Papers by Lorimer Moseley
Reading the Psychosomatic in Medical and Popular Culture (Ed. Carol Ann Farkas), 2017
“Narrative Coherence and Medical Explanations of Psychosomatic Pain” investigates the ways that p... more “Narrative Coherence and Medical Explanations of Psychosomatic Pain” investigates the ways that psychosomatic pain is explained in various editions of the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM), and how these explanations relate to those found in popular culture, including in Suzanne O’Sullivan’s book, It’s All in Your Head: True Stories of Imaginary Illness. Specifically, this chapter looks at the way that explanatory coherence in medicine sometimes is supported by narrative coherence, particularly through moments of closure. Connections are made between features of models of causation in medicine, on one hand, and features of narratives – actants, plot, teleology, closure – on the other. The chapter argues that actants in narratives function to bind representations of causal and moral
responsibility, which enhances narrative coherence and closure. Close readings of the related entries in various iterations of the DSM for psychosomatic pain and its variants reveal the tendency of these medical explanations to enhance explanatory coherency through the use of actant structures and narrative closure, which furthermore support the function of diagnosis, and thus the maintenance of medical authority. This is contrasted with the insights of contemporary
neurobiological, systems-based models of pain, and so the ethical and epistemological risks of privileging narrative closure as a means to explanatory coherence are highlighted.
Key Words: narratology, psychosomatic, pain, narrative theory, cognitive narratology
The Journal of Pain, 2015
Upper limb fracture is a common musculoskeletal injury that can lead to marked pain-related disab... more Upper limb fracture is a common musculoskeletal injury that can lead to marked pain-related disability. Unlike other common painful musculoskeletal conditions, such as low back pain, little consideration has been given to the role that psychological variables may play in explaining the relationship between pain and disability during early fracture recovery. This cross-sectional study aimed to determine if psychological distress (symptoms of depression, anxiety, and/or stress) mediate the relationship between pain and disability in acute hand/wrist fractures. Self-report data from a consecutive sample of 594 patients with acute hand/wrist fracture were used. Mediation analyses were conducted to determine the role of depression, anxiety, and stress in the relationship between pain and disability, controlling for relevant demographic and fracture related variables. Depression and stress, but not anxiety, significantly mediated the relationship between pain and disability. That is, while each psychological distress variable was associated with pain (P<0.001), only depression (b1=0.27, P=0.03) and stress (b3=0.23, P=0.02) were significantly associated with disability, and fulfilled recommended criteria for establishing a mediating variable. Elevated depression and stress, but not anxiety, explain the relationship between pain and disability and may be novel targets for interventions designed to reduce pain-related disability after upper limb fracture. This study presents the mediating effect of psychological distress on the relationship between pain and disability in acute upper limb fracture. These factors may be novel targets for interventions designed to reduce pain-related disability after acute fracture.
European journal of pain (London, England), 2014
Journal of physiotherapy, 2012
European journal of applied physiology, Jan 24, 2014
Movement restriction has been proposed as an important modulator of changes in sensory and percep... more Movement restriction has been proposed as an important modulator of changes in sensory and perceptual function and motor imagery performance that are observed in musculoskeletal pain syndromes. There are no empirical data to support this view. The primary objective of this experiment was to determine the effects of movement restriction on local and widespread sensory, perceptual and motor imagery changes after exercise-induced muscular pain. Further objectives were to investigate whether changes in sensory perception are correlated with pain intensity and tactile acuity or motor imagery performance. In forty healthy volunteers, delayed onset muscle soreness (DOMS) of the non-dominant elbow flexors was induced using eccentric contractions until exhaustion. Participants were then randomised into two groups: a movement restriction group (wearing a sling) or a control group (not wearing a sling). Sensory and perceptual functions were measured using a range of sensory tests and a motor i...
