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在急性疼痛存在的情况下,感觉运动冲突引起的感觉障碍而非运动障碍会增加。

Sensory Disturbances, but Not Motor Disturbances, Induced by Sensorimotor Conflicts Are Increased in the Presence of Acute Pain.

作者信息

Brun Clémentine, Gagné Martin, McCabe Candida S, Mercier Catherine

机构信息

Center for Interdisciplinary Research in Rehabilitation and Social IntegrationQuébec, QC, Canada.

Department of Rehabilitation, Laval UniversityQuébec, QC, Canada.

出版信息

Front Integr Neurosci. 2017 Jul 21;11:14. doi: 10.3389/fnint.2017.00014. eCollection 2017.

Abstract

Incongruence between our motor intention and the sensory feedback of the action (sensorimotor conflict) induces abnormalities in sensory perception in various chronic pain populations, and to a lesser extent in pain-free individuals. The aim of this study was to simultaneously investigate sensory and motor disturbances evoked by sensorimotor conflicts, as well as to assess how they are influenced by the presence of acute pain. It was hypothesized that both sensory and motor disturbances would be increased in presence of pain, which would suggest that pain makes body representations less robust. Thirty healthy participants realized cyclic asymmetric movements of flexion-extension with both upper limbs in a robotized system combined to a 2D virtual environment. The virtual environment provided a visual feedback (VF) about movements that was either congruent or incongruent, while the robotized system precisely measured motor performance (characterized by bilateral amplitude asymmetry and medio-lateral drift). Changes in sensory perception were assessed with a questionnaire after each trial. The effect of pain (induced with capsaicin) was compared to three control conditions (no somatosensory stimulation, tactile distraction and proprioceptive masking). Results showed that while both sensory and motor disturbances were induced by sensorimotor conflicts, only sensory disturbances were enhanced during pain condition comparatively to the three control conditions. This increase did not statistically differ across VF conditions (congruent or incongruent). Interestingly however, the types of sensations evoked by the conflict in the presence of pain (changes in intensity of pain or discomfort, changes in temperature or impression of a missing limb) were different than those evoked by the conflict alone (loss of control, peculiarity and the perception of having an extra limb). Finally, results showed no relationship between the amount of motor and sensory disturbances evoked in a given individual. Contrary to what was hypothesized, acute pain does not appear to make people more sensitive to the conflict itself, but rather impacts on the type and amount of sensory disturbances that they experienced in response to that conflict. Moreover, the results suggest that some sensorimotor integration processes remain intact in presence of acute pain, allowing us to maintain adaptive motor behavior.

摘要

我们的运动意图与动作的感觉反馈之间的不一致(感觉运动冲突)在各种慢性疼痛人群中会引发感觉知觉异常,在无疼痛个体中程度较轻。本研究的目的是同时调查感觉运动冲突引发的感觉和运动障碍,以及评估它们如何受到急性疼痛的影响。研究假设是,疼痛存在时感觉和运动障碍都会增加,这表明疼痛会使身体表征变得不那么稳定。30名健康参与者在一个与二维虚拟环境相结合的机器人系统中,用双上肢进行屈伸的周期性不对称运动。虚拟环境提供了关于运动的视觉反馈(VF),该反馈要么一致要么不一致,而机器人系统精确测量运动表现(以双侧幅度不对称和中外侧漂移为特征)。每次试验后用问卷评估感觉知觉的变化。将疼痛(用辣椒素诱发)的效果与三种对照条件(无体感刺激、触觉分心和本体感觉掩盖)进行比较。结果表明,虽然感觉运动冲突会引发感觉和运动障碍,但与三种对照条件相比,只有在疼痛状态下感觉障碍会增强。这种增加在VF条件(一致或不一致)之间没有统计学差异。然而,有趣的是,疼痛存在时冲突引发的感觉类型(疼痛或不适强度的变化、温度变化或肢体缺失的感觉)与单独冲突引发的感觉类型(失去控制、奇特感和有额外肢体的感觉)不同。最后,结果表明在给定个体中诱发的运动和感觉障碍量之间没有关系。与假设相反,急性疼痛似乎不会使人们对冲突本身更敏感,而是会影响他们因该冲突而经历的感觉障碍的类型和量。此外,结果表明在急性疼痛存在时一些感觉运动整合过程仍然完好,使我们能够维持适应性运动行为。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ef98/5519624/b5d96e13c5ae/fnint-11-00014-g0001.jpg

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