distortions in body perception primarily concern the affected limb, arm position sense (which relies on proprioception) has been found to be impaired bilaterally in CRPS (Brun et al, 2019;. Thus, deficits in proprioception in both limbs might slow down movement initiation due to uncertainty about their current positions.…”

Section: Spatially-defined Motor Functionmentioning

confidence: 99%

Disputing space-based biases in unilateral complex regional pain syndrome

Halicka

Vitterso

McCullough

et al. 2020

Preprint

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There is some evidence that people with Complex Regional Pain Syndrome (CRPS) show reduced attention to the affected relative to unaffected limb and its surrounding space, resembling hemispatial neglect after brain injury. These neuropsychological symptoms could be related to central mechanisms of pathological pain and contribute to its clinical manifestation. However, the existing evidence of changes in spatial cognition is limited and often inconsistent. We examined visuospatial attention, the mental representation of space, and spatially-defined motor function in 54 people with unilateral upper-limb CRPS and 22 pain-free controls. Contrary to our hypotheses and previous evidence, individuals with CRPS did not show any systematic spatial biases in visuospatial attention to or representation of the side of space corresponding to their affected limb (relative to the unaffected side). We found very little evidence of directional slowing of movements towards the affected relative to unaffected side that would be consistent with motor neglect. People with CRPS were, however, slower than controls to initiate and execute movements with both their affected and unaffected hands, which suggests disrupted central motor networks. Finally, we found no evidence of any clinical relevance of changes in spatial cognition because there were no relationships between the magnitude of spatial biases and the severity of pain or other CRPS symptoms. The results did reveal potential relationships between CRPS pain and symptom severity, subjective body perception disturbance, and extent of motor impairment, which would support treatments focused on normalizing body representation and improving motor function. Our findings suggest that previously reported spatial biases in CRPS might have been overstated.

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