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Visual illusions modulate body perception disturbance and pain in Complex Regional Pain Syndrome: A randomized trial

Lewis, Jennifer S.; Newport, Roger; Taylor, Gordon; Smith, Mike; McCabe, Candida S.

Visual illusions modulate body perception disturbance and pain in Complex Regional Pain Syndrome: A randomized trial Thumbnail


Authors

Dr Jenny Lewis Jenny4.Lewis@uwe.ac.uk
Senior Lecturer in Pain Science and Occupational Therapy

Roger Newport

Gordon Taylor

Mike Smith

Candy McCabe Candy.Mccabe@uwe.ac.uk
Florence Nightingale Foundation Chair



Abstract

Background: Effective treatment of longstanding Complex Regional Pain Syndrome (CRPS) is a challenge, as causal mechanisms remain elusive. People with CRPS frequently report distorted subjective perceptions of their affected limb. Evidence of pain reduction when the affected limb is visually altered in size suggests that visual illusions used to target central processing could restore coherence of this disrupted limb representation. We hypothesized that using virtual reality that alters hand image to match the patient's desired hand appearance would improve body perception disturbance and pain. Also, repeated exposure would maintain any therapeutic effect. Methods: A blinded randomized controlled trial of 45 participants with refractory upper-limb CRPS and body perception disturbance (BPD) viewed a digital image of their affected hand for 1min. The image was digitally altered according to the patient's description of how they desired their hand to look in the experimental group and unaltered in the control group. BPD and pain were measured pre- and post-intervention. A subgroup was followed up 2weeks after a course of repeated interventions. Results: BPD (mean-6, ±SD 7.9, p=0.036, effect size [ES]=0.6) and pain intensity (mean-0.43, ±SD 1.3, p=0.047, ES=0.5) reduced in 23 participants after single exposure compared to controls (n=22). At follow-up, the subgroup (experimental n=21; control n=18) showed sustained pain reduction only (p=0.037, ±SD 1.9, ES=0.7), with an overall 1.2 decrease on an 11-point scale. Conclusions: Visually changing the CRPS hand to a desired appearance modulates BPD and pain suggesting therapeutic potential for those with refractory CRPS. Further research to optimize this therapeutic effect is required. Significance: Visual bodily illusions that change the shape and appearance of the painful CRPS hand to that desired by the patient result in a rapid amelioration of pain and body perception disturbance in people with longstanding CRPS. These findings highlight the future potential of this drug-free approach in the treatment of refractory CRPS.

Citation

Lewis, J. S., Newport, R., Taylor, G., Smith, M., & McCabe, C. S. (in press). Visual illusions modulate body perception disturbance and pain in Complex Regional Pain Syndrome: A randomized trial. European Journal of Pain, https://doi.org/10.1002/ejp.1766

Journal Article Type Article
Acceptance Date Apr 10, 2021
Online Publication Date Mar 23, 2021
Deposit Date Apr 19, 2021
Publicly Available Date Apr 20, 2021
Journal European Journal of Pain
Print ISSN 1090-3801
Electronic ISSN 1532-2149
Publisher Wiley
Peer Reviewed Peer Reviewed
DOI https://doi.org/10.1002/ejp.1766
Keywords Anesthesiology and Pain Medicine
Public URL https://uwe-repository.worktribe.com/output/7271942
Publisher URL http://doi.org/10.1002/ejp.1766
Additional Information Received: 2020-07-07; Published: 2021-04-10

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