Halicka Monika, Vittersø Axel D, McCullough Hayley, Goebel Andreas, Heelas Leila, Proulx Michael J, Bultitude Janet H
Centre for Pain Research, University of Bath, Bath, UK; Department of Psychology, University of Bath, Bath, UK.
Centre for Pain Research, University of Bath, Bath, UK; Department of Psychology, University of Bath, Bath, UK; Department of Sport and Health Sciences, University of Exeter, Exeter, UK.
Cortex. 2020 Jun;127:248-268. doi: 10.1016/j.cortex.2020.02.018. Epub 2020 Mar 13.
There is some evidence that people with Complex Regional Pain Syndrome (CRPS) show reduced attention to the affected relative to unaffected limb and its surrounding space, resembling hemispatial neglect after brain injury. These neuropsychological symptoms could be related to central mechanisms of pathological pain and contribute to its clinical manifestation. However, the existing evidence of changes in spatial cognition is limited and often inconsistent. We examined visuospatial attention, the mental representation of space, and spatially-defined motor function in 54 people with unilateral upper-limb CRPS and 22 pain-free controls. Contrary to our hypotheses and previous evidence, individuals with CRPS did not show any systematic spatial biases in visuospatial attention to or representation of the side of space corresponding to their affected limb (relative to the unaffected side). We found very little evidence of directional slowing of movements towards the affected relative to unaffected side that would be consistent with motor neglect. People with CRPS were, however, slower than controls to initiate and execute movements with both their affected and unaffected hands, which suggests disrupted central motor networks. Finally, we found no evidence of any clinical relevance of changes in spatial cognition because there were no relationships between the magnitude of spatial biases and the severity of pain or other CRPS symptoms. The results did reveal potential relationships between CRPS pain and symptom severity, subjective body perception disturbance, and extent of motor impairment, which would support treatments focused on normalizing body representation and improving motor function. Our findings suggest that previously reported spatial biases in CRPS might have been overstated.
有证据表明，复杂性区域疼痛综合征（CRPS）患者对患侧肢体及其周围空间的注意力相对于未受影响的肢体有所下降，类似于脑损伤后的半侧空间忽视。这些神经心理学症状可能与病理性疼痛的中枢机制有关，并促成其临床表现。然而，现有的空间认知变化证据有限且常常不一致。我们对54名单侧上肢CRPS患者和22名无疼痛对照组进行了视觉空间注意力、空间心理表征以及空间定向运动功能的研究。与我们的假设和先前的证据相反，CRPS患者在对与其患侧肢体相对应的空间一侧进行视觉空间注意力或表征时，并未表现出任何系统性的空间偏差（相对于未受影响的一侧）。我们几乎没有发现与运动忽视相符的、朝向患侧相对于未受影响侧的运动方向减慢的证据。然而，CRPS患者用患手和未患手启动和执行运动的速度均比对照组慢，这表明中枢运动网络受到了干扰。最后，我们没有发现空间认知变化具有任何临床相关性的证据，因为空间偏差的程度与疼痛或其他CRPS症状的严重程度之间没有关联。结果确实揭示了CRPS疼痛与症状严重程度、主观身体感知障碍以及运动障碍程度之间的潜在关系，这将支持以使身体表征正常化和改善运动功能为重点的治疗方法。我们的研究结果表明，先前报道的CRPS中的空间偏差可能被夸大了。
