Interplay between body schema, visuospatial perception and pain in patients with spinal cord injury

Osinski, Thomas; Martinez, Valéria; Bensmaïl, Djamel; Hatem, Samar; Bouhassira, Didier

doi:10.1002/ejp.1600

Cited by 10 publications

(7 citation statements)

References 54 publications

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“…NP is not only associated with higher levels of pain but also brain related sensorimotor dysfunction [ 11 ]. Previous research has shown that body schema alterations are present in a large proportion of people with symptomatic hand OA [ 12 ] with 50% of participants presenting with neglect-like symptoms.…”

Section: Introductionmentioning

confidence: 99%

Neuropathic Pain in Hand Osteoarthritis: A Cross-Sectional Study

Magni

Collier

McNair

et al. 2021

JCM

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Symptomatic hand osteoarthritis (OA) is a severely debilitating condition. Neuropathic pain (NP) has been shown to be a factor affecting pain severity, hand function, psychological wellbeing, body schema, and the number of pain medications in people with OA of other joints. The aim of this study was to assess the prevalence of NP in symptomatic hand OA and assess its association with pain, hand function, measures of psychological wellbeing, sleep, body schema disturbances, and number of pain medications. Participants with symptomatic hand OA diagnosed through the American College of Rheumatology criteria, were recruited and completed a series of online questionnaires. These included the Douleur Neuropathique 4 interview (DN4-interview), Short Form Brief Pain Inventory (SF-BPI), Neglect-like Symptoms questionnaire, Functional Index of Hand Osteoarthritis (FIHOA), Centre for Epidemiologic Studies Depression Scale (CES-D), Pain Catastrophising Scale (PCS), and the Pittsburgh Sleep Quality Index (PSQI). Logistic regression with age, body mass index, and sex as covariates were utilised to assess differences between participants with and without NP as identified through the DN4-interview. Correlation analysis assessed the relationship between pain intensity, body schema alterations, and number of pain medications. A total of 121 participants were included in the present study. Forty-two percent of participants presented with NP. Participants with NP reported higher levels of worst pain (OR: 10.2 95%CI: 2.2 to 48.5; p = 0.007). Worst pain intensity correlated with the number of pain medications (rho = 0.2; p = 0.04), and neglect-like symptoms (rho = 0.4; p < 0.0001). No difference between phenotypes was shown for catastrophising, function, depression, neglect-like symptoms, pain interference, or sleep. A large proportion of people with symptomatic hand OA present with NP. This phenotype is characterised by greater levels of pain intensity. Pain intensity is associated with number of pain relief medications and body schema alteration. Psychological factors, hand function, and sleep do not appear to be affected by the presence of NP.

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Section: Introductionmentioning

confidence: 99%

Neuropathic Pain in Hand Osteoarthritis: A Cross-Sectional Study

Magni

Collier

McNair

et al. 2021

JCM

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“…[1][2][3] Increasing evidence shows that adults with SCI with motor and sensory impairments also experience body awareness deficits. [4][5][6][7][8][9][10][11][12][13][14][15] Body awareness refers to an attentional focus on and awareness of internal body sensations, including whole-body awareness as well as awareness of body parts in relation to each other, and how they are positioned and move in space. 16,17 These motor and sensory impairments, and particularly the loss of awareness of where the limbs are in space, 18 greatly compromise function and mobility.…”

Section: Introductionmentioning

confidence: 99%

“…In sum, these mental body representation deficits hinder functional recovery because the brain does not recognize the body's spatial location to guide movements. [4][5][6][12][13][14]18 Adults who have SCI-related neuropathic pain often have an altered perception related to the size and dimension of the painful and/or sensorimotor-impaired body parts, which justifies the use of CMR to treat neuropathic pain. They also have an altered perception of body weight, pressure, or touch in those body regions.…”

Section: Introductionmentioning

confidence: 99%

“…Because of the spinal cord lesion, the disrupted communication interferes with the correct processing of sensory signals between the body and the brain. This results in altered structural and functional brain activity, notably in the sensorimotor network and in the pain network, 12,26–39 which may explain why many adults with SCI perceive abnormal pain signals. 26,27,32–35 Neuroimaging studies have directly addressed SCI-related neuropathic pain.…”

Section: Introductionmentioning

confidence: 99%

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Identifying Body Awareness-Related Brain Network Changes after Cognitive Multisensory Rehabilitation for Neuropathic Pain Relief in Adults with Spinal Cord Injury: Delayed Treatment arm Phase I Randomized Controlled Trial

