Prisms to Shift Pain Away: Pathophysiological and Therapeutic Exploration of CRPS with Prism Adaptation

Christophe, Laure; Chabanat, E.; Delporte, Ludovic; Revol, Patrice; Volckmann, P.; Jacquin-Courtois, Sophie; Rossetti, Yves

doi:10.1155/2016/1694256

Cited by 39 publications

(97 citation statements)

References 47 publications

(106 reference statements)

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“…Reduction of pain and other CRPS symptoms following prism adaptation treatment (Bultitude & Rafal, 2010;Christophe, Chabanat, et al, 2016;Sumitani, Rossetti, et al, 2007), which is thought to increase attention to the affected side relative to the unaffected side, further supports the clinical relevance of spatial attention in CPRS. Therefore, understanding spatial biases in CRPS, and how they relate to clinical symptoms, could provide insights into the prevention and treatment of the disorder.…”

Section: Introductionmentioning

confidence: 63%

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Disputing space-based biases in unilateral complex regional pain syndrome

Halicka

Vitterso

McCullough

et al. 2020

Preprint

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There is some evidence that people with Complex Regional Pain Syndrome (CRPS) show reduced attention to the affected relative to unaffected limb and its surrounding space, resembling hemispatial neglect after brain injury. These neuropsychological symptoms could be related to central mechanisms of pathological pain and contribute to its clinical manifestation. However, the existing evidence of changes in spatial cognition is limited and often inconsistent. We examined visuospatial attention, the mental representation of space, and spatially-defined motor function in 54 people with unilateral upper-limb CRPS and 22 pain-free controls. Contrary to our hypotheses and previous evidence, individuals with CRPS did not show any systematic spatial biases in visuospatial attention to or representation of the side of space corresponding to their affected limb (relative to the unaffected side). We found very little evidence of directional slowing of movements towards the affected relative to unaffected side that would be consistent with motor neglect. People with CRPS were, however, slower than controls to initiate and execute movements with both their affected and unaffected hands, which suggests disrupted central motor networks. Finally, we found no evidence of any clinical relevance of changes in spatial cognition because there were no relationships between the magnitude of spatial biases and the severity of pain or other CRPS symptoms. The results did reveal potential relationships between CRPS pain and symptom severity, subjective body perception disturbance, and extent of motor impairment, which would support treatments focused on normalizing body representation and improving motor function. Our findings suggest that previously reported spatial biases in CRPS might have been overstated.

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Section: Introductionmentioning

confidence: 63%

“…Furthermore, very few previous studies tested different aspects of neglect (i.e. perceptual, representational, and motor) in the same group of participants (see Christophe, Chabanat, et al, 2016;Reid et al, 2016;Sumitani et al, 2014 for exceptions).…”

Section: Introductionmentioning

confidence: 99%

Disputing space-based biases in unilateral complex regional pain syndrome

Halicka

Vitterso

McCullough

et al. 2020

Preprint

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“…Altered body representation and effortful movement (“neglect-like symptoms”) are predictive of worse pain outcomes in chronic CRPS six months later [85]. Treatments that target bodily and spatial representation, such as graded motor imagery [50,52,53], and prism adaptation [8,14,74] can reduce pain and other CRPS symptoms [6]. Furthermore, hand temperature asymmetries can be reduced by crossing the CRPS-affected hand into the non-affected side of peripersonal space [55].…”

Section: Introductionmentioning

confidence: 99%

Characterising sensorimotor adaptation in Complex Regional Pain Syndrome

Vitterso

Buckingham²,

Halicka

et al. 2019

Preprint

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Distorted representations of the body and peripersonal space are common in Complex Regional Pain Syndrome (CRPS), and might modulate its symptoms (e.g. asymmetric limb temperature). In pain-free people, such representations are malleable, and update when we interact with objects in our environment (e.g. during tool-use). Distortions are also common after immobilisation, but quickly normalise once movement is regained. We tested the hypothesis that people with CRPS have problems updating bodily and spatial representations, which contributes to the maintenance of their distorted representations by preventing normalization. We also explored spatially defined modulations of hand temperature asymmetries, and any influence of updating bodily and spatial representations on this effect. Thirty-six people with unilateral CRPS (18 upper limb, 18 lower limb) and 36 pain-free controls completed tool-use tasks considered to alter body and peripersonal space representations (measured using tactile distance judgements and a visuotactile crossmodal congruency task, respectively). We also tested how the arrangement (crossed, uncrossed) of the hands and tools affected hand temperature. In upper limb CRPS the non-affected arm representation updated normally, but the affected arm representation updated in the opposite to normal direction. A similar pattern was seen in lower limbs CRPS, although not significant. Furthermore, people with CRPS showed more pronounced updating of peripersonal space than the controls. We did not observe any modulation of hand temperature asymmetries by the arrangement of hands or tools. Our findings suggest enhanced malleability of bodily and spatial representations in CRPS, potentially implicating central mechanisms in the aetiology of this condition.

