McGill University, Montreal, Canada The Royal National Hospital for Rheumatic Diseases NHS Foundation Trust, Bath, UK University of Southampton, Southampton, UK Auckland University of Technology, Auckland, New Zealand University of Bath, Bath, UK.
Pain. 2010 Jun;149(3):463-469. doi: 10.1016/j.pain.2010.02.007. Epub 2010 Apr 10.
Knowledge of the position of one's limbs is an essential component of daily function and relies on complex interactions of sensorimotor body schema-related information. Those with Complex Regional Pain Syndrome (CRPS) express difficulty in knowing where their affected limb is positioned. The aim of this study was to determine the degree to which experimental data supported the reported difficulty in limb position sense. A controlled experimental design was used to measure upper limb position accuracy amongst those with CRPS of one arm. Position accuracy was individually measured in both arms and compared to a known target position. Video captured each of 36 trials (half with arm in full view and half with vision obscured). The error in degrees between actual and known targets was determined using video analysis software. The Brief Pain Inventory measured pain. A subjective mental image representation of both upper limbs was documented. The CRPS group had moderate pain intensity and were significantly less accurate in positioning both the affected and unaffected limbs compared to controls (p<0.001). Position accuracy of the CRPS affected limb significantly improved with vision (8.3 degrees in view, 10.7 degrees not in view). Subjective mental representations of the affected limb were visualised as distorted. Evidence of bilateral arm positioning impairments in unilateral arm CRPS suggests that central mechanisms are involved. Cortical reorganisation in regions associated with the body schema (i.e. primary somatosensory and parietal cortices) is proposed as an explanation. The exact relationship between pain and limb position deficits requires further exploration.
肢体位置的知识是日常功能的重要组成部分，依赖于感觉运动身体图相关信息的复杂相互作用。患有复杂性区域疼痛综合征（CRPS）的人表示难以知道受影响的肢体处于什么位置。本研究旨在确定实验数据在多大程度上支持报告的肢体位置感知困难。采用对照实验设计测量单侧 CRPS 患者上肢的位置准确性。分别测量双臂的位置准确性，并与已知目标位置进行比较。视频捕捉了 36 次试验中的每一次（一半手臂完全可见，一半手臂视线受阻）。使用视频分析软件确定实际和已知目标之间的角度误差。使用Brief Pain Inventory 测量疼痛。记录对两个上肢的主观心理图像表示。CRPS 组疼痛强度中等，与对照组相比，受影响和未受影响的上肢定位准确性明显降低（p<0.001）。CRPS 受累肢体的位置准确性随着视力的提高而显著提高（在视野中为 8.3 度，在视野外为 10.7 度）。受累肢体的主观心理表现被视为扭曲。单侧手臂 CRPS 中双侧手臂定位障碍的证据表明，中枢机制参与其中。提出与身体图（即初级体感和顶叶皮层）相关的皮层重新组织作为一种解释。疼痛与肢体位置缺陷之间的确切关系需要进一步探索。
