Patients with complex regional pain syndrome overestimate applied force in observed hand actions

Hotta, Jaakko; Harno, Hanna; Nummenmaa, Lauri; Kalso, Eija; Hari, Riitta; Forss, Nina

doi:10.1002/ejp.669

Cited by 7 publications

(17 citation statements)

References 37 publications

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“…Sensorimotor conflicts can also occur in other chronic pain conditions associated with altered body perception. Individuals with complex regional pain syndrome (CRPS) report pain disproportionate to the original injury, perceive alterations in the size and shape of their painful limb (Moseley, 2008;Peltz, Seifert, Lanz, Müller, & Maihöfner, 2011) and overestimate the force exerted in observed hand actions (Hotta et al, 2015). Individuals with fibromyalgia (FM) and arthritis report sensations of excessive swelling (McCabe et al, 2000).…”

Section: Introductionmentioning

confidence: 99%

Sensory disturbances induced by sensorimotor conflicts are higher in complex regional pain syndrome and fibromyalgia compared to arthritis and healthy people, and positively relate to pain intensity

Brun

Mercier

Grieve

et al. 2018

European Journal of Pain

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Background Sensorimotor conflicts are well known to induce sensory disturbances. However, explanations as to why patients with chronic pain are more sensitive to sensorimotor conflicts remain elusive. The main objectives of this study were (a) to assess and compare the sensory disturbances induced by sensorimotor conflict in complex regional pain syndrome (n = 38), fibromyalgia (n = 36), arthritis (n = 34) as well as in healthy volunteers (HV) (n = 32); (b) to assess whether these disturbances were related to the intensity and duration of pain, or to other clinical variables assessed using questionnaires (abnormalities in sensory perception, depression and anxiety); and (c) to categorize different subgroups of conflict‐induced sensory disturbances. Methods One hundred and forty participants performed in phase or anti‐phase movements with their arms while viewing a reflection of one arm in a mirror (and the other arm obscured). They were asked to report changes in sensory disturbances using a questionnaire. Results First, results showed that patients with complex regional pain syndrome and fibromyalgia were more prone to report sensory disturbances than arthritis patients and HV in response to conflicts (small effect size). Second, conflict‐induced sensory disturbances were correlated with pain intensity (large effect size) and abnormalities in sensory perception (only in the CRPS group) but were not related to the duration of the disease or psychological factors. Finally, we identified two distinct subgroups of conflict‐induced sensory disturbances. Conclusions Our results suggest that pain lowers the threshold for the detection of sensorimotor conflicts, a phenomenon that could contribute to the maintenance of pain in clinical populations. Significance Individuals with complex regional pain syndrome and fibromyalgia were more sensitive to sensorimotor conflicts than arthritis patients and controls. Moreover, conflict‐induced sensory disturbances were specific to higher pain intensity and higher sensory abnormalities in all groups, suggesting that pain lowers the threshold for the detection of sensorimotor conflicts.

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Section: Introductionmentioning

confidence: 99%

Sensory disturbances induced by sensorimotor conflicts are higher in complex regional pain syndrome and fibromyalgia compared to arthritis and healthy people, and positively relate to pain intensity

Brun

Mercier

Grieve

et al. 2018

European Journal of Pain

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“…A substantial number of CRPS patients report "neglect-like" symptoms (Frettlöh, Hüppe, & Maier, 2006;Galer & Jensen, 1999;Galer et al, 1995) and more complex instances of "body perception disturbance" (Lewis, Kersten, McCabe, McPherson, & Blake, 2007). Experimental studies have shown that CRPS patients tend to perceive their affected hand as larger than it actually is (Moseley, 2005), exhibit shifts in the perceived visual body midline (Reinersmann et al, 2011;Sumitani et al, 2007), cannot accurately determine their affected limb's position in space (Lewis et al, 2010) and misjudge applied force when watching a hand grasp an object (Hotta et al, 2015). These findings point to a variety of potentially involved neurophysiological processes.…”

Section: Integration With Previous Findings and Outlookmentioning

confidence: 99%

Altered tactile localization and spatiotemporal integration in complex regional pain syndrome patients

