Watching your pain site reduces pain intensity in chronic back pain patients

Virtual and Augmented Reality in Management of Phantom Limb Pain: A Systematic Review

Upper and lower limb amputations are frequently associated with phantom limb pain (PLP). Recently, virtual reality (VR) and augmented reality (AR) have been reported as a potential therapy of PLP. We have conducted a systematic review of literature to evaluate the efficacy of VR and AR in managing PLP. Four databases were searched: PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, and Web of Science. We utilized the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for our organization. The initial search resulted in 164 results. After title, abstract, and full-text screening, 9 studies were included. One study was of good quality and 8 studies were of fair to poor quality. Seven studies utilized VR and 2 studies utilized AR. The number of treatment sessions ranged from 1 to 28 and the duration ranged from 10 minutes to 2 hours. Several pain scales were used to evaluate PLP pre- and postintervention including Numeric Rating Scale, Pain Rating Index, McGill Pain Questionnaire, and Visual Analog Scale. All the studies reported improvement of PLP on one or more of pain scales after one or more sessions of VR or AR. Despite the promising results reported by literature, we cannot recommend using VR or AR for PLP. Most of the studies are of poor design and have limited sample size with high bias levels. Therefore, no substantial evidence can be derived from them. However, we do believe further research with high-quality randomized controlled trials should take place to increase the knowledge of the potential advantages.

The sensorimotor theory of pathological pain revisited

Harris (1999) proposed that pain can arise in the absence of tissue damage because changes in the cortical representation of the painful body part lead to incongruences between motor intention and sensory feedback. This idea, subsequently termed the sensorimotor theory of pain, has formed the basis for novel treatments for pathological pain. Here we review the evidence that people with pathological pain have changes to processes contributing to sensorimotor function: motor function, sensory feedback, cognitive representations of the body and its surrounding space, multisensory processing, and sensorimotor integration. Changes to sensorimotor processing are most evident in the form of motor deficits, sensory changes, and body representations distortions, and for Complex Regional Pain Syndrome (CRPS), fibromyalgia, and low back pain. Many sensorimotor changes are related to cortical processing, pain, and other clinical characteristics. However, there is very limited evidence that changes in sensorimotor processing actually lead to pain. We therefore propose that the theory is more appropriate for understanding why pain persists rather than how it arises.

Virtual reality exergame for supplementing multimodal pain therapy in older adults with chronic back pain: a randomized controlled pilot study

Immersive Virtual Reality (VR) with head-mounted displays (HMD) can be a promising tool for increasing adherence to exercise in older adults. However, there is little known about the effectiveness of an interactive multimodal therapy in VR for older chronic back pain (CBP) patients. The aim of the exploratory randomized controlled trial was to examine the preliminary effectiveness of a VR multimodal therapy for older adults with CBP in a laboratory setting over a period of four weeks. The intervention group (IG; n = 11) received a multimodal pain therapy in VR (movement therapy and psychoeducation) and the control group (CG; n = 11) received a conventional multimodal pain therapy (chair-based group exercises and psychoeducation in a group setting). Although the VR therapy (IG) did not reach the pain intensity reduction of the CG (IG: MD = 0.64, p = .535; CG: MD = 1.64, p = .07), both groups showed a reduction in pain intensity on the Numeric Rating Scale. The functional capacity in the IG improved from Visit 1, x ¯ = 73.11% to Visit 2, x ¯ = 81.82% (MD = 8.71%; p = .026). In the changes of fear avoidance beliefs and general physical and mental health, no significance was achieved in either group. Although the IG did not reach a significant pain intensity reduction compared to the CG, the results of the present study showed that a pain intensity reduction can be achieved with the current VR application.

Watching Your Neck: The Influence of Real-Time Visual Feedback on Cervical Joint Position Sense in Chronic Neck Pain

Patients with neck pain demonstrate a variety of sensorimotor impairments, such as decreased cervical joint position sense (CJPS) acuity, which might also be associated with an impaired internal body representation. The present study evaluated the effect of real-time visual feedback of the individual's own neck on CJPS compared to observing a book. Twenty-three patients with neck pain participated in the experiment and received the interventions in randomized order on separate days in a within-subject pretest-posttest design. Before and immediately after each intervention, CJPS was measured by a therapist blinded to the intervention. The results demonstrate a significantly different development of CJPS (p = .04), with increased CJPS acuity after observing one's own neck and decreased acuity after observing a book. Real-time visual feedback of the neck improved CJPS acuity in patients with neck pain without active movements of the neck, indicating the importance of central nervous system processing for CJPS acuity.

