More on body awareness and chronic pain

Evidence has been accumulating that shows that people with chronic pain have modifications in body awareness. For example patients suffering from CRPS express feelings of foreignness towards their painful body part, distorted sense of size and shape, and difficulty determining the position of the affected limb (e.g., Lewis, Kersten, McCabe, McPherson & Blake 2007).

Now, Camila Valenzuela-Moguillansky is publishing an article where she does a large review on this issue. She presents studies showing that modifications on body awareness are expressed at the perceptual, behavioral and cortical level leading to the view that chronic pain is linked to a disruption in the central mechanisms that underlie body awareness. In addition, she points out that evidence is accumulating showing that the relation between pain and body awareness is bidirectional: not only does pain change your body perception, but modifications in one’s perception of the body can modulate pain. For instance devices that aim to alter body perception such as magnifying or minifying binoculars (Moseley, Parsons & Spence 2008), mirror -boxes (e.g., McCabe, Haigh, Ring, Halligan, Wall & Blake 2003) and prisms (Sumitani, Rossetti, Shibata, Matsuda, Sakaue, Inoue, Mashimo, & Miyauchi 2007) shows to modulate pain perception.

The ensemble of these findings have strengthen the hypothesis that pain is a result of incongruence between motor intention, proprioception and visual input -a sensorimotor interaction that is at the bases of body awareness (Harris 1999; McCabe, Haigh, Ring, Halligan & Blake 2005). Valenzuela-Moguillansky discusses this proposal presenting some issues that this hypothesis fails to explain and recalling an aspect that this hypothesis seems to ignore: the link between pain and the autonomous nervous system.

The author states that the sensorimotor incongruence hypothesis contemplates only the exteroceptive aspect of body awareness, which involve what might be called the exteroceptive senses (e.g., vision, touch) and the muscles under voluntary control. She suggests that in order to give a full account of the relationship between chronic pain and body awareness it might be necessary to include the interoceptive sensorimotor system (Craig 2003), meaning the interoceptive senses (e.g., blood pressure, body temperature) and the muscles under involuntary control. Incorporating the interoceptive dimension into the concept of body awareness may enlarge our view of this issue, notably opening up the way to an integration of the individual’s emotional states, which are thought to play a key role in health and disease.

About Camila

Camila More on body awareness and chronic pain
Camila Valenzuela Moguillansky studied Biology at the University of Chile. She finished a master in cognitive science at d’Ecole des Hautes Études en Science Sociales in Paris and currently she is in her last year of PhD at the University Pièrre et Marie Curie. Her thesis focuses in the relationship between body awareness and pain experience integrating third-person (techniques from experimental psychology) and first-person (phenomenological approach based on interview techniques) methodologies.

Her concern on body awareness does not remains only an object of study, but rather integrates a long-term practice that finds expression in her experience as a dancer and yoga practitioner. It is in fact from these practices that arises her interest in studying the relationship between consciousness, body awareness and pain experience.

References

Craig AD (2003). Interoception: the sense of the physiological condition of the body. Current opinion in neurobiology, 13 (4), 500-5 PMID: 12965300

Harris, A. (1999). Cortical origin of pathological pain The Lancet, 354 (9188), 1464-1466 DOI: 10.1016/S0140-6736(99)05003-5

Lewis JS, Kersten P, McCabe CS, McPherson KM, & Blake DR (2007). Body perception disturbance: a contribution to pain in complex regional pain syndrome (CRPS). Pain, 133 (1-3), 111-9 PMID: 17509761

McCabe CS, Haigh RC, Ring EF, Halligan PW, Wall PD, & Blake DR (2003). A controlled pilot study of the utility of mirror visual feedback in the treatment of complex regional pain syndrome (type 1). Rheumatology , 42 (1), 97-101 PMID: 12509620

McCabe CS, Haigh RC, Halligan PW, & Blake DR (2005). Simulating sensory-motor incongruence in healthy volunteers: implications for a cortical model of pain. Rheumatology, 44 (4), 509-16 PMID: 15644392
Moseley GL, Parsons TJ, & Spence C (2008). Visual distortion of a limb modulates the pain and swelling evoked by movement. Current biology, 18 (22), R1047-1048 PMID: 19036329

Sumitani M, Rossetti Y, Shibata M, Matsuda Y, Sakaue G, Inoue T, Mashimo T, & Miyauchi S (2007). Prism adaptation to optical deviation alleviates pathologic pain. Neurology, 68 (2), 128-33 PMID: 17210893

