Tactile acuity at the back and motor control of the trunk are decreased in people with
back pain
Lorimer MoseleyNHMRC Senior Research FellowPrince of Wales Medical Research Institute & School of Medical Sciences, University of New South Wales, Sydney, Australia
Team leaderThe GAMFI projectUniversity of Oxford, UK
© GL Moseley http://www.bodyinmind.com.au
TPDver(cal
TPDhorizontal
© GL Moseley www.BodyInMind.com.au
TPD=twopointdiscrimina(onthreshold–ameasureoftac(leacuity.
Luomajoki&Moseley2009BrJSportMed
Luomajoki&Moseley2009BrJSportMed© GL Moseley
www.BodyInMind.com.au
Thisshowsthattac(leacuityislessinpeoplewithbackpainthanitisinthosewithout.
Thisshowsvoluntarylumbopelviccontrolisworseinpeoplewithbackpainthaninthosewithout.
© GL Moseley www.BodyInMind.com.au
Thisshowsvoluntarylumbopelviccontrolandtac(leacuityarerelated.
Luomajoki&Moseley2009BrJSportMed
Canwetraintac(leacuity?
© GL Moseley www.BodyInMind.com.au
1 2 34
5
Probes
Stimulation sites
A. Stimulation
2 mm 11 mm
B. Condition
Photograph of affected part, with stimulation sites marked.
Affected part ATTENTION
5
1 2 345 1 2 345
1 2 345Screen
NO ATTENTION
Moseley,Zalucki&Wiech(2008)Pain137,3600‐8© GL Moseley
www.BodyInMind.com.au
Inonecondi(on,wejusttouchedtheaffectedhandatthesepointswhilethepa(entreadabook.Intheothercondi(on,wedididen(caltouchesbutnowtheyhadtodiscriminatebetweenthem–whichpointandwhichprobe.
0
5
10
Wait No attention
Attention Review
Task-specificNRS
0
4
8Pain NRS
30
60
TPDmm
ATTENTION
5
1 2 3451 2 345
1 2 345Screen
NO ATTENTION
© GL Moseley www.BodyInMind.com.au
Thisshowsthatwhiletherewasnoeffectofthes(mula(onalone,therewassignificantimprovementinpain,tac(leacuityandfunc(on.Improvementsweremaintainedat3monthfollow‐up.
Moseley,Zalucki&Wiech(2008)Pain137,3600‐8
0
3
6
-0.5 0 1 2
Change in pain NRS
Change in TPD
12
34
513
6
10
712
8 11
9
r2 = 0.34P = 0.04
123
4
513
6
10
7
12
8
11
9
0
3
-0.5 0 1
Change in pain NRS
ATTENTION
Change in TPD
NO ATTENTION
© GL Moseley www.BodyInMind.com.au
Thisshowsthatduringdiscrimina(on,thechangeintac(leacuityandthechangeinpainwererelated.
Moseley,Zalucki&Wiech(2008)Pain137,3600‐8
Can we use vision and gaze direction to make it better?
Taylor-Clarke et al (2002) Curr Biol 12, 233-6
These (and other) studies show that if you can see skin and look in the direction of a stimulus, our tactile acuity is better and sensory cortex response is bigger. © GL Moseley
www.BodyInMind.com.au
Inthisexperimentweusedthesamemethodastheclinicaltrial(condi(onE)andthenacondi(onthatalsocapturedvisualinputofskin(C),acondi(onthatcapturedgazedirec(onbutnotvisualinputofskin(D)andacondi(onthatcapturedboth(B).Eachsessioninvolved72s(mulirandomlytofivepointswitheitherafatoraskinnyprobe(A).
© GL Moseley www.BodyInMind.com.au
Moseley,Zalucki&Wiech(2008)Pain137,3600‐8
© GL Moseley www.BodyInMind.com.au
Thisshowsthat,a]erasingle30minutediscrimina(ontrainingsession,theincreaseintac(leacuitywasgreatestinthecondi(onthatcapturedbothvisualinputofskinandgazedirec(on.
Thisshowsthattherewasalsoasignificantdecreaseinpain.
Moseley,Zalucki&Wiech(2008)Pain137,3600‐8
Weshouldusevision&spa(ala^en(ontoenhanceTPDtraining
InCRPS,TPDtrainingcanreducepain
Doesthesameapplyfortheback?Howdoweusevisionthere?
© GL Moseley www.BodyInMind.com.au