ABSTRACT
Patients with complex regional pain syndrome (CRPS) report cognitive difficulties, affecting the ability to represent, perceive and use their affected limb. Moseley, Gallace & Spence (2009) observed that CRPS patients tend to bias the perception of tactile stimulation away from the pathological limb. Interestingly, this bias was reversed when CRPS patients were asked to cross their arms, implying that this bias is embedded in a complex representation of the body that takes into account the position of body-parts. Other studies have failed to replicate this finding (Filbrich et al., 2017) or have even found a bias in the opposite direction (Sumitani et al., 2007). Moreover, perceptual biases in CRPS patients have not often been compared to these of other chronic pain patients. Chronic pain patients are often characterized by an excessive focus of attention for bodily sensations. We might therefore expect that non-CRPS pain patients would show a bias towards instead of away from their affected limb. The aim of this study was to replicate the study of Moseley, Gallace & Spence (2009) and to extend it by comparing perceptual biases in a CRPS group with two non-CRPS pain control groups (i.e., chronic unilateral wrist and shoulder pain patients). In a temporal order judgment (TOJ) task, participants reported which of two tactile stimuli, one applied to either hand at various intervals, was perceived as occurring first. TOJs were made, either with the arms in a normal (uncrossed) position, or with the arms crossed over the body midline. We found no consistent perceptual biases in either of the patient groups and in either of the conditions (crossed/uncrossed). Individual differences were large and might, at least partly, be explained by other variables, such as pain duration and temperature differences between the pathological and non-pathological hand. Additional studies need to take these variables into account by, for example, comparing biases in CRPS (and non-CRPS) patients in an acute versus a chronic pain state.
ABSTRACT
BACKGROUND AND OBJECTIVE: Patients with fibromyalgia (FM) have a substantially reduced health-related quality of life (HRQoL). Their management should preferably focus on multidisciplinary nonpharmacological interventions. However, the long-term impact of such multicomponent therapies is not fully established. Waiting lists for patients seeking medical treatment are long, making individual-based approaches often unfeasible. The aim of our pragmatic study was to evaluate long-term HRQoL benefits of a comprehensive 8-week group-based multidisciplinary rehabilitation program focusing on patients' coping ability and self-care. METHODS: A total of 94 patients with clinically confirmed FM agreed to participate in this study. Before entering the program based on group-based cognitive behavioral therapy and graded activity training, patients completed questionnaires to screen for comorbidities. Health-related quality of life was assessed at the start, at 8 weeks, 6 months, and 1 year using the 36-Item Short-Form Health Survey instrument. Changes in HRQoL scores were analyzed according to linear mixed regression modeling. RESULTS: Baseline findings confirmed the substantially low physical and mental HRQoL in FM patients as well as high levels of depression, anxiety, and burnout. Only 2 patients left the program prematurely; 89% participated in the 1-year assessment. By the end of the program, HRQoL was significantly improved in all domains. This effect was maintained at 6 months and 1 year for all subscales. Changes at 1 year were greater in younger patients and those with depressive feelings before the start of treatment. CONCLUSIONS: Our group-based program offered to FM patients proved successful with significant improvements in their HRQoL both in the short and long term.