PAIN, 2015
Chronic pain is the most burdensome health issue facing the world today; its cost to Western coun... more Chronic pain is the most burdensome health issue facing the world today; its cost to Western countries is comparable with that of diabetes and cancer combined. Our understanding of the pathophysiology of chronic pain has increased substantially over the past 20 years, including but not limited to changes in the brain. However, we still do not know why chronic pain develops in some people and not in others, although we do know that the type or extent of their injury, personality, occupation, postcode, education level, race, or religion are not strong predictors. 6 Extensive research into the genetics of chronic pain has also thus far been underwhelming, perhaps because too many genes are involved and results are conflicting. 12 Chronic pain is very difficult to treat; 60% of those with chronic pain will still be in pain after 1 year. 7 It seems that despite extensive advances in multiple fields, we have made little ground. In this topical review, we put forward a new hypothesis of chronic pain that explains the most common painful disorders, such as chronic widespread pain, nonspecific back or neck pain, and fibromyalgia. Our hypothesis draws on a long history of fundamental research in associative learning and is based on 2 core assumptions (1) that pain can be considered a response, not just a stimulus, and (2) that encoding nonnociceptive information predictably coincident with nociceptive input underpins the response to subsequent similar events. Briefly, our hypothesis posits that the precision with which multisensory information (temporal, proprioceptive, spatial) about the painful event is encoded and represented in the brain will determine the degree to which the painful response will subsequently generalize to similar events.
Human Brain Mapping, 2014
It is widely accepted that complex regional pain syndrome (CRPS) is associated with shrinkage of ... more It is widely accepted that complex regional pain syndrome (CRPS) is associated with shrinkage of the primary somatosensory cortex (S1) representation of the affected limb. However, supporting evidence is surprisingly limited and may be compromised by high risk of bias. This study compared the S1 spatial representation of the hand in 17 patients with upper-limb CRPS to 16 healthy controls, using functional MRI. Innocuous vibration was delivered to digits one (D1) and five (D5) in a blockdesign. Resultant activation maxima were located within a bilateral S1 mask, determined a priori. Distance between D1 and D5 activation maxima, calculated for both hands, was used as a measure of S1 representation. Analyses were blinded to group and hand. In patients, S1 representation was smaller for the affected hand than it was for the healthy hand (t(11) 5 2.02, P 5 0.03), as predicted. However, S1 representation of the affected hand was no different to that of either hand in controls. Critically, S1 representation of the healthy hand of patients was larger than that of controls' hands. CRPS seems to be associated with an enlarged representation of the healthy hand, not a smaller representation of the affected hand. These findings raise important questions about neuroplasticity in CRPS. Hum Brain Mapp 00:000-000, 2014.
Rheumatology, 2013
Objective. Chronic pain from rheumatic and musculoskeletal conditions is associated with cortical... more Objective. Chronic pain from rheumatic and musculoskeletal conditions is associated with cortical changes and altered tactile acuity. Tactile acuity is considered a clinical signature of primary somatosensory representation. The two-point discrimination (TPD) threshold is increasingly used both clinically and in research. Remarkably, the reliability and precision of the measure at commonly used sites has not been determined. This study aimed to determine the utility, intra-and inter-rater reliability, bias and variability of TPD threshold assessment at the neck, back, hand and foot using mechanical callipers.
Plos One, 2014
The suggestion has recently been made that certain higher-order cortical areas involved in suppor... more The suggestion has recently been made that certain higher-order cortical areas involved in supporting multisensory representations of the body, and of the space around it, might also play a role in controlling thermoregulatory functions. Here we demonstrate that temporary interference with the function of one of these areas, the posterior parietal cortex, by repetitive transcranial magnetic stimulation, results in a decrease in limb temperature. By contrast, interference with the activity of a sensory-specific area (the primary somatosensory cortex) had no effect on temperature. The results of this experiment suggest that associative multisensory brain areas might exert a top-down modulation over basic physiological control. Such a function might be part of a larger neural circuit responsible for maintaining the integrity of the body at both a homeostatic and a psychological level.
PLoS ONE, 2012
Background: Many double-blind clinical trials of transcranial direct current stimulation (tDCS) u... more Background: Many double-blind clinical trials of transcranial direct current stimulation (tDCS) use stimulus intensities of 2 mA despite the fact that blinding has not been formally validated under these conditions. The aim of this study was to test the assumption that sham 2 mA tDCS achieves effective blinding.
