I can't find it! Distorted body image and tactile dysfunction in patients with chronic back pain.
The conscious sense of our body, or body image, is often taken for granted, but it is disrupted in many clinical states including complex regional pain syndrome and phantom limb pain. Is the same true for chronic back pain? Body image was assessed, via participant drawings, in six patients with chronic back pain and ten healthy controls. Tactile threshold and two-point discrimination threshold (TPD) were assessed in detail. All the patients, and none of the controls, showed disrupted body image of the back. Five patients were unable to clearly delineate the outline of their trunk and stated that they could not "find it". TPD was greatly increased in the same zone as the absence or disruption of body image, but was otherwise similar to controls. The disturbance of body image and decrease in tactile acuity coincided with the normal distribution of pain, although there was no allodynia and there was no relationship between resting pain level and TPD. Tactile threshold was unremarkable for patients and controls. These preliminary data indicate that body image is disrupted, and tactile acuity is decreased, in the area of usual pain, in patients with chronic back pain. This finding raises the possibility that training body image or tactile acuity may help patients in chronic spinal pain, as it has been shown to do in patients with complex regional pain syndrome or phantom limb pain.
Moseley
Lorimer G
LG
Department of Physiology, Anatomy & Genetics, University of Oxford, Le Gros Clark Building, South Parks Road, Oxford OX1 3QX, UK.
D000328:Adult; D001416:Back Pain / Q000150:complications* / Q000503:physiopathology*; D001828:Body Image; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012678:Sensation Disorders / Q000150:complications* / Q000503:physiopathology*; D014110:Touch
Barker K, Elliot C, Sackley C, Fairbank J. Treatment of chronic back pain by sensory discrimination training. A phase 1 RCT of a novel device (FairMed) vs TENS. BMC Musculoskelet Disord. 2008;9:97.
Brumagne S, Cordo P, Lysens R, Verschueren S, Swinnen S. The role of paraspinal muscle spindles in lumbosacral position sense in individuals with and without low back pain. Spine. 2000;25:989-994.
Brumagne S, Cordo P, Verschueren S. Proprioceptive weighting changes in persons with low back pain and elderly persons during upright standing. Neurosci Lett. 2004;366:63-66.
Flor H, Braun C, Elbert T, Birbaumer N. Extensive reorganization of primary somatosensory cortex in chronic back pain patients. Neurosci Lett. 1997;224:5-8.
Flor H, Denke C, Schaefer M, Grusser S. Effect of sensory discrimination training on cortical reorganisation and phantom limb pain. Lancet. 2001;357:1763-1764.
Flor H, Elbert T, Knecht S, Wienbruch C, Pantev C, Birbaumer N, et al. Phantom-limb pain as a perceptual correlate of cortical reorganization following arm amputation. Nature. 1995;375:482-484.
Flor H, Nikolajsen L, Jensen TS. Phantom limb pain: a case of maladaptive CNS plasticity? Nat Rev Neurosci. 2006;7:873-881.
Flor H, Nikolajsen L, Staehelin Jensen T. Phantom limb pain: a case of maladaptive CNS plasticity? Nat Rev Neurosci. 2006;7:873-881.
Gandevia S, Phegan C. Perceptual distortions of the human body image produced by local anaesthesia, pain and cutaneous stimulation. J Phys (Lond). 1999;514:609-616.
Knost B, Flor H, Birbaumer N, Schugens MM. Learned maintenance of pain: muscle tension reduces central nervous system processing of painful stimulation in chronic and subchronic pain patients. Psychophysiology. 1999;36:755-764.
Lotze M, Moseley GL. Role of distorted body image in pain. Curr Rheumatol Rep. 2007;9:488-496.
Maihofner C, Handwerker HO, Neundorfer B, Birklein F. Patterns of cortical reorganization in complex regional pain syndrome. Neurology. 2003;61:1707-1715.
Moberg E. Two-point discrimination test. A valuable part of hand surgical rehabilitation, e.g. in tetraplegia. Scand J Rehabil Med. 1990;22:127-134.
Moseley GL. Distorted body image in complex regional pain syndrome. Neurology. 2005;65:773.
Moseley GL, Olthof N, Venema A, Don S, Wijers M, Gallace A, Spence C. Psychologically induced cooling of a specific body part caused by the illusory ownership of an artificial counterpart. Proc Nat Acad Sci USA. 2008;105:1368-1372.
Moseley GL, Zalucki NM, Wiech K. Tactile discrimination, but not tactile stimulation alone, reduces chronic limb pain. Pain. 2008;137:600-608.
Taylor-Clarke M, Kennett S, Haggard P. Persistence of visual-tactile enhancement in humans. Neurosci Lett. 2004;354:22-25.