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 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