Abstract
Complex regional pain syndrome (CRPS) is associated with deficits in sensorimotor
control. Herein we have used a novel finger illusion to investigate whether CRPS is
associated with reduced weighting of bimanual hand representations. The illusion normally
induces a compelling feeling that the hands are close together when in fact they are
12 cm apart. People with CRPS and age, gender, and dominant hand-matched controls
tested the illusion in the midline then on either side of the midline. The illusion
had 2 variants; the passive pincer-grip position, without contact (no grasp condition)
and with contact (grasp condition) of the artificial finger. The primary outcome was
the perceived vertical distance between the index fingers. Twenty people with CRPS
and 20 controls participated (mean age 44.4 ± 11.7 years). During the no grasp condition,
participants with CRPS perceived the vertical distance significantly closer to the
actual 12 cm (mean 8.0 cm, 95% confidence interval 6.5-9.5 cm), than controls did
(mean 6.4 cm, 95% confidence interval 5.5-7.2 cm]). That is, the illusion was weaker
in people with CRPS than in controls during no grasp. There was no such difference
during grasp; that is, both groups showed the predicted illusion response. There was
no effect of hand placement relative to midline or relative to the opposite hand.
We conclude that people with unilateral CRPS have lower weighting of bimanual hand
representation than controls have, independent of hand location. However, adding additional
cutaneous input returns those with CRPS to the expected performance. We suggest the
results have clear clinical and research implications.
Perspective
An abnormal weighting of bilateral hand representation may reflect a vulnerability
for chronic CRPS, an adaptation to the disease, and/or a potential therapeutic target.
That addition of cutaneous input immediately normalizes the problem points to the
possible role of bimanual tasks in prevention or rehabilitation.
Key words
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References
- Dysynchiria: Watching the mirror image of the unaffected limb elicits pain on the affected side.Neurology. 2005; 65: 751-753
- Disrupting tactile spatial transformations with TMSE.Perception. 2009; 38: 143-144
- The posterior parietal cortex remaps touch into external space.Curr Biol. 2010; 20: 1304-1309
- Rubber hands 'feel' touch that eyes see.Nature. 1998; 391: 756
- Bimanual reaching across the hemispace: Which hand is yoked to which.Brain Cogn. 2010; 74: 341-346
- Derangement of body representation in complex regional pain syndrome: Report of a case treated with mirror and prisms.Exp Brain Res. 2010; 204: 409-418
- Space-based bias of covert visual attention in complex regional pain syndrome.Brain. 2017; 140: 2306-2321
- Body ownership and a new proprioceptive role for muscle spindles.Acta Physiol (Oxf). 2017; 220: 19-27
- Primary motor cortex function in complex regional pain syndrome: A systematic review and meta-analysis.J Pain. 2013; 14: 1270-1288
- Primary somatosensory cortex function in complex regional pain syndrome: A systematic review and meta-analysis.J Pain. 2013; 14: 1001-1018
- Interhemispheric somatosensory differences in chronic pain reflect abnormality of the Healthy side.Hum Brain Mapp. 2015; 36: 508-518
- An exploration into the cortical reorganisation of the healthy hand in upper-limb complex regional pain syndrome.Scand J Pain. 2016; 13: 18-24
- Biased visuospatial perception in complex regional pain syndrome.Sci Rep. 2017; 7: 9712
- Impaired self-perception of the hand in complex regional pain syndrome (CRPS).Pain. 2004; 110: 756-761
- Open science framework (OSF).J Med Libr Assoc. 2017; 105: 203-206
- Severity and specificity of neglect-like symptoms in patients with complex regional pain syndrome (CRPS) compared to chronic limb pain of other origins.Pain. 2006; 124: 184-189
- Neglect-like symptoms in complex regional pain syndrome: Results of a self-administered survey.J Pain Symptom Manage. 1999; 18: 213-217
- The analgesic effect of crossing the arms.Pain. 2011; 152: 1418-1423
- Spatial sensory organization and body representation in pain perception.Curr Biol. 2013; 23: R164-R176
- Validation of proposed diagnostic criteria (the "Budapest Criteria") for complex regional pain syndrome.Pain. 2010; 150: 268-274
- Time, touch and temperature affect perceived finger position and ownership in the grasp illusion.J Physiol. 2018; 596: 267-280
- Is this my finger? Proprioceptive illusions of body ownership and representation.J Physiol. 2013; 591: 5661-5670
- Proprioceptive bimanual test in intrinsic and extrinsic coordinates.Front Hum Neurosci. 2015; 9: 72
- On the coordination of two-handed movements.J Exp Psychol Hum Percept Perform. 1979; 5: 229-238
- Cognitive correlates of neglect-like syndrome in patients with complex regional pain syndrome.Pain. 2012; 153: 1063-1073
