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