Patient’s experience of altered body perception in musculoskeletal and rheumatic conditions

Objective. to investigate personal experience and perception of chronic musculoskeletal and rheumatic patients’ own body, in order to better understand the complex relationship between the mind and the body in pain. Design and Method. a literature review has been conducted by two independent reviewers on Medline (PubMed) and PsycINFO, searching for records indexed until November 2017. ‘Body perception’, ‘body representation’, ‘body schema’, ‘body image’ and ‘self image’ have been the main keywords used for the search. No limits have been applied for language or date of publication. Results. the literature on body perception associated to painful experience in musculoskeletal and rheumatic diseases is scarce. Three studies have been analyzed. They investigated the complex relationship between the sense of self, the body and the pain on patients with Complex Regional Pain Syndrome, Fibromyalgia and Chronic Low Back Pain. The methodologies of investigation varied from interpretative-phenomenological analysis to the grounded-theory approach. The present analysis shows that the main themes reported by patients are phenomena of disturbed perception of own body parts, such as distortions in shape, pressure and altered awareness of limb position, coexisting with a compromised or distorted sense of self, such as hostile feelings, spectrum of dissociations and altered body image. Interestingly, a contradictory association between the high level of alertness demanded by pain and a diminished attention, neglect-like, toward the affected body part seems to be present in such conditions. Conclusions. The theme of the experience of the own body suffering, particularly regarding the perception of the body and the related emotions, seems to be scarcely investigated in musculoskeletal and rheumatic diseases. Further qualitative studies are needed to better understand neurocognitive aspects associated to musculoskeletal and rheumatic chronic painful conditions as osteoarthritis, rheumatoid arthritis, neck and shoulder pain in view of a clinical implementation of such information in terms of assessment and treatment.