Comments

  1. Dan Aldrige Flores says:

    The way I look at it, you’re making it hard for me to understand chronic pain with this modifications. Well understandable for I’m not a doctor, only an ordinary massage therapist who specialized in pain management thru Hilot/Sliding deep tissue massage. One thing I noticed with those with Low Back pain problem is; the lumbar muscles to the gluts area are tightto quads and hamstring are tight. Lumbar tightens up because it is supporting us to sit erect and become tense, same with gluts and thigh muscles. When muscles are always tense it become tight. Tense muscles also react to cold weather, it tightens up as it defense against cold. When the muscles become tight it trapped the nerves irritating it every time you move, resulting in pain. However its easy to fix, by sliding deep tissue massage. After only 10 mins, my clients said pain is going away. How come no one consider these point? Sliding deep tissue massage is very different from other massage. As I always say ask my clients. You can see their names and numbers at my websites if you really want to know if what I claim is true.

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    elizabeth crawford Reply:

    May I ask how long this “feel better” affect lasts. I suffer from chronic pain and neuropathy in my legs. I am not able to feel my feet, have muscle wasting and foot drop. My calves are in a constant state of “tightness” due to the nerves firing repeatedly, over and over. I have found that massage feels good but has no lasting affects for my condition.

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    Dan Aldrige Flores Reply:

    Hi Elizabeth, It depend on the severity of the problem, For Example, I have a client 70 yrs old. Her chronic pain started when she was diagnosed with tb of the bones when she is 19 yrs old & newly married. She’s been to different doctors, physical therapist, chiropractor and massage therapist & her problem continue for almost 50 yrs, until I started working on her last year. We have a weekly session. According to her by the end of sixth days pain started to come back so we have a weekly session. I’m planning to do two sessions and see what happen.One time she panic according to her husband, because she cannot reach me by phone, the reason pain is coming back. Ever since I start working on her she stop taking pain medication. I was surprised because I thought she is taking pills. If you like go to my websites at facebook for her numbers.

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  2. Nicolás Sepúlveda says:

    Me parece un excelente artículo, porque no sólo añade variables a la visión existente del dolor crónico, sino que lo que está haciendo Camila es cambiar el marco teórico-conceptual de lo que entendemos como dolor crónico. Y esto último tiene importantes implicancias en la investigación del dolor crónico y -ojalá- en su tratamiento.

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  3. Dr Mick Thacker says:

    I note again the use of the term sensory-motor incongruence – this term baffles me – it is based on the concept of efferent copy for movement – surely in the paradigms quoted there is no intention of movement – why then are these not examples of sensory- sensory incongruence? I prefer to think of these as expectation-reality mismatches (could even be expectation-virtual reality) mismatches. I believe this offers a better understanding of how some of the therapies developed by Lorimer and others work.

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    Camila Valenzuela-Moguillansky Reply:

    Hello Dr. Thacker
    I am not sure if I understand correctly. In most of the paradigms that I present, there is intention to move and movement involved. I agree that there is sensory-sensory incongruence involved, but also sensory-motor incongruence, don’t you think? Or my be you see the contribution of movement as a sensory aspect too? Mmm, I will reflect about it…

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    Dr Mick Thacker Reply:

    Hi Camila – I do agree that some of the studies there is movement- intention to move – so sorry I should have been more careful before firing off a post – I still prefer the term expectation-reality mismatch as it does not tie us to just the sensory-motor aspects of these “incongruences”. It may also allow for understanding of different aspects of the persons experience as they try to may sense of the expectation-reality mismatch. Do you think we need to add a couple more dimensions to those preposed by Melzack to fully understand the relationship between first and third person perspectives ? For example – Perceptive-phenomenological and cultural-behavioural? Although realise the behavioural word is far from perfect! Thanks again for a great and thoughtful post.

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    Camila Valenzuela Reply:

    Hello Dr. Thacker
    Ok, I understand what you mean now. And yes I agree, in the case of pain, and chronic pain specifically, to talk about “sensori-motor incongruence” is a simplification. I think you raise a very important issue, which I believe is related to the “translationability” of the results and conclusions, from experimental studies to clinical or “real” life problems.
    And yes, if the use of the term expectation-reality mismatch opens the door for the understanding of other aspects of the person’s experiences regarding pain, I would have no problem in changing it.
    Regarding Melzack, do you mean the dimension of the neuromatrix?
    I am not sure if it is matter of adding more dimensions, I think in the neuromatrix Melzack considers subjective, social and cultural aspects. I believe that the problem resides more in the weight given to these dimensions, which I consider is very little.

