Ignoring space around a painful limb? No evidence for a body-related visuospatial attention bias in complex regional pain syndrome

Antonia F. Ten Brink, Monika Halicka, Axel D. Vittersø, Edmund Keogh, Janet H. Bultitude

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Background: Complex Regional Pain Syndrome (CRPS) is a disorder of severe chronic pain in one or more limb(s). People with CRPS report unusual perceptions of the painful limb suggesting altered body representations, as well as difficulty attending to their affected limb (i.e., a ‘neglect-like’ attention bias). Altered body representations and attention in CRPS might be related, however, existing evidence is unclear. We hypothesized that if there were a body-related visuospatial attention bias in CRPS, then any attention bias away from the affected side should be larger for or limited to circumstances when the (impaired) body representation is involved in the task versus when this is not the case. Methods: We included 40 people with CRPS, 40 with other limb pain conditions, and 40 pain-free controls. In half of the people with pain, their upper limb was affected, in the other half their lower limb. We administered computerized tasks of spatial attention, including free viewing of images, shape cancellation, temporal order judgement, and dot-probe. The degree to which different versions of each task involved body representation was manipulated by one or more of the following: (1) presenting stimuli nearer versus further away from the body, (2) using body related versus neutral stimuli, and (3) inducing mental rotation of body parts versus no mental rotation. In addition to perceptual judgements, eye movements were recorded as a sensitive index of spatial attention. Bayesian repeated measures analyses were performed. Results: We found no evidence for a (body-related) visuospatial attention bias in upper limb CRPS. Secondary analyses suggested the presence of a body-related visuospatial attention bias away from the affected side in some participants with lower limb CRPS. Discussion: Our results add to growing evidence that there might be no general visuospatial attention bias away from the affected side in CRPS.

Original languageEnglish
Pages (from-to)89-108
Number of pages20
Early online date24 Dec 2020
Publication statusPublished - 31 Mar 2021

Bibliographical note

Funding Information:
Antonia Ten Brink was supported by a Rubicon grant ( 019.173SG.019 ) from the Netherlands Organisation for Scientific Research . Axel Davies Vittersø received funding from the GW4 BioMed Medical Research Council Doctoral Training Partnership ( 1793344 ). The funders had no role in study design; collection, analysis and interpretation of data; writing the report; and the decision to submit the article for publication.

Publisher Copyright:
© 2021 The Authors

Copyright 2021 Elsevier B.V., All rights reserved.


  • Body representation
  • Chronic pain
  • Complex regional pain syndrome
  • Eye-tracking
  • Spatial attention

ASJC Scopus subject areas

  • Neuropsychology and Physiological Psychology
  • Experimental and Cognitive Psychology
  • Cognitive Neuroscience


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