Reduced Visuospatial Attention in Personal Space is Not Limited to the Affected Limb in Complex Regional Pain Syndrome

Monika Halicka,1– 3 Olivia Rose Cousins,3 Antonia F Ten Brink,2– 4 Axel D Vittersø,2,3,5 Michael J Proulx,3 Janet H Bultitude2,3 1Institute of Neuroscience, Universite catholique de Louvain, Brussels, Belgium; 2Centre for Pain Research, University of Bath, Bath, UK; 3Department of Psychology, University of Bath, Bath, UK; 4Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, the Netherlands; 5Division of Mental Health Services, Akershus University Hospital, Lørenskog, NorwayCorrespondence: Monika Halicka, Institute of Neuroscience (IoNS), Université catholique de Louvain, Avenue Mounier 53, B1.53.04, 1200 Woluwe-Saint-Lambert, Brussels, Belgium, Email mon.halicka@gmail.comPurpose: Alterations in spatial attention have been reported in people with chronic pain and may be relevant to understanding its cortical mechanisms and developing novel treatments. There is conflicting evidence as to whether people with Complex Regional Pain Syndrome (CRPS) have reduced visuospatial attention to their affected limb and/or its surrounding space, with some evidence that these deficits may be greater in personal (bodily) space. We aimed to test the competing hypotheses of whether the visuospatial attentional bias is specific to the personal space of the affected limb or generalizes to the personal space of other parts of the affected side of the body.Patients and Methods: Using visual Temporal Order Judgement tasks, we measured spatial attention in the personal space of the hands and feet of patients with upper (n=14) or lower (n=14) limb CRPS and pain-free controls (n=17). Participants judged the order of two light flashes presented at different temporal offsets on each of their hands or feet. Slower processing of the flash on one side relative to the other reflects reduced attention to that side of space.Results: Controls prioritized stimuli on the non-dominant (left) relative to dominant side, consistent with the well-documented normal leftward bias of attention (ie “pseudoneglect”). Regardless of the location (upper or lower limb) of the pain or visual stimuli, people with CRPS showed no such asymmetry, representing reduced attention to the affected side (compared to the greater attention of controls to their non-dominant side). More severe CRPS symptoms were associated with a greater tendency to deprioritize stimuli on the affected side.Conclusion: Our findings suggest that relative visuospatial bias in CRPS is generalized to the personal space of the affected side of the body, rather than being specific to the personal space of the CRPS-affected limb.Keywords: complex regional pain syndrome, spatial attention, personal space, pseudoneglect, temporal order judgement, chronic pain