  4. Hi Dr Mick,
    I agree with you to an extent but what if there is also a motor -sensory incongruence too. For example, the movement of using the hand to do ‘X’ in someone who has CRPS subconscoiusly could be very threatening in someone who has put in that belief from past experience. From my clincical observations the intended ‘movement ‘ of grip for example could just as likely be a metaphorical holding of………….
    Findng that subconscious belief/perspective on this can dramatically reduce the pain and improve muscle strength.

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  5. elizabeth crawford says:

    If you are looking for study participants to interview I would be interested.

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    Camila Valenzuela Reply:

    Hello Elizabeth
    Yes, why not?! Write me to my email addresse so we can communicate.
    camilavalenzuelamogui(at)gmail.com

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  6. lloyd skett says:

    Hi Camila ,
    nice post.
    Regarding the interoceptive aspects that undoubtedly contribute to pain experience- I experience the mismatches regularly for example when a work or social situation stimulates negative self beliefs creating fearful or stress laden expectations- based at some point in time on some sort of experience or combination of experiences but in ‘reality’ or present time not accurate. I think youre right that while there is recognition of exteroceptive and cognitive drivers there is less acknowledgement of the power of sensation from the viscera – this is not just about heart rate, blood pressure, breathing but about the quality and nature of senation in the gut , solar plexus, chest /heart, throat. Like much of this it is chicken or egg but in terms of recursive loops we are powerfully driven and often completly unaware of how much our activity is driven from our interoceptive markers.
    Stephen Porges has some very interesting work looking at the evolutionary phases within the development of the vagal nerve which is 80% afferent which he calls the Polyvagal Theory- he describes the most recent mammalian development of a mylenated aspect of the nerve which links vocal ,inner ear and I think facial expressive components which he believes underlie mammalian social communication/ calming/ soothing funtions that are a more evolved response to threatening/ stressful situations. Its a very interesting window into how tone of voice eye contact facial expression may be operating to either aggravate or ease arousal levels. which is a large part of the theraputic task
    Like lots of things there is a spectrum. While it might be overly dramatic and unhelpful to apply a PTSD label to many chronic pain patients there are spectrum similarities.There is alot of really interesting admittedly clinical and theory driven work in the trauma field. Babette Rothschild for example has some great work which meshes nicely with what we are talking about in relationship to pain. alot of the body based psychotherapies pay alot of attention to interoceptive experience.
    check out http://www.traum-pages.com

    anyway better do some work.

    regards
    Lloyd

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  7. I really enjoy the article.Thanks Again. Awesome.

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  8. Hello Camila
    thanks for sharing this information and view on body awareness.
    From one yogi/health professional to another, and from the perspective of experience combined with listening to the experiences/expressed perceptions of people in pain, I understand what you are saying quite well.
    The difficulties with this subject matter are the confines of (scientifically exceptable) language while we attempt to explain human experience. Good for you for putting these words out there, and responding eloquently to the language and paradigm questions.
    Regardless of our beliefs about cause-effect, or the source of these perceptual issues, being curious about the experience and how they inter-relate with perpetuation of pain and siability are the origin of innovation.
    Neil

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    Lynn Brice Rosen Reply:

    Hello Neil–your comment about language or descriptive difficulties is apt. Through Gendlin’s practice, Focusing, we guide people to an embodied experience of the Self and then accompany them through their process of refining experiences and symbolization. What a pity that western medical research necessitates narrowly defined categories…. And equal pity that so few chronic pain patients, and equally few chronic pain practitioners, have the requisite sensing-abilities that allow mutual communication. As if chronic pain itself weren’t difficult enough….

    Perhaps the neuro-phenomenological research that Rachel Zahn is doing will eventually lead to the development of technologies which will be able to measure/quantify what occurs in chronic pain.

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  9. Danilo Teodoro says:

    I was surprised to learn that to a lot of people these medical jargon and terminology or how you say it is important, I thought finding answer for chronic pain is the topic of these discussions. May I know what should be done to find the answer. Why not give your input. I already told you what I’m doing based on Manual of Surgery. But before you castigate me, Please look for name & numbers of my clients and ask them at my websitesfb. They are my proof. I know nobody believe these, but it’s alright because a lot of my clients in the Bay Area believe it. Actually the always call when the pain come back. I want to see some input so that I might incorporate it to my practiced. Thanks a lot to all.

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