PLoS ONE, 2012
The sense of body ownership can be easily disrupted during illusions and the most common illusion... more The sense of body ownership can be easily disrupted during illusions and the most common illusion is the rubber hand illusion. An idea that is rapidly gaining popularity in clinical pain medicine is that body ownership illusions can be used to modify pathological pain sensations and induce analgesia. However, this idea has not been empirically evaluated. Two separate research laboratories undertook independent randomized repeated measures experiments, both designed to detect an effect of the rubber hand illusion on experimentally induced hand pain. In Experiment 1, 16 healthy volunteers rated the pain evoked by noxious heat stimuli (5 s duration; interstimulus interval 25 s) of set temperatures (47u, 48u and 49uC) during the rubber hand illusion or during a control condition. There was a main effect of stimulus temperature on pain ratings, but no main effect of condition (p = 0.32), nor a condition x temperature interaction (p = 0.31). In Experiment 2, 20 healthy volunteers underwent quantitative sensory testing to determine heat and cold pain thresholds during the rubber hand illusion or during a control condition. Secondary analyses involved heat and cold detection thresholds and paradoxical heat sensations. Again, there was no main effect of condition on heat pain threshold (p = 0.17), nor on cold pain threshold (p = 0.65), nor on any of the secondary measures (p,0.56 for all). We conclude that the rubber hand illusion does not induce analgesia.
Sports Medicine, 2014
Tendon pain remains an enigma. Many clinical features are consistent with tissue disruption-the p... more Tendon pain remains an enigma. Many clinical features are consistent with tissue disruption-the pain is localised, persistent and specifically associated with tendon loading, whereas others are not-investigations do not always match symptoms and painless tendons can be catastrophically degenerated. As such, the question 'what causes a tendon to be painful?' remains unanswered. Without a proper understanding of the mechanism behind tendon pain, it is no surprise that treatments are often ineffective. Tendon pain certainly serves to protect the area-this is a defining characteristic of pain-and there is often a plausible nociceptive contributor. However, the problem of tendon pain is that the relation between pain and evidence of tissue disruption is variable. The investigation into mechanisms for tendon pain should extend beyond local tissue changes and include peripheral and central mechanisms of nociception modulation. This review integrates recent discoveries in diverse fields such as histology, physiology and neuroscience with clinical insight to present a current state of the art in tendon pain. New hypotheses for this condition are proposed, which focus on the potential role of tenocytes, mechanosensitive and chemosensitive receptors, the role of ion channels in nociception and pain and central mechanisms associated with load and threat monitoring.
PLoS ONE, 2014
Objectives: It has been proposed that in the same way that conflict between vestibular and visual... more Objectives: It has been proposed that in the same way that conflict between vestibular and visual inputs leads to motion sickness, conflict between motor commands and sensory information associated with these commands may contribute to some chronic pain states. Attempts to test this hypothesis by artificially inducing a state of sensorimotor incongruence and assessing self-reported pain have yielded equivocal results. To help clarify the effect sensorimotor incongruence has on pain we investigated the effect of moving in an environment of induced incongruence on pressure pain thresholds (PPT) and the pain experienced immediately on completion of PPT testing.
