Body Representation Among Adults with Phantom Limb Pain: Results from a Foot Identification Task

Overview

Journal Eur J Pain

Publisher Wiley

Specialties Critical Care
Neurology
Psychiatry

Date 2021 Sep 7

PMID 34490685

Citations 3

Authors

Emma H Beisheim-Ryan

Ryan T Pohlig

Jared Medina

Gregory E Hicks

Jaclyn M Sions

Affiliations

Soon will be listed here.

Abstract

Background: Impaired body representation (i.e. disrupted body awareness or perception) may be a critical, but understudied, factor underlying phantom limb pain (PLP). This cross-sectional study investigated whether adults with lower-limb loss (LLL) and PLP demonstrate impaired body representation as compared to Pain-Free peers with and without LLL.

Methods: Participants (n = 41 adults with PLP, n = 27 Pain-Free peers with LLL, n = 39 Controls with intact limbs) completed an online foot identification task. Participants judged whether randomized images depicted left or right feet (i.e. left-right discrimination) as quickly as possible without limb movement. Using two Generalized Estimating Equations, effects of group, image characteristics (i.e. side, foot type, view, angle) and trial block (i.e. 1-4) were evaluated, with task response time and accuracy as dependent variables (a ≤ 0.050).

Results: Adults with PLP demonstrated slower and less accurate performance as compared to Controls with intact limbs (p = 0.018) but performed similarly to Pain-Free peers with LLL (p = 0.394). Significant three-way interactions of group, view and angle indicated between-group differences were greatest for dorsal-view images, but smaller and angle-dependent for plantar-view images. While all groups demonstrated significant response time improvements across blocks, improvements were greatest among adults with PLP, who also reported significant reductions in pain intensity.

Conclusions: Adults with PLP demonstrate body representation impairments as compared to Controls with intact limbs. Body representation impairments, however, may not be unique to PLP, given similar performance between adults with and without PLP following LLL.

Significance: Following lower-limb loss, adults with phantom limb pain (PLP) demonstrate impaired body representation as compared to Controls with intact limbs, evidenced by slower response times and reduced accuracy when completing a task requiring mental rotation. Importantly, 80% of participants with pre-task PLP reported reduced pain intensity during the task, providing compelling evidence for future investigations into whether imagery-based, mind-body interventions have positive effects on PLP.

Citing Articles

Graded motor imagery and its phases for individuals with phantom limb pain following amputation: A scoping review.

Falbo K, Phelan H, Hackman D, Vogsland R, Rich T Clin Rehabil. 2023; 38(3):287-304.

PMID: 37849299 PMC: 10860367. DOI: 10.1177/02692155231204185.

Implicit Motor Imagery for Chronic Pelvic Pain: A Cross-Sectional Case-Control Study.

Diaz-Mohedo E, Gonzalez-Roldan G, Munoz-Gamez I, Padilla-Romero V, Castro-Martin E, Cabrera-Martos I J Clin Med. 2023; 12(14).

PMID: 37510853 PMC: 10380828. DOI: 10.3390/jcm12144738.

The Efficacy of Graded Motor Imagery and Its Components on Phantom Limb Pain and Disability: A Systematic Review and Meta-Analysis.

Limakatso K, Cashin A, Williams S, Devonshire J, Parker R, McAuley J Can J Pain. 2023; 7(1):2188899.

PMID: 37214633 PMC: 10193907. DOI: 10.1080/24740527.2023.2188899.

References

Moseley G . Graded motor imagery is effective for long-standing complex regional pain syndrome: a randomised controlled trial. Pain. 2004; 108(1-2):192-8. DOI: 10.1016/j.pain.2004.01.006. View

Fiorio M, Tinazzi M, Aglioti S . Selective impairment of hand mental rotation in patients with focal hand dystonia. Brain. 2005; 129(Pt 1):47-54. DOI: 10.1093/brain/awh630. View

Louw A, Schmidt S, Louw C, Puentedura E . Moving without moving: immediate management following lumbar spine surgery using a graded motor imagery approach: a case report. Physiother Theory Pract. 2015; 31(7):509-17. DOI: 10.3109/09593985.2015.1060656. View

Moseley G, Gallace A, Spence C . Bodily illusions in health and disease: physiological and clinical perspectives and the concept of a cortical 'body matrix'. Neurosci Biobehav Rev. 2011; 36(1):34-46. DOI: 10.1016/j.neubiorev.2011.03.013. View

