tactile acuity at the back

Tactile acuity at the back and motor control of the trunk are decreased in people with

back pain

Lorimer MoseleyNHMRC Senior Research FellowPrince of Wales Medical Research Institute & School of Medical Sciences, University of New South Wales, Sydney, Australia

Team leaderThe GAMFI projectUniversity of Oxford, UK

© GL Moseley http://www.bodyinmind.com.au

TPDver(cal

TPDhorizontal

© GL Moseley www.BodyInMind.com.au

TPD=twopointdiscrimina(onthreshold–ameasureoftac(leacuity.

Luomajoki&Moseley2009BrJSportMed

Luomajoki&Moseley2009BrJSportMed© GL Moseley

www.BodyInMind.com.au

Thisshowsthattac(leacuityislessinpeoplewithbackpainthanitisinthosewithout.

Thisshowsvoluntarylumbopelviccontrolisworseinpeoplewithbackpainthaninthosewithout.

© GL Moseley www.BodyInMind.com.au

Thisshowsvoluntarylumbopelviccontrolandtac(leacuityarerelated.

Luomajoki&Moseley2009BrJSportMed

Canwetraintac(leacuity?

© GL Moseley www.BodyInMind.com.au

1 2 34

5

Probes

Stimulation sites

A. Stimulation

2 mm 11 mm

B. Condition

Photograph of affected part, with stimulation sites marked.

Affected part ATTENTION

5

1 2 345 1 2 345

1 2 345Screen

NO ATTENTION

Moseley,Zalucki&Wiech(2008)Pain137,3600‐8© GL Moseley

www.BodyInMind.com.au

Inonecondi(on,wejusttouchedtheaffectedhandatthesepointswhilethepa(entreadabook.Intheothercondi(on,wedididen(caltouchesbutnowtheyhadtodiscriminatebetweenthem–whichpointandwhichprobe.

0

5

10

Wait No attention

Attention Review

Task-specificNRS

0

4

8Pain NRS

30

60

TPDmm

ATTENTION

5

1 2 3451 2 345

1 2 345Screen

NO ATTENTION

© GL Moseley www.BodyInMind.com.au

Thisshowsthatwhiletherewasnoeffectofthes(mula(onalone,therewassignificantimprovementinpain,tac(leacuityandfunc(on.Improvementsweremaintainedat3monthfollow‐up.

Moseley,Zalucki&Wiech(2008)Pain137,3600‐8

0

3

6

-0.5 0 1 2

Change in pain NRS

Change in TPD

12

34

513

6

10

712

8 11

9

r2 = 0.34P = 0.04

123

4

513

6

10

7

12

8

11

9

0

3

-0.5 0 1

Change in pain NRS

ATTENTION

Change in TPD

NO ATTENTION

© GL Moseley www.BodyInMind.com.au

Thisshowsthatduringdiscrimina(on,thechangeintac(leacuityandthechangeinpainwererelated.

Moseley,Zalucki&Wiech(2008)Pain137,3600‐8

Can we use vision and gaze direction to make it better?

Taylor-Clarke et al (2002) Curr Biol 12, 233-6

These (and other) studies show that if you can see skin and look in the direction of a stimulus, our tactile acuity is better and sensory cortex response is bigger. © GL Moseley

www.BodyInMind.com.au

Inthisexperimentweusedthesamemethodastheclinicaltrial(condi(onE)andthenacondi(onthatalsocapturedvisualinputofskin(C),acondi(onthatcapturedgazedirec(onbutnotvisualinputofskin(D)andacondi(onthatcapturedboth(B).Eachsessioninvolved72s(mulirandomlytofivepointswitheitherafatoraskinnyprobe(A).

© GL Moseley www.BodyInMind.com.au

Moseley,Zalucki&Wiech(2008)Pain137,3600‐8

© GL Moseley www.BodyInMind.com.au

Thisshowsthat,a]erasingle30minutediscrimina(ontrainingsession,theincreaseintac(leacuitywasgreatestinthecondi(onthatcapturedbothvisualinputofskinandgazedirec(on.

Thisshowsthattherewasalsoasignificantdecreaseinpain.

Moseley,Zalucki&Wiech(2008)Pain137,3600‐8

Weshouldusevision&spa(ala^en(ontoenhanceTPDtraining

InCRPS,TPDtrainingcanreducepain

Doesthesameapplyfortheback?Howdoweusevisionthere?

© GL Moseley www.BodyInMind.com.au