Exploring the Relationships Between Altered Body Perception, Limb Position Sense, and Limb Movement Sense in Complex Regional Pain Syndrome

J Pain. 2019 Jan;20(1):17-27. doi: 10.1016/j.jpain.2018.07.008. Epub 2018 Aug 9.

Abstract

Chronic pain is often accompanied by patient-reported distorted body perception and an altered kinesthesia (referring to the senses of limb position and limb movement), but the association between these deficits is unknown. The objectives of this study were to assess body perception and the senses of limb position and limb movement in complex regional pain syndrome (CRPS) and to test whether these variables are related to each other and to pain intensity. Thirteen patients with upper limb CRPS (mean pain intensity, 4.2 ± 2.4 out of 10) and 13 controls were recruited. Body perception was self-reported with a questionnaire, and the senses of limb position (task 1) and of limb movement (task 2) were assessed with a robotic system combined with a 2D virtual reality display. The results showed altered kinesthesia in the patients with CRPS compared with controls (all P < .05). Moreover, in the CRPS group, greater pain intensity was associated with lower performance on task 2 (r = -.60; P < .05). Although alterations in participants' sense of limb position and limb movement were associated with each other (r = -.70, P < .01), they were not related to the altered body perception (all P > .26). Therefore, the results suggest that kinesthesia and body perception should be considered and evaluated separately in patients with CRPS. PERSPECTIVE: Senses of limb position and movement rely on sensorimotor integration. Both are altered in complex regional pain syndrome. However, they are not related to the subjective perception of the painful limb, and thus they should be assessed separately in rehabilitation.

Keywords: Complex regional pain syndrome; body perception; sense of limb movement; sense of limb position; virtual reality.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Chronic Pain / physiopathology*
  • Complex Regional Pain Syndromes / physiopathology*
  • Female
  • Humans
  • Kinesthesis / physiology
  • Male
  • Middle Aged
  • Proprioception / physiology*
  • Upper Extremity / physiopathology*
  • Virtual Reality