Karpin Hana, Vatine Jean-Jacques, Livshitz Anatoly, Weissman-Fogel Irit
Physical Therapy Department, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.
Physical Medicine and Rehabilitation Department, Sackler Faculty of Medicine, Tel Aviv, Israel.
Eur J Pain. 2025 Oct;29(9):e70123. doi: 10.1002/ejp.70123.
Body Perception Disturbances (BPD) are common in chronic limb pain conditions characterised by negative feelings toward the limb and a reduced sense of agency. Prior research has focused on isolated associations between psychological factors, pain hypersensitivity and BPD. Therefore, an integrated examination of the interconnections between these variables within a theory-driven model is necessary.
The model hypothesises that pain hypersensitivity (hyperalgesia, allodynia), directly linked with BPD (assessed by the Bath-BPD and Neurobehavioral questionnaires) or indirectly, via symptom severity [assessed by complex regional pain syndrome (CRPS) severity score]; coping strategies (depersonalization, kinesiophobia) and psychological symptoms (somatization, depression) are directly related to BPD; and BPD is associated with pain severity and Quality of Life (QoL).
The model was examined using a path analysis of 92 patients with chronic limb pain. Results indicate that depersonalization was directly linked with the Bath-BPD (β = 0.50, p < 0.001), and depersonalization and kinesiophobia with the Neurobehavioral (β = 0.24, p = 0.010; β = 0.22, p = 0.020, respectively). CRPS severity score accounts for the associations between hyperalgesia intensity and BPD and is directly related to the Bath-BPD (β = 0.25, p = 0.014), Neurobehavioral (β = 0.24, p = 0.037), pain (β = 0.28, p = 0.014) and QoL (β = -0.34, p = 0.001). The Bath-BPD marginally associated with QoL (β = -0.20, p = 0.052) but not with pain severity.
The theory-driven model fits the data, suggesting that psychological copying strategies play a dominant role in BPD. The symptom severity explains the associations between pain hypersensitivity and BPD and is directly linked to BPD, pain and QoL. The model revealed potential mechanisms underlying BPD and its associated clinical outcomes.
This study is the first to use path analysis to examine the predictors and effects of Body Perception Disturbances (BPD) in chronic limb pain. Results identified depersonalization and kinesiophobia as key psychological predictors of BPD, while hyperalgesia has no direct effect. The Complex Regional Pain Syndrome (CRPS) severity score is negatively associated with BPD, pain and quality of life. Findings emphasise the role of dysfunctional psychological processes in BPD and suggest that targeting these processes and reducing CRPS symptoms may improve BPD and treatment outcomes.
身体感知障碍（BPD）在慢性肢体疼痛病症中很常见，其特征是对肢体有负面情绪且能动性降低。先前的研究集中在心理因素、疼痛超敏反应与BPD之间的孤立关联上。因此，有必要在一个理论驱动的模型中对这些变量之间的相互联系进行综合考察。
该模型假设疼痛超敏反应（痛觉过敏、感觉异常）与BPD直接相关（通过巴斯BPD问卷和神经行为问卷评估），或通过症状严重程度间接相关[通过复杂性区域疼痛综合征（CRPS）严重程度评分评估]；应对策略（人格解体、运动恐惧）和心理症状（躯体化、抑郁）与BPD直接相关；并且BPD与疼痛严重程度和生活质量（QoL）相关。
使用对92例慢性肢体疼痛患者的路径分析对该模型进行了检验。结果表明，人格解体与巴斯BPD直接相关（β = 0.50，p < 0.001），人格解体和运动恐惧与神经行为问卷相关（分别为β = 0.24，p = 0.010；β = 0.22，p = 0.020）。CRPS严重程度评分解释了痛觉过敏强度与BPD之间的关联，并且与巴斯BPD直接相关（β = 0.25，p = 0.014）、神经行为问卷（β = 0.24，p = 0.037）、疼痛（β = 0.28，p = 0.014）和生活质量（β = -0.34，p = 0.001）。巴斯BPD与生活质量有微弱关联（β = -0.20，p = 0.052），但与疼痛严重程度无关。
该理论驱动的模型与数据拟合，表明心理应对策略在BPD中起主导作用。症状严重程度解释了疼痛超敏反应与BPD之间的关联，并且与BPD、疼痛和生活质量直接相关。该模型揭示了BPD及其相关临床结果的潜在机制。
本研究首次使用路径分析来考察慢性肢体疼痛中身体感知障碍（BPD）的预测因素和影响。结果确定人格解体和运动恐惧是BPD的关键心理预测因素，而痛觉过敏没有直接影响。复杂性区域疼痛综合征（CRPS）严重程度评分与BPD、疼痛和生活质量呈负相关。研究结果强调了功能失调的心理过程在BPD中的作用，并表明针对这些过程并减轻CRPS症状可能会改善BPD和治疗结果。
