The cortical model of pain and movement Musicians and Whiplash Associated Disorders as model.

摘要

Pain without an obvious causal etiology is a complex and puzzling problem. Sensorimotor incongruence has been suggested as one cause of pain in those conditions where nociceptive etiology cannot be convincingly established. The primary aim of this dissertation was to investigate the role of sensorimotor incongruence on pain and other sensations, previously described as the cortical model of pain. Secondly, it was aimed at evaluating whether sensorimotor integration and pain processing mechanisms, which are proposed to be two components of one integrated system orchestrated by the brain, are associated.;The first part reports the effect of a provoked sensorimotor incongruence on sensations in violinists suffering from symptoms without a clear nociceptive etiology. Violinists with baseline symptoms reported significant more sensations compared to those without symptoms. These findings suggest that sensorimotor incongruence may play a role in the generation/maintenance of symptoms in violinists. However, the findings do not support the hypothesis that sensorimotor incongruence causes pain.;The second part focuses on the effect of an induced sensorimotor incongruence on pain and other sensations in whiplash associated disorders (WAD). An experimental study investigating the effect of visual mediated changes between sensory feedback and motor output on sensations in acute and chronic WAD showed that reducing/disturbing the visual input was sufficient to exacerbate symptoms and/or elicit additional sensations in WAD. These findings suggest altered perception of distorted visual feedback and altered sensorimotor nervous processing in WAD.;The evidence for central sensitization in acute and chronic WAD was supported by the findings of an experimental study examining endogenous pain modulation. Dysfunctional pain modulation was observed in acute and chronic WAD. However, no association between pain modulation and perception of distorted visual feedback was found in WAD, suggesting that both underlie distinctive mechanisms.;In conclusion, the results of this dissertation demonstrated that sensorimotor incongruence can cause sensations in violinists, and particularly in those with unexplained symptoms. Further, the involvement of central mechanisms in WAD is further supported by the findings of altered perception of distorted visual feedback and dysfunctional pain modulation in acute and chronic WAD. Surprisingly, no relationship was found between perception of distorted visual feedback and endogenous pain modulation in WAD, suggesting that both underlie distinctive mechanisms.