Body perception disturbance in complex regional pain syndrome

Abstract

Complex regional pain syndrome (CRPS) is a painful, debilitating condition that is poorly understood. The syndrome is characterised by pain, motor disturbances and abnormalities in trophic, sudomotor, vascular temperature and sensation. The underlying mechanisms are unknown. Clinical observations have identified a novel phenomenon whereby patients pay little attention to, and fail to care for, their painful affected limb. The literature describes this phenomenon in terms of neglect-like symptoms similar to neurological neglect as described in stroke literature. However, this does not seem to fully fit with or explain the nature of clinical observations.

Therefore the aim of the qualitative first study was to more fully describe the phenomenon through an investigation of the patient experience and words used to describe those experiences. Six themes emerged from the data and were as follows: hostile feelings; spectrum of disassociation; disparity between what is apparent and what is felt; distorted mental image of affected parts; awareness of limb position and conscious attention. From these findings a theory emerged which serves to further our understanding of body perception disturbance in CRPS.

Based on these findings, the second study aimed to quantify a feature of body perception disturbance by measuring limb position accuracy of those with CRPS compared to Healthy Controls (HC) and those with Rheumatological Pain (RP).

The CRPS group were significantly less accurate in positioning of both the affected and unaffected upper limbs (median=9°, Interquartile rang e (IQR), 5.7°-13.3°) compared to both HC (6.5°, IQR, 4°-10.7°) and RP groups (7.7°, IQR, 5 °-11.7°). In the CRPS group position accuracy of the affected limb significantly improved with vision (8.3° in view, 10.7° not in view). Pain intensity was significantly greater in the CRPS (6.5, IQR, 5.4-7.7) than the RP group (4.6, IQR, 3.6-5.7).

Based on the findings of this research programme, a definition of body perception disturbance in CRPS is presented. Furthermore, a disrupted body schema model is proposed as an explanation of the central mechanisms responsible for body perception disturbance in CRPS.

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