<p>Clinical Intervention Using Body Shadows for a Patient with Complex Regional Pain Syndrome Who Reported Severe Pain and Self-Disgust Toward the Affected Site: A Case Report</p>

Abstract

A woman in her thirties developed complex regional pain syndrome in her left shoulder due to a traffic accident. She demonstrated autonomic nervous symptoms (swelling, sweating, and skin color asymmetry) in her left hand, severe allodynia, neglect-like symptoms (NLS), impaired body image associated with impaired body awareness, and functional impairment of the left shoulder and elbow. She also reported physical self-disgust toward her affected limb, describing it as "reptilian," as well as aversion to touching others; this body awareness exacerbated her pain and NLS. We therefore conducted stepwise interventions using body shadows. The intervention did not trigger physical self-disgust, enabling formation of body ownership and a body image unaccompanied by pain. Consequently, the patient showed improvements in pain, NLS, and autonomic nervous symptoms.

Person-centred management of upper limb complex regional pain syndrome: an integrative review of non-pharmacological treatment

“…Six different designs were identified; 14 single case studies, 36–49 eight randomised control trials, 50–57 eight prospective cohort studies, 58–65 four case series, 66–68 three retrospective notes reviews, 69–71 and one mixed methods study. 72 13 interventions were categorised as sensory retraining, 37,38,40,42,54,55,57,58,63,64,67,69,71 seven as kinesiotherapy, 36,39,45,48,65,66,68 seven as manual therapies, 43,44,46,49,53,56,73 six as physical modalities, 50–52,59,62,72 and five as interdisciplinary treatment. 41,47,60,61,70…”

“…These included Prism Adaptation, 37,40,54,58 Graded Motor Imagery, 38,57,67 Virtual Reality, 55,64,69 graded somatosensory stimulation, 63,71 and body shadows. 42…”

Intervention Using Body Shadow to Evoke Loading Imagery in a Patient with Complex Regional Pain Syndrome in the Foot: A Case Report

“…Posttraumatic stress [ 8 ], catastrophic thinking [ 9 ], and depression and anxiety [ 10 ] are psychosocial factors reported to affect CRPS pain. Moreover, Hirakawa et al [ 11 ] reported a case of CRPS in which pain was affected by aversion for the appearance of the affected limb. Osumi et al [ 12 ] and Turner-Cobb et al [ 13 ] reported that such aversion for the affected limb can increase pain sensitivity [ 14 ] and exacerbate pain, and McCabe et al [ 15 ] and colleagues [ 13 ] suggested that developing negative feelings regarding the appearance of the affected limb is an important symptom of CRPS.…”

“…For this reason, in cases where pain is related to negative emotions, such as disgust for the affected limb, symptoms may be temporarily relieved during MT, but when the patient sees the actual affected area, the pain reappears along with disgust, and the symptoms may not show consistent improvement. It has been reported that treatment with body shadow in such cases resulted in continuous improvement of symptoms [ 11 ].…”

“…The case we report here documents a CRPS patient who had a gait disorder due to severe foot pain and body image disorder [ 25 ] and had a strong disgust for the affected area. We performed an intervention in this case using a body shadow, similar to that which was carried out in a previous study [ 11 ]. This intervention resulted in reduced pain, but it did not improve her walking ability, as she complained that ‘the thought of loading (the foot) hurts.’ Therefore, we developed a new body-shadow intervention for the treatment of this patient, allowing us to imagine a more subjective and active load.…”