• Hironobu Uematsu, Masahiko Sumitani, Arito Yozu, Yuko Otake, Masahiko Shibata, Takashi Mashimo, and Satoru Miyauchi.
• Department of Acute Critical Medicine (Anesthesiology), Osaka University, Graduate School of Medicine, Osaka, Japan.
• Ann Acad Med Singap. 2009 Nov 1;38(11):931-6.

IntroductionComplex regional pain syndrome (CRPS) patients show impaired visuospatial perception in the dark, as compared to normal patients with acute nociceptive pain. The purpose of this study is 2-fold: (i) to ascertain whether this distorted visuospatial perception is related to the chronicity of pain, and (ii) to analyse visuospatial perception of CRPS in comparison with another neuropathic pain condition.Materials And MethodsWe evaluated visual subjective body-midline (vSM) representation in 27 patients with post-herpetic neuralgia (PHN) and 22 with CRPS under light and dark conditions. A red laser dot was projected onto a screen and moved horizontally towards the sagittal plane of the objective body-midline (OM). Each participant was asked to direct the dot to a position where it crossed their vSM. The distance between the vSM and OM was analysed to determine how and in which direction the vSM deviated.ResultsUnder light condition, all vSM judgments approximately matched the OM. However, in the dark, CRPS patients, but not PHN patients, showed a shifted vSM towards the affected side.ConclusionWe demonstrated that chronic pain does not always impair visuospatial perception. The aetiology of PHN is limited to the peripheral nervous system, whereas the distorted visuospatial perception suggests a supraspinal aetiology of CRPS.

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