Ignoring space around a painful limb? No evidence for a body-related visuospatial attention bias in complex regional pain syndrome

Brink, Antonia F. Ten; Halicka, Monika; Vitterso, Axel; Keogh, Edmund; Bultitude, Janet

doi:10.1016/j.cortex.2020.12.007

Cited by 12 publications

(25 citation statements)

References 92 publications

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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%

“…Complex Regional Pain Syndrome (CRPS) is pathological pain condition characterised by motor deficits, and autonomic symptoms [ 1 , 2 ]. 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 ].…”

Section: Introductionmentioning

confidence: 99%

“…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%

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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“…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 results are still conflicting: some studies support the hypotheses of neglect similar to neglect after stroke while others do not (Brink, Antonia, Halicka, Vittersø, Keogh, & Bultitude, 2021 ; Halicka et al, 2020 ; Kolb et al, 2012 ; Reid et al, 2016 ; Wittayer et al, 2018 ).…”

Section: Introductionmentioning

confidence: 99%

Assessment of body perception disturbances in complex regional pain syndrome: A systematic review using the COSMIN guideline

Acapo¹,

Osinski

Rulleau

et al. 2022

European Journal of Pain

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Objective To conduct a systematic review to identify which tools are being used to assess body perception disturbances in Complex Regional Pain Syndrome (CRPS) and to provide an evidence‐based recommendation in the selection of an assessment tool, based on measurement properties. Databases and data treatment Five electronic databases (EMBASE, Pubmed, PsycInfo, Science Direct and Web of Science) were searched for English or French written articles, with no time restrictions. All original articles using a body perception assessment tool with adult patients with CRPS were selected, regardless of their design (controlled trials, single case, qualitative study). Two investigators screened abstracts, selected full articles and extracted data independently. Results Thirty‐eight full‐text papers were obtained and three main methods to evaluate body perception disturbances were identified: The Bath Body Perception Disturbance Scale, the Neglect‐like Symptoms questionnaire adapted from Galer and the patient's body perception description. No full psychometric assessments were found. The Limb Laterality Recognition Task was also used in conjunction with another method. Conclusions Three main assessment methods for CRPS body perception disturbances are currently used. Full psychometric evaluation has not been completed for any of the assessment methods. As a consequence, we could not fully apply the COSMIN guideline. To date, there is no agreement concerning the use of a specific questionnaire or scale. The results indicate a need for further research such as psychometric properties of these questionnaires. Significance This systematic review identified body perception disturbances assessment methods and their the psychometric properties in order to provide help and guidance to researchers and clinicians to investigate those clinical features.

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Ignoring space around a painful limb? No evidence for a body-related visuospatial attention bias in complex regional pain syndrome

Cited by 12 publications

References 92 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

Assessment of body perception disturbances in complex regional pain syndrome: A systematic review using the COSMIN guideline

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