A Model of Body Perception Disturbances in Chronic Limb Pain: The Predictive Role of Kinesiophobia, Depersonalization and Symptom Severity

IF 3.4 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain Pub Date : 2025-09-08 DOI:10.1002/ejp.70123

Hana Karpin, Jean-Jacques Vatine, Anatoly Livshitz, Irit Weissman-Fogel

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Abstract

Background

Body Perception Disturbances (BPD) are common in chronic limb pain conditions characterised by negative feelings toward the limb and a reduced sense of agency. Prior research has focused on isolated associations between psychological factors, pain hypersensitivity and BPD. Therefore, an integrated examination of the interconnections between these variables within a theory-driven model is necessary.

Methods

The model hypothesises that pain hypersensitivity (hyperalgesia, allodynia), directly linked with BPD (assessed by the Bath-BPD and Neurobehavioral questionnaires) or indirectly, via symptom severity [assessed by complex regional pain syndrome (CRPS) severity score]; coping strategies (depersonalization, kinesiophobia) and psychological symptoms (somatization, depression) are directly related to BPD; and BPD is associated with pain severity and Quality of Life (QoL).

Results

The model was examined using a path analysis of 92 patients with chronic limb pain. Results indicate that depersonalization was directly linked with the Bath-BPD (β = 0.50, p < 0.001), and depersonalization and kinesiophobia with the Neurobehavioral (β = 0.24, p = 0.010; β = 0.22, p = 0.020, respectively). CRPS severity score accounts for the associations between hyperalgesia intensity and BPD and is directly related to the Bath-BPD (β = 0.25, p = 0.014), Neurobehavioral (β = 0.24, p = 0.037), pain (β = 0.28, p = 0.014) and QoL (β = −0.34, p = 0.001). The Bath-BPD marginally associated with QoL (β = −0.20, p = 0.052) but not with pain severity.

Conclusions

The theory-driven model fits the data, suggesting that psychological copying strategies play a dominant role in BPD. The symptom severity explains the associations between pain hypersensitivity and BPD and is directly linked to BPD, pain and QoL. The model revealed potential mechanisms underlying BPD and its associated clinical outcomes.

Significance Statement

This study is the first to use path analysis to examine the predictors and effects of Body Perception Disturbances (BPD) in chronic limb pain. Results identified depersonalization and kinesiophobia as key psychological predictors of BPD, while hyperalgesia has no direct effect. The Complex Regional Pain Syndrome (CRPS) severity score is negatively associated with BPD, pain and quality of life. Findings emphasise the role of dysfunctional psychological processes in BPD and suggest that targeting these processes and reducing CRPS symptoms may improve BPD and treatment outcomes.

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慢性肢体疼痛的躯体知觉障碍模型：运动恐惧症、人格解体和症状严重程度的预测作用

身体知觉障碍（BPD）在慢性肢体疼痛中很常见，其特征是对肢体的负面感觉和代理感降低。先前的研究主要集中在心理因素、疼痛过敏和BPD之间的孤立联系。因此，有必要在理论驱动的模型中对这些变量之间的相互联系进行综合检查。方法该模型假设与BPD直接相关（通过Bath-BPD和神经行为问卷评估）或通过症状严重程度间接相关（通过复杂区域疼痛综合征（CRPS）严重程度评分评估）的疼痛超敏感（痛觉过敏、异常性疼痛）；应对策略（人格解体、运动恐惧症）和心理症状（躯体化、抑郁）与BPD直接相关；BPD与疼痛严重程度和生活质量（QoL）有关。结果对92例慢性肢体疼痛患者进行通径分析。结果表明，人格解体与Bath-BPD直接相关（β = 0.50, p < 0.001），人格解体和运动恐惧症与神经行为直接相关（β = 0.24, p = 0.010; β = 0.22, p = 0.020）。CRPS严重程度评分反映了痛觉过敏强度与BPD之间的相关性，并与Bath-BPD （β = 0.25, p = 0.014）、神经行为（β = 0.24, p = 0.037）、疼痛（β = 0.28, p = 0.014）和生活质量（β = - 0.34, p = 0.001）直接相关。Bath-BPD与生活质量相关（β = - 0.20, p = 0.052），但与疼痛严重程度无关。结论理论驱动模型与数据吻合，表明心理复制策略在BPD中起主导作用。症状的严重程度解释了疼痛超敏反应和BPD之间的联系，并与BPD、疼痛和生活质量直接相关。该模型揭示了BPD的潜在机制及其相关的临床结果。本研究首次使用通径分析来研究慢性肢体疼痛的身体知觉障碍（BPD）的预测因素和影响。结果发现人格解体和运动恐惧症是BPD的关键心理预测因素，而痛觉过敏没有直接影响。复杂局部疼痛综合征（CRPS）严重程度评分与BPD、疼痛和生活质量呈负相关。研究结果强调了功能障碍心理过程在BPD中的作用，并表明针对这些过程和减少CRPS症状可能改善BPD和治疗结果。

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来源期刊

European Journal of Pain 医学-临床神经学

CiteScore

7.50

自引率

5.60%

发文量

163

审稿时长

4-8 weeks

期刊介绍： European Journal of Pain (EJP) publishes clinical and basic science research papers relevant to all aspects of pain and its management, including specialties such as anaesthesia, dentistry, neurology and neurosurgery, orthopaedics, palliative care, pharmacology, physiology, psychiatry, psychology and rehabilitation; socio-economic aspects of pain are also covered. Regular sections in the journal are as follows: • Editorials and Commentaries • Position Papers and Guidelines • Reviews • Original Articles • Letters • Bookshelf The journal particularly welcomes clinical trials, which are published on an occasional basis. Research articles are published under the following subject headings: • Neurobiology • Neurology • Experimental Pharmacology • Clinical Pharmacology • Psychology • Behavioural Therapy • Epidemiology • Cancer Pain • Acute Pain • Clinical Trials.