- Dysynchiria is not a common feature of neuropathic pain.Eur J Pain. 2008; 12: 128-131
- Altered neurocognitive processing of tactile stimuli in patients with complex regional pain syndrome (CRPS).J Pain. 2018; 19: 395-409
- Pain, body, and space: What do patients with complex regional pain syndrome really neglect?.Pain. 2012; 153: 948-951
- Wherever is my arm? Impaired upper limb position accuracy in complex regional pain syndrome.Pain. 2010; 149: 463-469
- Cortical reorganization during recovery from complex regional pain syndrome.Neurology. 2004; 63: 693-701
- Clinical features and pathophysiology of complex regional pain syndrome.Lancet Neurol. 2011; 10: 637-648
- Impaired self-perception of the hand in complex regional pain syndrome (CRPS).Pain. 2004; 110 (Pain 114:518; author reply 519, 2005): 756-761
- Why do people with complex regional pain syndrome take longer to recognize their affected hand?.Neurology. 2004; 62: 2182-2186
- Distorted body image in complex regional pain syndrome.Neurology. 2005; 65 (773-773)
- Limb-specific autonomic dysfunction in complex regional pain syndrome modulated by wearing prism glasses.Pain. 2013; 154: 2463-2468
- Spatially defined modulation of skin temperature and hand ownership of both hands in patients with unilateral complex regional pain syndrome.Brain. 2012; 135: 3676-3686
- Space-based, but not arm-based, shift in tactile processing in complex regional pain syndrome and its relationship to cooling of the affected limb.Brain J Neurol. 2009; 132: 3142-3151
- Bodily illusions in health and disease: Physiological and clinical perspectives and the concept of a cortical 'body matrix'.Neurosci Biobehav Rev. 2012; 36: 34-46
- The sensory hand. Neural mechanisms of somatic sensation..Harvard University Press, London, UK2005
- The assessment and analysis of handedness: The Edinburgh Inventory.Pneuropsychologica. 1971; 9: 97-113
- Somatosensory plasticity and motor learning.J Neurosci. 2010; 30: 5384-5393
- Multiplex cytokine concentration measurement: How much do the medium and handling matter?.Mediators Inflamm. 2013; 2013890706
- Impaired hand size estimation in CRPS.J Pain. 2011; 12: 1095-1101
- Patterns of cortical reorganization parallel impaired tactile discrimination and pain intensity in complex regional pain syndrome.Neuroimage. 2006; 32: 503-510
- Sensorimotor returning in complex regional pain syndrome parallels pain reduction.Ann Neurol. 2005; 57: 425-429
- A new kind of spatial inattention associated with chronic limb pain?.Ann Neurol. 2016; 79: 701-704
- Spatially-defined motor deficits in people with unilateral complex regional pain syndrome.Cortex. 2018; 104: 154-162
- Pain and the body schema: Effects of pain severity on mental representations of movement.Neurology. 2002; 59: 775-777
- Pain and the body schema: Evidence for peripheral effects on mental representations of movement.Brain. 2001; 124: 2098-2104
- Two hands, one perception: How bimanual haptic information is combined by the brain.J Neurophysiol. 2012; 107: 544-550
- Dissociation in accessing space and number representations in pathologic pain patients.Brain Cogn. 2014; 90: 151-156
- Sensing the body in chronic pain: A review of psychophysical studies implicating altered body representation.Neurosci Biobehav Rev. 2015; 52: 221-232
- Unimanual muscle activation increases interhemispheric inhibition from the active to the resting hemisphere.Neurosci Lett. 2008; 445: 209-213
- Proprioceptive signals contribute to the sense of body ownership.J Physiol. 2011; 589: 3009-3021
- Bimanual proprioception: Are two hands better than one?.J Neurophysiol. 2014; 111: 1362-1368
Article info
Publication history
Published online: September 14, 2018
Accepted:
August 27,
2018
Received in revised form:
July 31,
2018
Received:
December 21,
2017
Footnotes
Disclosures
A.P.W. was funded by educational grants from the Australian Pain Society—Australian Pain Relief Association- Mundipharma #3 PhD Scholarship and NeuRA. This project was funded by a National Health and Medical Research Council (NHMRC) (grant ID 630431). G.L.M. is supported by a research fellowship from the NHMRC of Australia (grant ID 10611279). G.L.M. receives royalties from books on pain, complex regional pain syndrome, and rehabilitation, and speaker's fees for lectures on pain, performance, and rehabilitation. He has received support from Pfizer; Workers’ Compensation Boards in Australia, Europe, and North America; AIA Australia; the International Olympic Committee; Port Adelaide Football Club; and Arsenal Football Club. C.D.R. has received travel funding from Philips Electronics Australia and an editorial stipend from Springer.
Supplementary data accompanying this article are available online at www.jpain.org and www.sciencedirect.com.
Identification
Copyright
© Published by Elsevier Inc. on behalf of the American Pain Society
