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Ravat S.1, Olivier B.1, Gillion N.1
1University of Witwatersrand, Department of Physiotherapy, Johannesburg, South Africa
Background: Chronic pain is a health problem that occurs across cultures and across the globe. Treatment of chronic pain is challenging and there is often failure of recovery, with the need to look at different approaches to understanding chronic pain. It was recently found that chronic pain has both central and peripheral features. These central features may be contributing to the chronicity of pain. People with chronic pain disorders experience a disturbance in body schema. Laterality judgment performance is dependent on body schema and therefore can determine the central mechanisms affected in chronic pain patients.
Purpose: The aim of this systematic review is to determine whether there is a difference in laterality judgment between people with chronic pain and healthy individuals.
Methods: A comprehensive search was done of the following databases: MEDLINE (Pubmed), CINAHL Plus, Cochrane Controlled Trials Registered, Physiotherapy Evidence Database (PEDro), Science Direct, SCOPUS, Clinical Key and Google Scholar. A total of 15 studies were included in this review. Methodological quality was assessed by two independent reviewers using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross Sectional Studies.
Results: Meta-analysis of all studies showed a large statistically significant effect size (2.59) and significant 95%CI (1.44 - 3.74), where reaction time was increased in chronic pain compared to healthy individuals. In the sub-group analysis, results were similar i.e. reaction time for CRPS and upper limb conditions was increased compared to healthy individuals (effect size= 2.20; 95%CI= 0.83 - 3.56). In terms of accuracy, meta-analysis of all studies showed a medium statistically significant effect size (0.42) with a significant 95%CI (-0.10 - 0.93), whereby accuracy was decreased in chronic pain compared to healthy individuals. The sub-group analysis for accuracy in lower limb conditions vs. healthy individuals showed a medium statistically significant effect size (0.59) with a significant 95%CI (0.11 to 1.07). Results for low back pain could not be pooled into a meta-analysis, but showed that laterality judgment impairments are present in the low back pain population.
Conclusion(s): There is conclusive evidence that laterality judgment is impaired in CRPS 1, upper limb and lower limb pain. Although results are mixed in low back pain, it is more favourable that laterality judgment impairments are present in the low back pain population. There is no conclusive evidence with regard to laterality judgment impairment in people with cervical pain.
Implications: It is evident that the impairment of laterality judgment cannot be assumed amongst all chronic pain conditions. This systematic review can be used as a foundation for future research: research studies can be designed to remediate laterality recognition in affected conditions and assess the effect hereof on levels of pain and functional abilities. This could solve the missing link in understanding chronic pain syndromes and their rehabilitation. Clinicians can also gain insight on incorporating techniques (e.g. graded motor imagery) to re-train the brains neural plasticity, and in turn decrease chronic pain.
Funding acknowledgements: This systematic review was self-funded.
Topic: Pain & pain management
Ethics approval: An ethical clearance waiver was obtained (Reference: W-C-J-160505-1) through the University of the Witwatersrands Human Research Ethics Committee.
All authors, affiliations and abstracts have been published as submitted.
