I can't find it! Distorted body image and tactile dysfunction in patients with chronic back pain

Abstract

The conscious sense of our body, or body image, is often taken for granted, but it is disrupted in many clinical states including complex regional pain syndrome and phantom limb pain. Is the same true for chronic back pain? Body image was assessed, via participant drawings, in six patients with chronic back pain and ten healthy controls. Tactile threshold and two-point discrimination threshold (TPD) were assessed in detail. All the patients, and none of the controls, showed disrupted body image of the back. Five patients were unable to clearly delineate the outline of their trunk and stated that they could not "find it". TPD was greatly increased in the same zone as the absence or disruption of body image, but was otherwise similar to controls. The disturbance of body image and decrease in tactile acuity coincided with the normal distribution of pain, although there was no allodynia and there was no relationship between resting pain level and TPD. Tactile threshold was unremarkable for patients and controls. These preliminary data indicate that body image is disrupted, and tactile acuity is decreased, in the area of usual pain, in patients with chronic back pain. This finding raises the possibility that training body image or tactile acuity may help patients in chronic spinal pain, as it has been shown to do in patients with complex regional pain syndrome or phantom limb pain. © 2008 International Association for the Study of Pain.