Pain, body, and space: What do patients with complex regional pain syndrome really neglect?

Basal ganglia dysfunction in complex regional pain syndrome – A valid hypothesis?

“…Little is known about the pathomechanisms and the involved CNS areas in some intriguing body perception disturbances in CRPS, such as misjudgement of laterality recognition (Moseley, 2004b) or the inability to correctly localize the position of the affected limb (Lewis et al, 2010). However, as several investigators have pointed out, it seems that these symptoms are not necessarily a neglect of the affected limb, but rather an impairment of the reference frame of the side of space where the limb is located (Reinersmann et al, 2012) or even an over-representation of the affected limb (Torta et al, 2016), driven by a maladaptive reorganization of the motor and somatosensory cortices (Lotze and Moseley, 2007;Marinus et al, 2011) and faulty multisensory integration (Legrain et al, 2012). However, as several investigators have pointed out, it seems that these symptoms are not necessarily a neglect of the affected limb, but rather an impairment of the reference frame of the side of space where the limb is located (Reinersmann et al, 2012) or even an over-representation of the affected limb (Torta et al, 2016), driven by a maladaptive reorganization of the motor and somatosensory cortices (Lotze and Moseley, 2007;Marinus et al, 2011) and faulty multisensory integration (Legrain et al, 2012).…”

“…Sometimes these signs have been labelled as neglect-like syndrome (Galer and Jensen, 1999;Frettloh et al, 2006). The posterior parietal cortex is a possible brain area where such multisensory and spatial integration may be performed (Legrain et al, 2012) as well as the basal ganglia Nagy et al, 2006). The posterior parietal cortex is a possible brain area where such multisensory and spatial integration may be performed (Legrain et al, 2012) as well as the basal ganglia Nagy et al, 2006).…”

“…Sometimes these signs have been labelled as neglect-like syndrome (Galer and Jensen, 1999;Frettloh et al, 2006). However, as several investigators have pointed out, it seems that these symptoms are not necessarily a neglect of the affected limb, but rather an impairment of the reference frame of the side of space where the limb is located (Reinersmann et al, 2012) or even an over-representation of the affected limb (Torta et al, 2016), driven by a maladaptive reorganization of the motor and somatosensory cortices (Lotze and Moseley, 2007;Marinus et al, 2011) and faulty multisensory integration (Legrain et al, 2012). The posterior parietal cortex is a possible brain area where such multisensory and spatial integration may be performed (Legrain et al, 2012) as well as the basal ganglia Nagy et al, 2006).…”

Effect of Painful and Non-Painful Sensorimotor Manipulations on Subjective Body Midline

“…In other words, it suggests that the association between altered sensorimotor processing and pain is not related (or at least not exclusively related) to an altered somatotopical body representation, as plastic changes observed in the primary sensorimotor cortices might suggest. Rather, it seems to imply broader, multimodal information processing related to the egocentric framing of space (Legrain et al, 2012). …”

Attentional bias to pain-relevant body locations: New methods, new challenges

“…On the other hand, it is well known that CRPS patients are an atypical population that may not be representative for the broader chronic pain population. Specifically, we should be very cautious in generalizing the neglect-like avoidance of the space in which the painful limb usually resides in CRPS patients (Legrain, Bultitude, De Paepe, & Rossetti, 2012) to other chronic pain populations, and to question theoretical assumptions on over-attentiveness that are present in several pain models based upon these CRPS studies.…”