CRPS: Body Perception Disturbance (BPD) in CRPS
by Jenny Lewis, PhD, Dip COT and C. S. McCabe, PhD, RGN
| McCabe and Lewis deserve considerable credit for this innovative
contribution to the care of people with CRPS. I’ve no doubt that in the very near
future all practitioners and physical therapists concerned with the plight of those with
neuropathic pain will be skilled in the assessment and treatment of body perception
disorders. |
— Peter A. Moskovitz, MD |
Complex Regional Pain Syndrome (CRPS) is a chronic pain condition of unknown aetiology
that com-monly occurs following trauma to a limb, although it may occur spontaneously. It
is defined as type 1 or type 2, depending on whether known major nerve damage is absent or
present, respectively.1,2 Patients with Complex Regional Pain Syndrome commonly
describe a diverse range of sensory and motor problems. These include pain to touch or the
threat of touch, temperature, colour and sweating abnormalities, problems in initiating
movement and reduced function. Changes in body perception are perhaps less easily
identified since patients are commonly reluctant to discuss these phenomena unless
directly questioned. They often express altered perceptions, thoughts and feelings about
their affected limb. They may describe their limb with negative emotional feelings such as
hate and anger, disgust and repulsion. Recent research has identified a strong desire for
amputation of the affected limb, perceived changes in limb size and structure and
dissociation from the limb. These perceptions may influence patients’ engagement with
therapy and inform the development of new interventions.
Recent evidence suggests that body perception disturbance (BPD) is becoming an
increasingly recognized feature of CRPS with a reported prevalence ranging from 54.4% to
84%.3-5 Although not always immediately apparent to the clinical practitioner,
these symptoms can be easily identified with an appropriate approach. The presence of BPD
commonly results in patients having difficulty in engaging with their affected limb and so
can be detrimental to rehabilitation outcomes. All members of the multi-disciplinary team
should have an appreciation of the impact and presentation of BPD in this condition. From
our clinical experience of seeing approximately 100 new CRPS patients each year, greater
understanding of these seemingly bizarre phenomena can improve communication between the
patient and their practitioner, build trust and confidence in the patient of their
clinical team, and allay unnecessary fears of impending “madness” that patients
commonly report in association with these symptoms.
The purpose of this article is to help the practitioner understand BPD in CRPS by
providing a theoretical understanding of body perception processes—both normal and
aberrant—and how these may relate to body schema. We provide a definition of body
perception disturbances and introduce a new clinical tool, The Bath CRPS Body Perception
Disturbance Scale (See Appendix 1) to aid the practitioner in the identification and
assessment of BPD in CRPS. Finally, we will discuss current and emerging therapeutic
approaches that target central mechanisms for the resolution of BPD.
Please refer to the April 2010 issue for the complete text. In the event you need to order a back issue, please click here.
— April 2010
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