altered body perception and pain - by tim beames at physio first 2015

Altered body perception & pain:

“What just touched my arm? Hang on, where is my arm?!”

Tim BeamesPhysio First Conference,

Nottingham29th March 2015

Aims• Present a view of body perception• See how body perceptual changes can

manifest clinically in pain• Consider appropriate assessment &

treatment techniques

Experiencing your body

• How does your body feel now?

• Are you aware of any part of your body?

• Let’s explore further

What about the person in pain?

Edwards et al 2014 Pain Med 15: 364-378

• We must understand the lived experience of the person in pain

• Pain is a personal experience

• Pain is linked to the state of one’s body but what does the embodiment of pain consist of?

First-person experiences of people with CRPS

Lewis & McCabe 2010 Prac Pain Manage, 60-66

• Distortions in shape/size/weight/temperature/pressure

• Hostile feelings• A sense of disowning the body part• Impaired limb position sense• Loss of anatomical parts on mental imagery• A desire to amputate

A subjective experience Förderreuther et al 2004 Pain 110: 756-761

“This is not my hand”

“This hand feels like the hand of another person”

“This hand feels as though it’s not part of the rest of my body”

What feeds this experience of bodily perception?

Lotze & Moseley 2007 Curr Rheum Rep 9: 488-496; Longo et al 2012 J Neurosci 32(8): 2601-2607

• Multisensory – internal & external environments

• Feed forward (predict) & feedback systems (monitor)

• Conscious & unconscious perspectives

• Creates ever-changing online representation

Experimentally altering our body perception

• Body perception can shift or be modified e.g. Rubber Hand Illusion

Bekrater-Bodmann et al 2012 Brain Res 1452: 130-139

Physiology changes with altered body perception

Moseley, Gallace & Spence 2011 Neurosci & Biobehav Rev 36(1): 34-46

Space-based processing & limb temperature linked to body perception change in CRPS

Barnsley et al 2013 Curr Biol 21(23): R945-6

Altered immune reaction with a change in body perception!

What does all this tell us about body perception?

Tsakiris et al 2007 Conscious & Cogn 16: 645-660

• Experiencing our bodies depends on the interpretation of efferent information with afferent information in action contexts

Assessing body perception -Two-point discrimination

Moseley 2008 Pain 140: 239-243

Localisation of touchMaihöfner et al 2006 J Neurol 253: 772-779

Implicit Motor ImageryBowering et al 2014 Clin J Pain 30:1070-75

Positions expected to be painful are slower in CRPS

Moseley 2004 Neurology 62: 2182-2186

What does this all mean?

• Pain or the expectation of pain appears to affect our bodily perception – i.e. the way we feel & experience ourselves

• Changes in our body perception may affect us when making sense of the world

Sense making & pain?Iannetti & Mouraux 2010 Exp Brain Res 205: 1-12

‘We have the ability to detect & react to

salient (& possibly threatening) stimuli & thereby trigger swift & appropriate behavioral

responses.’

http://www.youtube.com/watch?v=oh87njiWTmw&feature=player_detailpage

Targeting body perception in rehabilitation

• Tactile discrimination training• Implicit & explicit motor imagery• Mirror visual feedback• Intelligent/mindful movement• Education

Tactile discrimination not just stimulation required

Moseley et al 2008 Pain 137: 600-608; Lotze & Moseley 2007 Curr Rheum Report 9:488-496

Cork/pen• “I’ve tried comparing right/left thigh with

lower leg & the sensations are the same. I have started tracing one letter onto right & left foot. This does not feel the same, I can still feel the letter on my left foot for 5 minutes after I’ve done it. This is cope able & a nice challenge. I am quite sure this will even out like it did with my lower leg.”

Training effects in left/right discrimination tasks

Results for different types of neuropathic pain

Moseley 2006 Neurology 67:2129-2134

Systematic review

What happens with training?• Improving body perception may help to

reduce pain– Changing the saliency of a given stimulus to

the affected body part

• However, reducing pain may also help improve body perception!

Thanks

tim.beames@gmail.com

www.painandperformance.com