Altered body perception and pain. Presented by Tim Beames at the Physio First Conference 2015, Nottingham, UK.

1. Altered body perception
& pain:
“What just touched my
arm? Hang on, where is
my arm?!”
Tim Beames
Physio First
Conference,
Nottingham
29th
March 2015

2. Aims
• Present a view of body
perception
• See how body
perceptual changes
can manifest clinically
in pain
• Consider appropriate
assessment &
treatment techniques

3. Experiencing
your body
• How does your body
feel now?
• Are you aware of
any part of your
body?
• Let’s explore
further

4. What about the
person in pain?
Edwards et al 2014 Pain Med 15: 364-
378
• We must understand
the lived
experience of the
person in pain
• Pain is a personal experience
• Pain is linked to the
state of one’s body
but what does the
embodiment of pain

5. First-person
experiences of
people with
CRPS
Lewis & McCabe 2010 Prac
Pain Manage, 60-66• Distortions in
shape/size/weight/temp
erature/pressure
• Hostile feelings
• A sense of disowning the
body part
• Impaired limb position
sense
• Loss of anatomical

6. A subjective
experience
Förderreuther et al 2004 Pain
110: 756-761
“This is not my hand”
“This hand feels like
the hand of
another person”
“This hand feels as
though it’s not part
of the rest of my
body”

7. What feeds this
experience of
bodily
perception?
Lotze & Moseley 2007 Curr Rheum
Rep 9: 488-496;
Longo et al 2012 J Neurosci 32(8):
2601-2607
• Multisensory – internal
& external environments
• Feed forward (predict) &
feedback systems
(monitor)
• Conscious & unconscious
perspectives
• Creates ever-changing

8. Experimentally
altering our
body perception
• Body perception can
shift or be modified
e.g. Rubber Hand
Illusion
Bekrater-Bodmann et al 2012
Brain Res 1452: 130-139

9. Physiology
changes with
altered body
perception
Moseley, Gallace & Spence 2011
Neurosci & Biobehav Rev 36(1): 34-46

10. Space-based
processing & limb
temperature linked
to body perception
change in CRPS

11. Barnsley et
al 2013
Curr Biol
21(23): R945-6
Altered
immune
reaction
with a
change
in body
percepti
on!

12. What does all
this tell us
about body
perception?
Tsakiris et al 2007 Conscious
& Cogn 16: 645-660
• Experiencing our
bodies depends on the
interpretation of
efferent information
with afferent
information in action
contexts

13. Assessing body
perception -
Two-point
discrimination
Moseley 2008
Pain 140: 239-243

14. Localisation of
touch
Maihöfner et al 2006 J Neurol
253: 772-779

16. Implicit Motor
Imagery
Bowering et al 2014 Clin J Pain
30:1070-75

17. Positions expected
to be painful are
slower in CRPS
Moseley 2004 Neurology 62: 2182-
2186

18. What does
this all
mean?
• Pain or the
expectation of pain
appears to affect our
bodily perception – i.e.
the way we feel &
experience ourselves
• Changes in our body
perception may affect
us when making sense
of the world

19. Sense making &
pain?
Iannetti & Mouraux 2010 Exp Brain
Res 205: 1-12
‘We have the
ability to
detect &
react to
salient (&
possibly
threatening)
stimuli &
thereby
trigger
swift &
appropriate
http://www.youtube.com/wa
tch?
v=oh87njiWTmw&feature=pla
yer_detailpage

20. Targeting body
perception in
rehabilitation
• Tactile discrimination
training
• Implicit & explicit
motor imagery
• Mirror visual
feedback
• Intelligent/mindful
movement

21. Tactile discrimination
not just stimulation
required
Moseley et al 2008 Pain 137: 600-608;
Lotze & Moseley 2007 Curr Rheum Report
9:488-496

22. Cork/pen
• “I’ve tried comparing
right/left thigh with
lower leg & the
sensations are the
same. I have started
tracing one letter
onto right & left
foot. This does not
feel the same, I can
still feel the letter
on my left foot for 5

32. Training effects in
left/right
discrimination
tasks

34. Results for different
types of neuropathic
pain
Moseley 2006 Neurology 67:2129-2134

35. Systematic
review

36. What happens
with training?
• Improving body
perception may help
to reduce pain
– Changing the saliency of
a given stimulus to the
affected body part
• However, reducing pain
may also help improve
body perception!

37. Thanks
tim.beames@gmail.com
www.painandperformanc