Investigating the Mechanisms of Graded Sensorimotor Precision Training in Adults With Chronic Nonspecific Low Back Pain: Protocol for a Causal Mediation Analysis of the RESOLVE Trial

Background

Chronic low back pain (CLBP) is a global health problem associated with an increasing burden on individuals, health care systems, and society. Common treatments for people with CLBP produce, on average, small short-term improvements in pain and function compared with minimal care. The RESOLVE trial randomly allocated 276 people with CLBP to a new complex treatment strategy, pain education integrated with graded sensorimotor precision training (RESOLVE), or a sham control. The RESOLVE treatment was developed within a theoretical framework to target possible treatment mechanisms associated with CLBP development and persistence.

Objective

This protocol describes the planned evaluation of these proposed treatment mechanisms. Improved understanding of the mechanisms underpinning the RESOLVE treatment may guide its refinement and implementation.

Methods

We will use causal mediation analysis to evaluate the proposed treatment mechanisms, including pain self-efficacy, back beliefs, pain catastrophizing, kinesiophobia, back perception, tactile acuity, and movement coordination. The primary outcomes are pain intensity and function at 18 weeks following allocation. Data were collected blind to allocation and hypotheses at baseline (mediators, outcomes, confounders), end of treatment (mediators), and at 18 weeks following allocation (outcomes). We will test the robustness of our findings by conducting planned sensitivity analyses.

Results

Ethical approval was granted by the University of New South Wales Human Research Ethics Committee (HC15357). A total of 276 participants have been recruited from primary care practices and the community in Sydney, Australia.

Conclusions

The RESOLVE treatment constitutes a new paradigm for CLBP management with potentially wide-reaching implications. This mechanistic evaluation will provide evidence for the hypothesized treatment mechanisms and help explain why the treatment strategy did or did not have an effect on patient-reported outcomes. These results will help guide the treatment refinement and implementation.

Trial Registration

Australian and New Zealand Clinical Trials Registry ACTRN12615000610538; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368619&isReview=true

International Registered Report Identifier (IRRID)

DERR1-10.2196/26053

Body perception disturbances in women with pregnancy-related lumbopelvic pain and their role in the persistence of pain postpartum

Background

Lumbopelvic pain (LPP) is common during pregnancy and can have long-lasting negative consequences in terms of disability and reduced quality of life. Therefore, it is crucial to identify women at risk of having pregnancy-related LPP after childbirth. This study aimed to investigate the association between body perception, pain intensity, and disability in women with pregnancy-related LPP during late pregnancy and postpartum, and to study whether a disturbed body perception during late pregnancy predicted having postpartum LPP.

Methods

A prospective cohort study in 130 primiparous women (median age = 30 years) was performed. Pain intensity, disability, and lumbopelvic body perception during the last month of pregnancy and 6 weeks postpartum were assessed with the Numerical Pain Rating Scale (NPRS), Oswestry Disability Index, and Fremantle Back Awareness Questionnaire, respectively. Having pregnancy-related LPP was defined as an NPRS score ≥ 1/10. At both timepoints, women were categorized into three groups; pain-free, LPP with low disability, and LPP with high disability (based on Oswestry Disability Index scores). At each timepoint, body perception was compared between groups, and correlations between body perception, pain intensity, and disability were evaluated in women with LPP by using non-parametric tests. Logistic regression analysis was used to determine whether body perception during the last month of pregnancy predicted the presence of LPP 6 weeks postpartum.

Results

Women with LPP at the end of pregnancy, and 6 weeks postpartum reported a more disturbed body perception compared to pain-free women (p ≤ 0.005). Greater body perception disturbance correlated with higher pain intensity (σ = 0.266, p = 0.008) and disability (σ = 0.472, p < 0.001) during late pregnancy, and with pain intensity 6 weeks postpartum (σ = 0.403, p = 0.015). A disturbed body perception during late pregnancy nearly significantly predicted having postpartum LPP (Odds Ratio = 1.231, p = 0.052).

