Behavioral and Neurophysiological Evidence for Altered Interoceptive Bodily Processing in Chronic Pain

Author: Marco Solcà 1, Hyeong Dong Park 2, Fosco Bernasconi 2, Olaf Blanke 3
Author Information:
1Laboratory of Cognitive Neuroscience, Center for Neuroprosthetics & Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of 1 Technology (EPFL), Lausanne, Switzerland; Department of Mental Health and Psychiatry, University Hospital, Geneva, Switzerland.
2 Laboratory of Cognitive Neuroscience, Center for Neuroprosthetics & Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland.
3 Laboratory of Cognitive Neuroscience, Center for Neuroprosthetics & Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland; Department of Clinical Neurosciences, University Hospital, Geneva, Switzerland. Electronic address: olaf.blanke@epfl.ch.
Conference/Journal: Neuroimage
Date published: 2020 May 10
Other: Pages: 116902 , Special Notes: doi: 10.1016/j.neuroimage.2020.116902 , Word Count: 248


PMID: 32438047 DOI: 10.1016/j.neuroimage.2020.116902
Abstract
Whereas impaired multisensory processing of bodily stimuli and distorted body representation are well-established in various chronic pain disorders, such research has focused on exteroceptive bodily cues and neglected bodily signals from the inside of the body (or interoceptive signals). Extending existing basic and clinical research, we investigated for the first time interoception and its neurophysiological correlates in patients with complex regional pain syndrome (CRPS). In three different experiments, including a total of 36 patients with CRPS and 42 aged-gender matched healthy controls, we measured interoceptive sensitivity (heart beat counting task, HBC) and neural responses to heartbeats (heartbeat evoked potentials, HEP). As hypothesized, we observed reduced sensitivity in perceiving interoceptive bodily stimuli, i.e. their heartbeat, in two independent samples of CRPS patients (studies 1 and 2). Moreover, the cortical processing of their heartbeat, i.e. the HEP, was reduced compared to controls (study 3) and reduced interoceptive sensitivity and HEPs were related to CRPS patients' motor impairment and pain duration. By providing consistent evidence for impaired processing of interoceptive bodily cues in CRPS, this study shows that the perceptual changes occurring in chronic pain include signals originating from the visceral organs, suggesting changes in the neural body representation, that includes next to exteroceptive, also interoceptive bodily signals. By showing that impaired interoceptive processing is associated with clinical symptoms, our findings also encourage the use of interoceptive-related information in future rehabilitation for chronic pain.

Keywords: Chronic pain; Heartbeat evoked potential; body ownership; interoception; multisensory.

Copyright © 2020. Published by Elsevier Inc.

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