Abstract
People with fibromyalgia (FM) have movement-related fear impacting on daily activities. While virtual reality has been used as a distractor to promote exercise, it can be used to manipulate visual feedback (VF) about movement, potentially influencing pain and movement. Objectives: A. To determine whether altered VF modulates pain during movement; B. To compare adaptation to an altered VF between FM participants and healthy controls (HC); C. To explore relationships between adaptation, limb position sense, kinesiophobia and pain. 20 FM participants and 20 HC performed a reaching task during two sessions in a KINARM exoskeleton including a virtual reality interface allowing to replace their arm with a virtual arm. In one session, VF was altered to show GREATER movements while in the other it showed SMALLER movements (randomized order). Pain was assessed periodically using a numerical rating scale. Movement amplitude was assessed during exposure to altered VF (adaptation) and pre-/post-exposure (without VF; after-effects). Limb position sense was assessed with a KINARM task, and kinesiophobia was assessed with the Tampa Scale for Kinesiophobia (TSK-11). Pain intensity increased slightly with movement repetitions (p < 0.001), but did not differ between the VF conditions (GREATER vs. SMALLER). Both groups exhibited visuomotor adaptation, as shown by VF-dependent changes in movement amplitude and speed during exposure to altered VF, and by the presence of VF-dependent after-effects (p < 0.001 for all variables). However, no differences were observed across groups for any of these variables, despite the fact that FM had significantly more difficulty to correctly detect VF conditions than HC (p = 0.046). No clear limb position sense deficits were observed in FM participants, and no significant relationships were found between TSK-11 scores and changes in pain intensity during exposure to altered VF. Altering VF did not influence pain during a reaching task in the FM group. Surprisingly, both groups adapted similarly to altered VF. Visuomotor adaptation is therefore preserved in FM, despite impairments in sensory perception and the poor ability to detect VF alterations in the present study. Further research is warranted to clarify the relationship between sensory perceptions and motor control in FM.
Highlights
Fibromyalgia (FM) syndrome is a chronic widespread pain condition (Wolfe et al, 2016) affecting 2.7% of the population (Queiroz, 2013), mainly women (McNally et al, 2006), and requiring a combination of pharmacological and nonpharmacological treatments (Goldenberg et al, 2004)
The general aim of this study was to assess whether altered visual feedback (VF) influenced pain intensity and upper limb (UL) kinematics in FM participants
The results showed that altered VF did not impact on pain intensity and that both FM and healthy controls (HC) adapted their movement amplitude and speed upon and after exposure to SMALLER and GREATER VF, without any differences observed between FM and HC while FM participants had more difficulty to detect the altered VF
Summary
Fibromyalgia (FM) syndrome is a chronic widespread pain condition (Wolfe et al, 2016) affecting 2.7% of the population (Queiroz, 2013), mainly women (McNally et al, 2006), and requiring a combination of pharmacological and nonpharmacological treatments (Goldenberg et al, 2004). A VR intervention based on altered VF for people with FM could potentially promote greater movement amplitude and alleviate pain intensity, as participants would perform greater movements without necessarily noticing it. We hypothesized that: A—SMALLER VF would induce less pain than GREATER VF during reaching movements, since SMALLER VF would make the reaching movement seem less threatening, provoking less pain compared to a GREATER VF about that same movement; and that B— both FM and HC participants would adapt their movement amplitude and average speed upon (B.1) and after (B.2) exposure to altered VF, but that FM would adapt to a lesser extent because patients with chronic pain have a less accurate detection of movement manipulation compared to healthy participants (Roosink et al, 2015; Brun et al, 2018b). A secondary aim (aim C) was to explore relationships between adaptation upon exposure to altered VF, limb position sense, kinesiophobia and pain
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