Conclusions

Body perception disturbance was greater in women experiencing LPP during late pregnancy and postpartum compared to pain-free women, and correlated with pain intensity and disability. Though non-significant (p = 0.052), the results of the regression analysis suggest that greater body perception disturbance during late pregnancy might predict having LPP postpartum. However, future studies should follow up on this.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-03704-w.

Relationship of prosthesis ownership and phantom limb pain: results of a survey in 2383 limb amputees

ABSTRACT

Phantom limb pain (PLP) accounts for a significant reduction in quality of life and is difficult to treat. Prosthesis use has been shown to negatively covary with PLP. Recent research on body perception in amputees suggest that prosthesis ownership, defined as the extent to which a prosthesis is experienced as being part of the body rather than an artificial device foreign to the body, might interact with PLP. We used survey data from 2383 unilateral prosthesis-using upper-limb or lower-limb amputees and performed regression analyses to determine the relationship between prosthesis ownership and PLP. To test for specificity, we examined the role of prosthesis ownership also for residual limb pain (RLP) and nonpainful phantom limb sensations (npPLS). Prosthesis ownership was reduced in older participants and higher in lower-limb compared to upper-limb amputees. A longer residual limb and more frequent prosthesis use as well as a longer time since amputation also yielded higher values. Prostheses based on natural principles were associated with higher prosthesis ownership. Phantom limb pain and RLP were lower with higher prosthesis ownership, and RLP but not PLP was lower when prosthesis use was frequent. There were no significant associations for npPLS. The regression results differ in some aspects from those revealed by univariate analyses, emphasizing the importance of multivariate statistical approaches. Our findings provide insights into the interplay of body- and pain-related sensations after amputation, and could help to develop new treatment approaches for both PLP and RLP.

Differential effects of visually induced analgesia and attention depending on the pain stimulation site

BACKGROUND

The term 'visually induced analgesia' describes a reduced pain perception induced by watching the painful body part as opposed to watching a neutral object. In chronic back pain patients, experimental pain, movement-induced pain and habitual pain can be reduced with visual feedback. Visual feedback can also enhance the effects of both massage treatment and manual therapy. The impact of somatosensory attentional processes remains unclear.

METHODS

In the current study, participants received painful electrical stimuli to their thumb and back while being presented with either a real-time video of their thumb or back (factor feedback). In addition, using an oddball paradigm, they had to count the number of deviant stimuli, applied to either their back or thumb (factor attention) and rate the pain intensity.

RESULTS

We found a significant main effect for attention with decreased pain ratings during attention. There was no main effect for visual feedback and no significant interaction between visual feedback and attention. Post-hoc tests revealed that the lowest pain intensity ratings were achieved during visual feedback of the back/ thumb and counting at the back/ thumb.

CONCLUSION

These data suggest that the modulation of perceived acute pain by visually induced analgesia may be influenced by a simultaneous somatosensory attention task.

SIGNIFICANCE

Somatosensory attention reduced experimental pain intensity in the thumb and back in the presence of both congruent and incongruent visual feedback. We found no significant visual feedback effect on the complex interplay between visual feedback and somatosensory attention.

Endogenous antinociceptive system and potential ways to influence It

The biological significance of pain is to protect the organism from possible injury. However, there exists a situation, where, in the interest of survival, it is more important not to perceive pain. Spontaneous suppression of pain or weakening of nociception is mediated by an endogenous antinociceptive (analgesic) system. Its anatomical substrate ranges from the periaqueductal gray matter of the midbrain, through the noradrenergic and serotonergic nuclei of the brain stem to the spinal neurons, which receive "pain" information from nociceptors. Moreover, the activity of this system is under significant control of emotional and cognitive circuits. Pain can be moderated primarily through stimulation of positive emotions, while negative emotions increase pain. Paradoxically, one pain can also suppress another pain. Analgesia can be induced by stress, physical exercise, orosensory stimulation via a sweet taste, listening to music, and after placebo, i.e. when relief from pain is expected. Since pain has sensory, affective, and cognitive components, it turns out that activation of these entire systems can, in specific ways, contribute to pain suppression.

The RESOLVE Trial for people with chronic low back pain: statistical analysis plan

BACKGROUND

Statistical analysis plans describe the planned data management and analysis for clinical trials. This supports transparent reporting and interpretation of clinical trial results. This paper reports the statistical analysis plan for the RESOLVE clinical trial. The RESOLVE trial assigned participants with chronic low back pain to graded sensory-motor precision training or sham-control.