Trojan

Speck

Kleinböhl

et al. 2018

European Journal of Pain

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Background In complex regional pain syndrome (CRPS), altered perception of the affected hand and neglect‐like symptoms of the affected body side are common features. In this study, we presented tactile stimuli to the affected hands in CRPS patients and matched healthy controls. Methods The participants’ task was to point at the perceived positions of the stimuli using a tracking device. The spatial coordinates of the perceived positions were analysed for accuracy and consistency. We also presented patterns consisting of two stimuli at distinct positions with a delay of 100 ms. These patterns are known to induce spatiotemporal integration (“sensory saltation”). Results CRPS patients were less accurate and less consistent in the spatial perception of tactile stimuli on their hands. Furthermore, they showed increased spatiotemporal integration, although these effects were smaller than expected. These deficiencies were related to the clinically assessed intensity of recurrent pain episodes. Surprisingly, the intensity of clinically assessed ongoing pain was associated with increased precision. Conclusions In line with earlier reports, our findings indicate that the representation of the affected hands in CRPS patients is less accurate than in healthy people, probably reflecting reorganization in somatosensory cortices. The exact relationships between these findings and other aspects of CRPS remain to be elucidated. Significance CRPS patients performed poorly in localizing positions on their affected hands via pointing and exhibited increased spatiotemporal integration. The presented method may prove useful in diagnostics as well as psychophysical and neurofunctional research on CRPS and other chronic pain disorders.

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“…During fMRI scanning, the subjects viewed the same 3.2-second video clips of hand actions that we applied in our previous study in which the stimuli appeared unpleasant and even painful for the patients to observe. 31 In the current experiment, the video clips were shown in 4-clip blocks (Fig 2). Each of the 48 blocks contained videos of hand actions in 1 of 3 possible categories: either left or right hand remaining static (STATIC condition), repeating gentle movements of opening and closing the fist (FIST), or squeezing an object with maximum force (SQUEEZE; the squeezed objects are presented in Supplementary Fig 1).…”

Section: Experimental Designmentioning

confidence: 99%

“…To familiarize the subjects with the hand actions, before scanning we asked them to perform the actions and then view the video stimuli (for the protocol details, see Hotta et al 31 ). The stimuli were shown in conditionwise blocks, and after each block, the subjects rated their level of pain and valence during the observation on the 11-point numeric rating scale (pain: 0 = no pain, 10 = extreme pain; valence: 0 = very pleasant, 5 = neutral, 10 = very unpleasant).…”

Section: Experimental Designmentioning

confidence: 99%

See 1 more Smart Citation

Abnormal Brain Responses to Action Observation in Complex Regional Pain Syndrome

Hotta

Saari

Koskinen

et al. 2017

The Journal of Pain

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Patients with complex regional pain syndrome (CRPS) display various abnormalities in central motor function, and their pain is intensified when they perform or just observe motor actions. In this study, we examined the abnormalities of brain responses to action observation in CRPS. We analyzed 3-T functional magnetic resonance images from 13 upper limb CRPS patients (all female, ages 31-58 years) and 13 healthy, age-and sex-matched control subjects. The functional magnetic resonance imaging data were acquired while the subjects viewed brief videos of hand actions shown in the first-person perspective. A pattern-classification analysis was applied to characterize brain areas where the activation pattern differed between CRPS patients and healthy subjects. Brain areas with statistically significant group differences (q < .05, false discovery rate-corrected) included the hand representation area in the sensorimotor cortex, inferior frontal gyrus, secondary somatosensory cortex, inferior parietal lobule, orbitofrontal cortex, and thalamus. Our findings indicate that CRPS impairs action observation by affecting brain areas related to pain processing and motor control. Perspective: This article shows that in CRPS, the observation of others' motor actions induces abnormal neural activity in brain areas essential for sensorimotor functions and pain. These results build the cerebral basis for action-observation impairments in CRPS.

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Patients with complex regional pain syndrome overestimate applied force in observed hand actions

Cited by 7 publications

References 37 publications

Sensory disturbances induced by sensorimotor conflicts are higher in complex regional pain syndrome and fibromyalgia compared to arthritis and healthy people, and positively relate to pain intensity

Sensory disturbances induced by sensorimotor conflicts are higher in complex regional pain syndrome and fibromyalgia compared to arthritis and healthy people, and positively relate to pain intensity

Altered tactile localization and spatiotemporal integration in complex regional pain syndrome patients

Abnormal Brain Responses to Action Observation in Complex Regional Pain Syndrome

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