An Embarrassment of Sensation

I only have access, at the moment, to the abstract of this article, published in the October 16, 2008 issue of Rheumatology. The reference popped up as the latest item on my MedWorm "CRPS" news feed.

C. S. McCabe, one of the authors, is known to me (giggle) as someone who is at the forefront of investigations into (Step away from this non-scientist's understanding!) how to bridge the gaps between pain sensations, the complex processes of pain perception, and the expressions of pain -- he has written extensively on mirror visual feedback, for example.

Yes, I get the rolly-polly poly-semy of expression.

D. R. Blake is unknown to me, though from looking over his work, as represented in PubMed listings, he seems more oriented toward microbiology and his study of sensory/motor incongruence takes place more often at a cellular level (That was an attempt at clever levity. Quite successful, I'd say.) He also seems to have an intense interest in Chlamydia. (Ar!)

Both hail from the Royal National Hospital for Rheumatic Diseases in conjunction with The School for Health, University of Bath, Bath, UK.

Here is the abstract:

An embarrassment of pain perceptions? Towards an understanding of and explanation for the clinical presentation of CRPS type 1
October 16, 2008 (Rheumatology)


Complex regional pain syndrome (CRPS), a fairly common problem in rheumatological and orthopaedic practice, is an allodynic pain state of uncertain pathology often variably and unpredictably responsive to treatments. Although published diagnostic criteria are available, in the reality of clinical practice these do not appear to encompass the wide variety of symptoms that a patient may present with. This leads to scepticism on the part of the clinician and confusion for the sufferer. This article aims to provide some explanations for an often bewildering clinical picture. We provide a construct for the plethora of symptoms that we have entitled ‘the embarrassment of pain perceptions’. With the aid of a case report we examine recent research that suggests how peripherally based symptoms and signs arise from changes within the central nervous system, with particular attention given to the control function of the motor–proprioceptive integrative system. We speculate how these changes within the central nervous system may provide the patient with CRPS the ability to access complex layers of lower level perceptions that are normally suppressed. We propose that such a system may explain some of the clinical puzzlements seen in this condition and suggest that the complexities of CRPS may provide an insight into brain development through evolution, which is a fruitful area for interdisciplinary clinical and scientific research.


KEY WORDS: Complex regional pain syndrome, Pain, Motor control system

This goes far toward explaining (because in an acceptable format, because provided by acceptable people) the often off-putting richness of pain vocabulary chez someone with CRPS.

Cough. Of course, I am not fooled by the seemingly haphazard use of "interdisciplinary" -- a quaint word in an ugly code.

But then, I haven't read the article yet.