RESULTS

We report the planned data management and analysis for the primary and secondary outcomes. The primary outcome is pain intensity at 18-weeks post randomization. We will use mixed-effects models to analyze the primary and secondary outcomes by intention-to-treat. We will report adverse effects in full. We also describe analyses if there is non-adherence to the interventions, data management procedures, and our planned reporting of results.

CONCLUSION

This statistical analysis plan will minimize the potential for bias in the analysis and reporting of results from the RESOLVE trial.

TRIAL REGISTRATION

ACTRN12615000610538 (https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368619).

Heat pain modulation with virtual water during a virtual hand illusion

Immersive virtual reality is a powerful method to modify the environment and thereby influence experience. The present study used a virtual hand illusion and context manipulation in immersive virtual reality to examine top-down modulation of pain. Participants received painful heat stimuli on their forearm and placed an embodied virtual hand (co-located with their real one) under a virtual water tap, which dispensed virtual water under different experimental conditions. We aimed to induce a temperature illusion by a red, blue or white light suggesting warm, cold or no virtual water. In addition, the sense of agency was manipulated by allowing participants to have high or low control over the virtual hand’s movements. Most participants experienced a thermal sensation in response to the virtual water and associated the blue and red light with cool/cold or warm/hot temperatures, respectively. Importantly, the blue light condition reduced and the red light condition increased pain intensity and unpleasantness, both compared to the control condition. The control manipulation influenced the sense of agency, but did not influence pain ratings. The large effects revealed in our study suggest that context effects within an embodied setting in an immersive virtual environment should be considered within VR based pain therapy.

Synchronous Stimulation With Light and Heat Induces Body Ownership and Reduces Pain Perception

In this study, we investigated whether illusionary body ownership over artificial hands and non-corporeal objects modulates pain perception. Previous research has yielded to mixed results, but has separated painful stimulation used to test pain perception from the stimulation that was used to induce the illusion. Here, we used a variant of the rubber hand illusion (RHI) paradigm and induced the illusion directly via a combination of visual and painful stimuli. We presented heat pain stimuli at the real hand and visual stimuli beneath a rubber hand (part1), or a glass ball (part2). Illusion ratings were higher and pain ratings were lower in the synchronous compared to the asynchronous condition in both parts of the experiment. This study demonstrated the successful induction of a body illusion using a new visual-thermal method with painful stimuli. We showed that the RHI and interestingly also the glass ball has an analgesic effect on the perception of the heat pain stimuli. Our data suggests that induced ownership over artificial limbs but also over non-corporeal objects can reduce the perceived pain perception. This might be mediated via a partial referral of the perceived location of pain or respectively a distribution of pain over 2 locations. PERSPECTIVE: This article presents a new visual-thermal method with painful stimuli for the induction of the Rubber Hand Illusion. An illusionary body ownership over artificial hands and non-corporeal has an analgesic effects on the perception of pain. Similar approaches might be useful to alleviate chronic pain, but needs further testing.

Immersive Virtual Reality and Virtual Embodiment for Pain Relief

A significant body of experimental evidence has demonstrated that it is possible to induce the illusion of ownership of a fake limb or even an entire fake body using multisensory correlations. Recently, immersive virtual reality has allowed users to experience the same sensations of ownership over a virtual body inside an immersive virtual environment, which in turn allows virtual reality users to have the feeling of being "embodied" in a virtual body. Using such virtual embodiment to manipulate body perception is starting to be extensively investigated and may have clinical implications for conditions that involve altered body image such as chronic pain. Here, we review experimental and clinical studies that have explored the manipulation of an embodied virtual body in immersive virtual reality for both experimental and clinical pain relief. We discuss the current state of the art, as well as the challenges faced by, and ideas for, future research. Finally, we explore the potentialities of using an embodied virtual body in immersive virtual reality in the field of neurorehabilitation, specifically in the field of pain.

Neuroimaging the pain network - Implications for treatment

In this chapter, we provide an overview of neuroimaging studies in chronic pain. We start with an introduction about the phenomenology of pain. In the following section, the application of functional and structural imaging techniques is shown in selected chronic pain syndromes (chronic back pain, fibromyalgia syndrome (FMS), phantom limb pain, and complex regional pain syndrome (CRPS)), and commonalities and peculiarities of imaging correlates across different types of chronic pain are discussed. We conclude this chapter with implications for treatments, with focus on behavioral interventions, sensory and motor trainings, and mirror and motor imagery trainings.