Winckel

Carpentier

Deng

et al. 2023

Preprint

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Background: Neuropathic pain after spinal cord injury (SCI) is notoriously hard to treat. Mechanisms of neuropathic pain are unclear, which makes finding effective treatments challenging. Prior studies have shown that adults with SCI have body awareness deficits. Recent imaging studies, including ours, point to the parietal operculum and insula as key areas for both pain perception and body awareness. Cognitive multisensory rehabilitation (CMR) is a physical therapy approach that helps improve body awareness for pain reduction and sensorimotor recovery. Based on our prior brain imaging work in CMR in stroke, we hypothesized that improving body awareness through restoring parietal operculum network connectivity leads to neuropathic pain relief and improved sensorimotor and daily life function in adults with SCI. Thus, the objectives of this study were to (1) determine baseline differences in resting-state and task-based functional magnetic resonance imaging (fMRI) brain function in adults with SCI compared to healthy controls and (2) identify changes in brain function and behavioral pain and pain-associated outcomes in adults with SCI after CMR. Methods: Healthy adults underwent a one-time MRI scan and completed questionnaires. We recruited community-dwelling adults with SCI-related neuropathic pain, with complete or incomplete SCI >3 months, and highest neuropathic pain intensity level of >3 on the Numeric Pain Rating Scale (NPRS). Participants with SCI were randomized into two groups, according to a delayed treatment arm phase I randomized controlled trial (RCT): Group A immediately received CMR intervention, 3x/week, 45 min/session, followed by a 6-week and 1-year follow-up. Group B started with a 6-week observation period, then 6 weeks of CMR, and a 1-year follow-up. Highest, average, and lowest neuropathic pain intensity levels were assessed weekly with the NPRS as primary outcome. Other primary outcomes (fMRI resting-state and functional tasks; sensory and motor function with the INSCI AIS exam), as well as secondary outcomes (mood, function, spasms, and other SCI secondary conditions), were assessed at baseline, after the first and second 6-week period. The INSCI AIS exam and questionnaires were repeated at the 1-year follow-up. Findings: Thirty-six healthy adults and 28 adults with SCI were recruited between September 2020 and August 2021, and 31 healthy adults and 26 adults with SCI were enrolled in the study. All 26 participants with SCI completed the intervention and pre-post assessments. There were no study-related adverse events. Participants were 52+/-15 years of age, and 1-56 years post-SCI. During the observation period, group B did not show any reductions in neuropathic pain and did not have any changes in sensation or motor function (INSCI ASIA exam). However, both groups experienced a significant reduction in neuropathic pain after the 6-week CMR intervention. Their highest level of neuropathic pain of 7.81+/-1.33 on the NPRS at baseline was reduced to 2.88+/-2.92 after 6 weeks of CMR. Their change scores were 4.92+/-2.92 (large effect size Cohen d=1.68) for highest neuropathic pain, 4.12+/-2.23 (d=1.85) for average neuropathic pain, and 2.31+/-2.07 (d=1.00) for lowest neuropathic pain. Nine participants out of 26 were pain-free after the intervention (34.62%). The results of the INSCI AIS testing also showed significant improvements in sensation, muscle strength, and function after 6 weeks of CMR. Their INSCI AIS exam increased by 8.81+/-5.37 points (d=1.64) for touch sensation, 7.50+/-4.89 points (d=1.53) for pin prick sensation, and 3.87+/-2.81 (d=1.38) for lower limb muscle strength. Functional improvements after the intervention included improvements in balance for 17 out of 18 participants with balance problems at baseline; improved transfers for all of them and a returned ability to stand upright with minimal assistance in 12 out of 20 participants who were unable to stand at baseline. Those improvements were maintained at the 1-year follow-up. With regard to brain imaging, we confirmed that the resting-state parietal operculum and insula networks had weaker connections in adults with SCI-related neuropathic pain (n=20) compared to healthy adults (n=28). After CMR, stronger resting-state parietal operculum network connectivity was found in adults with SCI. Also, at baseline, as expected, right toe sensory stimulation elicited less brain activation in adults with SCI (n=22) compared to healthy adults (n=26). However, after CMR, there was increased brain activation in relevant sensorimotor and parietal areas related to pain and mental body representations (i.e., body awareness and visuospatial body maps) during the toe stimulation fMRI task. These brain function improvements aligned with the AIS results of improved touch sensation, including in the feet. Interpretation: Adults with chronic SCI had significant neuropathic pain relief and functional improvements, attributed to the recovery of sensation and movement after CMR. The results indicate the preliminary efficacy of CMR for restoring function in adults with chronic SCI. CMR is easily implementable in current physical therapy practice. These encouraging impressive results pave the way for larger randomized clinical trials aimed at testing the efficacy of CMR to alleviate neuropathic pain in adults with SCI.

