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Prism adaptation to optical deviation alleviates pathologic pain

From the Department of Acute Critical Medicine (Anesthesiology) (M. Sumitani, M. Shibata, Y.M., G.S., T.I., T.M.), Osaka University, Graduate School of Medicine, and Center for Pain Management, Osaka University Hospital, Osaka, Japan; Espace et Action (Y.R.), Institut National de la Santé Et de la Recherché Médicale (INSERM), Unité 534, Bron, France; and Kobe Advanced ICT Research Center (S.M.), National Institute of Information and Communications Technology, Kobe, Japan.

Address correspondence and reprint requests to Dr. Satoru Miyauchi, Kobe Advanced ICT Research Center, National Institute of Information and Communications Technology, 588-2 Iwaoka, Iwaoka-cho, Nishi-ku, Kobe-shi, Hyogo 651-2492, Japan; e-mail: miyauchi{at}po.nict.go.jp

Background: The human visual and somatosensory systems are interdependent. Using a visual subjective body-midline (SM) judgment task, we previously confirmed that pathologic pain and deafferentation can modify visuospatial perception, indicating that altered somatosensory experience can modify visual perception. Conversely, in the present study we investigated whether a change in visual experience can modify perception of pathologic pain.

Methods: We used prism adaptation (PA) to modify subjects' visual experience. Five patients with complex regional pain syndrome (CRPS) adapted to wedge prisms, producing a 20-degree visual displacement toward the unaffected side. Further, we used several types of prisms in a longitudinal single-case study. Wearing prismatic goggles, the subjects performed a target-pointing task once a day for 2 weeks. We evaluated pain intensity and visual SM judgment to measure the adaptive aftereffects at three time points: before PA (pre-test), immediately after the first PA exposure (IA-test), and after a 14-day sequence of PA exposure (post-test).

Results: PA toward the unaffected side alleviated pathologic pain and other CRPS pathologic features, when measured at post-test. None of the IA-test results showed an analgesic effect. In the longitudinal study, sham PA and 5-degree PA did not produce any effects, and PA toward the affected side actually exacerbated the subjective pain.

Conclusions: Our findings suggest that vision can influence pathologic pain, and preliminarily suggest that prism adaptation has a direction-specific and reproducible effect on not only pathologic pain but also other CRPS pathologic features. Thus, prism adaptation may be a viable cognitive treatment for CRPS.

See also page 152

Disclosure: The authors report no conflicts of interest.

Received December 22, 2005. Accepted in final form September 14, 2006.

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