Neuroplasticity of Sensorimotor Control in Low Back Pain

Low back pain (LBP) is an important medical and socioeconomic problem. Impaired sensorimotor control has been suggested to be a likely mechanism underlying development and/or maintenance of pain. Although early work focused on the structural and functional abnormalities within the musculoskeletal system, in the past 20 years there has been an increasing realization that patients with LBP might also have extensive neuroplastic changes within the central nervous system. These include changes related to both the structure (eg, gray matter changes) and function (eg, organization of the sensory and motor cortices) of the nervous system as related to processing of pain and nociception and to motor and somatosensory systems. Moreover, clinical interventions increasingly aim to drive neuroplasticity with treatments to improve pain and sensorimotor function. This commentary provides a contemporary overview of neuroplasticity of the pain/nociceptive and sensorimotor systems in LBP. This paper addresses (1) defining neuroplasticity in relation to control of the spine and LBP, (2) structural and functional nervous system changes as they relate to nonspecific LBP and sensorimotor function, and (3) related clinical implications. Individuals with recurrent and persistent LBP differ from those without LBP in several markers of the nervous system's function and structure. Neuroplastic changes may be addressed by top-down cognitive-based interventions and bottom-up physical interventions. An integrated clinical approach that combines contemporary pain neuroscience education, cognition-targeted sensorimotor control, and physical or function-based treatments may lead to better outcomes in patients with recurrent and persistent LBP. This approach will need to consider variation among individuals, as no single finding/mechanism is present in all individuals, and no single treatment that targets neuroplastic changes in the sensorimotor system is likely to be effective for all patients with LBP. J Orthop Sports Phys Ther 2019;49(6):402-414. doi:10.2519/jospt.2019.8489.

Mirror therapy versus augmented/virtual reality applications: towards a tailored mechanism-based treatment for phantom limb pain

Phantom limb pain (PLP) is a clinically relevant consequence of limb amputation and its treatment is still challenging. Mirror therapy, in other words, observing and engaging in the intact limb's mirrored movements, offers a promising, mechanism-based treatment for PLP. However, intervention and patient characteristics, such as the realism of mirrored exercises and perceptions related to the phantom limb, might influence treatment effectiveness. Novel approaches using augmented and virtual reality setups represent an alternative to traditional mirror therapy. In this paper, based on recent studies in the field, we compare both approaches and discuss their unique advantages and disadvantages. We argue for the necessity of a tailored treatment for PLP that is personalized to the patients’ characteristics, preferences and psychological needs.

Embodying the illusion of a strong, fit back in people with chronic low back pain. A pilot proof-of-concept study

OBJECTIVE

This proof-of-concept pilot study aimed to investigate if a visual illusion that altered the size and muscularity of the back could be embodied and alter perception of the back.

METHODS

The back visual illusions were created using the MIRAGE multisensory illusion system. Participants watched real-time footage of a modified version of their own back from behind. Participants undertook one experimental condition, in which the image portrayed a muscled, fit-looking back (Strong), and two control conditions (Reshaped and Normal) during a lifting task. Embodiment, back perception as well as pain intensity and beliefs about the back during lifting were assessed.

RESULTS

Two participants with low back pain were recruited for this study: one with altered body perception and negative back beliefs (Participant A) and one with normal perception and beliefs (Participant B). Participant A embodied the Strong condition and pain and fear were less and both perceived strength and confidence were more than for the Normal or the Reshaped condition. Participant B did not embody the Strong condition and reported similar levels of pain, fear strength and confidence across all three conditions.

DISCUSSION

An illusion that makes the back look strong successfully induced embodiment of a visually modified back during a lifting task in a low back pain patient with altered body perception. Both participants tolerated the illusion, there were no adverse effects, and we gained preliminary evidence that the approach may have therapeutic potential.

A single session of visual feedback improves range of motion in patients with chronic idiopathic neck pain: A randomized and controlled study

INTRODUCTION

Chronic pain is associated with cortical reorganization, and interventions targeting cortical remapping, such as visual feedback of the painful body segment, seem promising. The primary aim of the present study was to evaluate the impact of visual feedback of the neck, using mirrors on pain intensity. Secondary aims were to evaluate the impact of visual feedback on neck range of motion and unadjusted cognitive processes.