Uritani D, Nishida T, Sakaguchi N, Kawakami T, Jones L, Kirita T . Difference in Response to a Motor Imagery Task: A Comparison between Individuals with and without Painful Temporomandibular Disorders. Pain Res Manag. 2018; 2018:6810412. PMC: 6091325. DOI: 10.1155/2018/6810412. View

Stone K, Dijkerman H, Bekrater-Bodmann R, Keizer A . Mental rotation of feet in individuals with Body Integrity Identity Disorder, lower-limb amputees, and normally-limbed controls. PLoS One. 2019; 14(8):e0221105. PMC: 6697338. DOI: 10.1371/journal.pone.0221105. View

Curtze C, Otten B, Postema K . Effects of lower limb amputation on the mental rotation of feet. Exp Brain Res. 2009; 201(3):527-34. PMC: 2832871. DOI: 10.1007/s00221-009-2067-z. View

Saimpont A, Pozzo T, Papaxanthis C . Aging affects the mental rotation of left and right hands. PLoS One. 2009; 4(8):e6714. PMC: 2726952. DOI: 10.1371/journal.pone.0006714. View

Hanley M, Ehde D, Campbell K, Osborn B, Smith D . Self-reported treatments used for lower-limb phantom pain: descriptive findings. Arch Phys Med Rehabil. 2006; 87(2):270-7. DOI: 10.1016/j.apmr.2005.04.025. View

10.

Griswold M, Swihart B, Caffo B, Zeger S . Practical Marginalized Multilevel Models. Stat. 2013; 2(1). PMC: 3865434. DOI: 10.1002/sta4.22. View

11.

Guo X, Lin Z, Lyu Y, Bekrater-Bodmann R, Flor H, Tong S . The Effect of Prosthesis Use on Hand Mental Rotation After Unilateral Upper-Limb Amputation. IEEE Trans Neural Syst Rehabil Eng. 2017; 25(11):2046-2053. DOI: 10.1109/TNSRE.2017.2702117. View

12.

Harris P, Taylor R, Thielke R, Payne J, Gonzalez N, Conde J . Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2008; 42(2):377-81. PMC: 2700030. DOI: 10.1016/j.jbi.2008.08.010. View

13.

Breckenridge J, Ginn K, Wallwork S, McAuley J . Do People With Chronic Musculoskeletal Pain Have Impaired Motor Imagery? A Meta-analytical Systematic Review of the Left/Right Judgment Task. J Pain. 2018; 20(2):119-132. DOI: 10.1016/j.jpain.2018.07.004. View

14.

Parsons L, Shimojo S . Perceived spatial organization of cutaneous patterns on surfaces of the human body in various positions. J Exp Psychol Hum Percept Perform. 1987; 13(3):488-504. DOI: 10.1037//0096-1523.13.3.488. View

15.

Owings M, Kozak L . Ambulatory and inpatient procedures in the United States, 1996. Vital Health Stat 13. 1998; (139):1-119. View

16.

Coslett H, Medina J, Kliot D, Burkey A . Mental motor imagery indexes pain: the hand laterality task. Eur J Pain. 2010; 14(10):1007-13. PMC: 2958243. DOI: 10.1016/j.ejpain.2010.04.001. View

17.

Ramachandran V, Chunharas C, Marcus Z, Furnish T, Lin A . Relief from intractable phantom pain by combining psilocybin and mirror visual-feedback (MVF). Neurocase. 2018; 24(2):105-110. DOI: 10.1080/13554794.2018.1468469. View

18.

Lee D, Choi S, Noh E, Lee W, Jang J, Moon J . Impaired Performance in Mental Rotation of Hands and Feet and Its Association with Social Cognition in Patients with Complex Regional Pain Syndrome. Pain Med. 2021; 22(6):1411-1419. PMC: 8185560. DOI: 10.1093/pm/pnaa482. View

19.

Palermo L, Di Vita A, Boccia M, Nemmi F, Brunelli S, Traballesi M . Action and Non-Action Oriented Body Representations: Insight from Behavioural and Grey Matter Modifications in Individuals with Lower Limb Amputation. Biomed Res Int. 2018; 2018:1529730. PMC: 6211209. DOI: 10.1155/2018/1529730. View

20.

Schwoebel J, Friedman R, Duda N, Coslett H . Pain and the body schema: evidence for peripheral effects on mental representations of movement. Brain. 2001; 124(Pt 10):2098-104. DOI: 10.1093/brain/124.10.2098. View