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“…In CRPS patients for example, distortions of the egocentric reference frame (Sumitani, Shibata, et al, 2007;Uematsu et al, 2009) and a lateralized spatial bias in tactile and visual processing (Bultitude et al, 2017;Filbrich et al, 2017;Moseley et al, 2009) have been demonstrated, as well as symptoms suggesting a distorted representation of the affected limb. Furthermore, prismatic adaptation, a therapy that is often used effectively to treat visuospatial deficits in hemispatial neglect patients, has also been shown beneficial in reducing pain and other related symptoms in CRPS (Bultitude & Rafal, 2010;Christophe et al, 2016;Jacquin-Courtois et al, 2012;Sumitani, Rossetti, et al, 2007). Alterations in space perception can also be observed in hemiplegic patients without classical symptoms of hemispatial neglect (Bartolo, Carlier, Hassaini, Martin, & Coello, 2014) or after unilateral hand amputation (Makin et al, 2010).…”

Section: Discussionmentioning

confidence: 99%

“…Forderreuther, Sailer, & Straube, 2004;Galer, Butler, & Jensen, 1995;Galer & Jensen, 1999;Lewis, Kersten, McCabe, McPherson, & Blake, 2007;McCabe, Haigh, Halligan, & Blake, 2003;Moseley, 2004Moseley, , 2005Moseley, Gallace, & Spence, 2009;Schwoebel, Friedman, Duda, & Coslett, 2001). However, neglect-like symptomatology in CRPS could not been evidenced by classical neuropsychological testing (Christophe et al, 2016;Forderreuther et al, 2004;Kolb, Lang, Seifert, & Maihofner, 2012;Reid et al, 2016;Reinersmann et al, 2012) and visuo-spatial abnormalities have only been demonstrated in very specific experimental testing conditions. For instance, Sumitani, Shibata, et al (2007) observed difficulties in judging the position of a visual stimulus according to their own body midline in CRPS patients.…”

Section: Introductionmentioning

confidence: 99%

Robot-assisted line bisection test in virtual reality

Filbrich¹,

Xivry²,

Verfaille³

et al. 2018

Preprint

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There is growing evidence in the literature suggesting that sensori-motor deficits have a detrimental impact on cognitive abilities, such as the perception and representation of space. Most of the tasks classically used to assess spatial perception abilities after brain damage seem however not adequate to reveal potentially more discrete impairments in patients that are predominantly suffering from sensori-motor symptoms. To this aim we adapted the classic line bisection task in a virtual reality environment for the use with patients with upper-limb sensory-motor deficits. Here, we report the results from two pre-clinical experiments with healthy volunteers. Lines were projected horizontally on a semi-reflective mirror. Participants were asked to bisect the lines at their estimated midpoint by means of a robotic handle. Manipulated factors were the static hand, the position of the static hand (inside or outside of workspace), the visibility of the hands and the location of the lines. Results showed that participants neglected the most lateral part of the lines when they were projected distantly from the starting point. Bisection biases were in general more important when participants could see their hands. Additionally, participants took more time to initiate movements when they had to cover a short distance to reach the lines. We conclude that our robotic adaptation of the line bisection task was able to highlight subtle perceptual asymmetries in healthy individuals and that its use to reveal discrete cognitive deficits in patients with sensory-motor impairments seems therefore promising.

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Prisms to Shift Pain Away: Pathophysiological and Therapeutic Exploration of CRPS with Prism Adaptation

Cited by 39 publications

References 47 publications

Disputing space-based biases in unilateral complex regional pain syndrome

Disputing space-based biases in unilateral complex regional pain syndrome

Characterising sensorimotor adaptation in Complex Regional Pain Syndrome

Robot-assisted line bisection test in virtual reality

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