METHODS

Pain intensity, range of motion, fear of movement, catastrophizing and anxiety were assessed before and after 10 repetitions of each of the neck movements, with (experimental group; n = 21) and without (control group; n = 21) visual feedback of the neck.

RESULTS

A significant increase in the range of motion of all neck movements (p < 0.05) was found in the experimental group when compared with the control group. Increases in range of motion varied between 2.5° and 3.4°. No significant effects were found for the remaining variables (p > 0.05).

CONCLUSIONS

The study findings suggest that performing a series of 10 active movements of the neck while observing the reflection of the neck in a mirror might help to improve neck range of motion. Furthermore, our results support further studies investigating the effect of longer interventions using visual feedback of the neck, either alone or combined with other interventions.

The effect of visual feedback of body parts on pain perception: A systematic review of clinical and experimental studies

The aim of this systematic review was to evaluate the effect of visual feedback techniques on pain perception by analysing the effect of normal-sized, magnified or minified visual feedback of body parts on clinical and experimentally-induced pain. Databases searched: Medline, Embase, PsychInfo, PEDro, CINAHL, CENTRAL and OpenSIGLE. Studies investigating pain patients and pain-free participants exposed to experimentally-induced pain were analysed separately. Risk of bias was assessed and data were meta-analysed. Thirty four studies were included. A meta-analysis of clinical data favoured mirror visual feedback (six trials; mean difference = -13.06 mm; 95% CI = -23.97, -2.16). Subgroup analysis favoured mirror visual feedback when used as a course of treatment (three trials; mean difference = -12.76 mm; 95% CI = -24.11, -1.40) and when used for complex regional pain syndrome for complex regional pain syndrome (three trials; standard mean difference = -1.44; 95% CI = -1.88, -0.99). There is insufficient evidence to determine differences between normal-sized view and a size-distorted view of the limb. Mirror visual feedback was not superior to object view or direct view of the hand for reducing experimental pain in pain-free participants. There were inconsistencies in study findings comparing normal-sized reflection of a body part and a reflection of an object, or a magnified or minified reflection. There is tentative evidence that mirror visual feedback can alleviate pain when delivered as a course of treatment, and for patients with complex regional pain syndrome. It was not possible to determine whether normal-sized, magnified or minified visual feedback of body parts affects pain perception because of contradictory findings in primary studies.

SIGNIFICANCE

It was not possible to determine whether normal-sized, magnified or minified visual feedback of body parts affected pain perception in clinical or experimental settings because of contradictory findings in primary studies. This emphasizes the need for higher quality studies.

Disrupted body-image and pregnancy-related lumbopelvic pain. A preliminary investigation

BACKGROUND

Recent investigations have suggested that disrupted body-image may contribute to the lumbopelvic pain experience. The changes in body shape and size associated with pregnancy suggest that pregnancy-related lumbopelvic pain might be a problem in which alterations in body-image are particularly relevant.

OBJECTIVES

To investigate if self-reported body-image is related to lumbopelvic pain status in women during pregnancy and explore the factors that might contribute to changes in body-image in women experiencing pregnancy-related lumbopelvic pain.

DESIGN

Cross-sectional cohort study.

METHOD

Forty-two women in the third trimester of pregnancy were recruited regardless of clinical status. Pain intensity and disability were measured to estimate clinical severity. The Fremantle Back Awareness Questionnaire was used to assess body-image. Participants also completed a series of questionnaires and physical tests to explore factors that might be associated with altered body-image.

RESULTS

The median Fremantle Back Awareness Questionnaire score for the pain free women was 1 (IQR 0-1.5) and the median score for those in pain was 3.5 (IQR 2-8). This difference was statistically significant (p = 0.005). The questionnaire score was significantly correlated with pain intensity but not with disability. Of the measured variables only pain catastrophisation was significantly associated with disrupted body-image.

CONCLUSIONS

Self-reported disruption of body-image was significantly greater in pregnant women who were experiencing lumbopelvic pain than those who weren't and the extent of body-image disruption was associated with pain intensity. Only pain related catastrophisation was related to disrupted body-image.