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“…[13][14][15][16][17] Concurrently with reduced or absent sensation, recently, increasing evidence shows that adults with SCI experience deficits in body awareness. [18][19][20][21][22][23][24][25][26][27][28][29][30][31] Body awareness deficits are thought to contribute to the production or maintenance of chronic neuropathic pain. [18][19][20]22,24,25 Body awareness refers to an attentional focus on and awareness of internal body sensations, which includes an awareness of how the body and body parts are positioned and move in space.…”

Section: Introductionmentioning

confidence: 99%

Using remotely delivered Spring Forest Qigong™ to reduce neuropathic pain in adults with spinal cord injury: A non-randomized controlled trial

Winckel

Carpentier

Deng

et al. 2023

Preprint

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Importance: The manuscript proposes the feasibility and potential of a remote Qigong intervention to reduce neuropathic pain in adults with spinal cord injury (SCI)-related neuropathic pain. Objective: We determined the feasibility and estimates of efficacy of a remotely delivered Qigong intervention in adults with SCI-related neuropathic pain. Design: This is a non-randomized controlled trial with outcomes assessed at baseline-, 6- and 12-weeks of Qigong practice, and at 6-weeks and 1-year follow-up. Setting: Completely remote clinical trial. Participants: Adults with SCI-related neuropathic pain, with SCI of at least 3 months, with complete or incomplete SCI, and highest neuropathic pain level of >3 on the Numeric Pain Rating Scale (NPRS). We used nationwide volunteer sampling. We recruited 23 adults with chronic SCI (7/2021-2/2022). Eighteen participants started the study and completed all study components, including the 6-week follow-up. Twelve participants completed the 1-year follow-up assessment. Intervention: Participants practiced the Spring Forest Qigong Five Element Healing Movements with an online video by combining movement with kinesthetic imagery, at least 3x/week for 12 weeks. Main Outcome(s) and Measure(s): To address the feasibility outcome and track adherence, the website automatically monitored the days and duration that the Qigong video was played. Self-report neuropathic pain intensity and SCI-related symptoms such as spasms, functional performance, mood, and body appreciation were also collected. Results: Eighteen participants, 60+/-12 years of age, 15+/-11 years post-SCI had a highest baseline neuropathic pain of 7.94+/-2.33 on the NPRS, which was reduced to 4.17+/-3.07 after 12 weeks of Qigong practice (Cohen d=1.75). This pain relief remained at 6-week and 1-year follow-ups. Participants reported reduced spasm frequency (change score 1.17+/-1.20, d=0.98) and severity (0.72+/-1.02, d=0.71), and reduced interference of neuropathic pain on mood (3.44+/-2.53, d=1.36), sleep (3.39+/-2.40, d=1.41), and daily activities (3.17+/-2.77, d=1.14). They had a greater ability to perform functional activities (Patient Specific Functional Scale, 6.68+/-3.07, d=2.18) and had improved mood (Patient Health Questionnaire-9, 2.33+/-3.31, d=0.70). Conclusions and Relevance: Our preliminary data demonstrate the feasibility of Qigong practice in adults with SCI-related neuropathic pain and promising results of neuropathic pain relief and improvement in SCI-related symptoms after Qigong practice.

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Interplay between body schema, visuospatial perception and pain in patients with spinal cord injury

Cited by 10 publications

References 54 publications

Neuropathic Pain in Hand Osteoarthritis: A Cross-Sectional Study

Neuropathic Pain in Hand Osteoarthritis: A Cross-Sectional Study

Identifying Body Awareness-Related Brain Network Changes after Cognitive Multisensory Rehabilitation for Neuropathic Pain Relief in Adults with Spinal Cord Injury: Delayed Treatment arm Phase I Randomized Controlled Trial

Using remotely delivered Spring Forest Qigong™ to reduce neuropathic pain in adults with spinal cord injury: A non-randomized controlled trial

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