PAIN®, 2013
In unilateral upper-limb complex regional pain syndrome (CRPS), the temperature of the hands is m... more In unilateral upper-limb complex regional pain syndrome (CRPS), the temperature of the hands is modulated by where the arms are located relative to the body midline. We hypothesized that this effect depends on the perceived location of the hands, not on their actual location, nor on their anatomical alignment. In 2 separate cross-sectional randomized experiments, 10 (6 female) unilateral CRPS patients wore prism glasses that laterally shifted the visual field by 20°. Skin temperature was measured before and after 9-minute periods in which the position of one hand was changed. Placing the affected hand on the healthy side of the body midline increased its temperature (Δ°C=+0.47 ± 0.14°C), but not if prism glasses made the hand appear to be on the body midline (Δ°C=+0.07 ± 0.06°C). Similarly, when prism glasses made the affected hand appear to be on the healthy side of the body midline, even though it was not, the affected hand warmed up (Δ°C=+0.28 ± 0.14°C). When prism glasses made the healthy hand appear to be on the affected side of the body midline, even though it was not, the healthy hand cooled down (Δ°C=-0.30 ± 0.15°C). Friedman's analysis of variance and Wilcoxon pairs tests upheld the results (P<0.01 for all). We conclude that, in CRPS, cortical mechanisms responsible for encoding the perceived location of the limbs in space modulate the temperature of the hands.
PAIN, 2013
People with chronic pain commonly report impaired cognitive function. However, to date, there has... more People with chronic pain commonly report impaired cognitive function. However, to date, there has been no systematic evaluation of the body of literature concerning cognitive impairment and pain. Nor have modern meta-analytical methods been used to verify and clarify the extent to which cognition may be impaired. The objective of this study was to systematically evaluate and critically appraise the literature concerning working memory function in people with chronic pain. The study was conducted along Cochrane collaboration and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. A sensitive search strategy was designed and conducted with the help of an expert librarian using 6 databases. Twenty-four observational studies evaluating behavioural and/or physiological outcomes in a chronic pain group and a control group met the inclusion criteria. All studies had a high risk of bias, owing primarily to lack of assessor blinding to outcome. High heterogeneity within the field was found with the inclusion of 24 papers using 21 different working memory tests encompassing 9 different working memory constructs and 9 different chronic pain populations. Notwithstanding high heterogeneity, pooled results from behavioural outcomes reflected a consistent, significant moderate effect in favour of better performance by healthy controls and, with the exception of one study, pooled results from physiological outcomes reflected no evidence for an effect. Future research would benefit from the use of clearly defined constructs of working memory, as well as standardised methods of testing.
Mediators of Inflammation, 2013
Cytokine concentrations are thought to be affected by methods of sampling and processing and by s... more Cytokine concentrations are thought to be affected by methods of sampling and processing and by storage conditions. In this study we compared 17 cytokine concentrations obtained from plasma and serum at baseline and after a controlled thaw condition. We found that absolute agreement was poor between concentrations of cytokines in plasma and serum, except for MIP1 . A thaw condition significantly changed the concentrations of most cytokines, but serum appeared less affected by this than plasma was. Closer examination using Bland-Altman analyses revealed that for each comparison, agreement was moderately good for many cytokine concentrations. This is important because measures of agreement must be interpreted based on the required precision, which may differ between clinical and research demands. We also identified that for some cytokines, the relationship between serum and plasma is affected by concentration, thus advocating for the use of appropriate methods when performing such comparisons in studies such as systematic reviews and meta-analyses.
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Papers by Lorimer Moseley
responsibility, which enhances narrative coherence and closure. Close readings of the related entries in various iterations of the DSM for psychosomatic pain and its variants reveal the tendency of these medical explanations to enhance explanatory coherency through the use of actant structures and narrative closure, which furthermore support the function of diagnosis, and thus the maintenance of medical authority. This is contrasted with the insights of contemporary
neurobiological, systems-based models of pain, and so the ethical and epistemological risks of privileging narrative closure as a means to explanatory coherence are highlighted.
Key Words: narratology, psychosomatic, pain, narrative theory, cognitive narratology
responsibility, which enhances narrative coherence and closure. Close readings of the related entries in various iterations of the DSM for psychosomatic pain and its variants reveal the tendency of these medical explanations to enhance explanatory coherency through the use of actant structures and narrative closure, which furthermore support the function of diagnosis, and thus the maintenance of medical authority. This is contrasted with the insights of contemporary
neurobiological, systems-based models of pain, and so the ethical and epistemological risks of privileging narrative closure as a means to explanatory coherence are highlighted.
Key Words: narratology, psychosomatic, pain, narrative theory, cognitive narratology