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Clinical Intervention Using Body Shadows for a Patient with Complex Regional Pain Syndrome Who Reported Severe Pain and Self-Disgust Toward the Affected Site: A Case Report

Authors Hirakawa Y, Fujiwara A, Imai R, Hiraga Y, Morioka S

Received 31 October 2019

Accepted for publication 10 April 2020

Published 6 May 2020 Volume 2020:13 Pages 971—977

DOI https://doi.org/10.2147/JPR.S236786

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Robert B. Raffa


Yoshiyuki Hirakawa,1 Akira Fujiwara,2 Ryota Imai,3,4 Yuki Hiraga,1,5 Shu Morioka4,6

1Department of Rehabilitation, Fukuoka Rehabilitation Hospital, Fukuoka City, Fukuoka, Japan; 2Department of Orthopedics, Fukuoka Reha Orthopedic Clinic, Fukuoka City, Fukuoka, Japan; 3School of Rehabilitation, Osaka Kawasaki Rehabilitation University, Kaizuka City, Osaka, Japan; 4Department of Occupational Therapy, International Univesrity of Health and Welfare, Okawa,Fukuoka, Japan; 5Neurorehabilitation Research Centre, Kio University, Nara, City, Nara, Japan; 6Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, Nara City, Nara, Japan

Correspondence: Yoshiyuki Hirakawa
Department of Rehabilitation, Fukuoka Rehabilitation Hospital, 7-770 Nokata, Nishi-ku, Fukuoka City 819-8551, Fukuoka, Japan
Tel +81 92 812-1555
Fax +81 92 811-0330
Email yutsuki0903@yahoo.co.jp

Abstract: A woman in her thirties developed complex regional pain syndrome in her left shoulder due to a traffic accident. She demonstrated autonomic nervous symptoms (swelling, sweating, and skin color asymmetry) in her left hand, severe allodynia, neglect-like symptoms (NLS), impaired body image associated with impaired body awareness, and functional impairment of the left shoulder and elbow. She also reported physical self-disgust toward her affected limb, describing it as “reptilian,” as well as aversion to touching others; this body awareness exacerbated her pain and NLS. We therefore conducted stepwise interventions using body shadows. The intervention did not trigger physical self-disgust, enabling formation of body ownership and a body image unaccompanied by pain. Consequently, the patient showed improvements in pain, NLS, and autonomic nervous symptoms.

Keywords: pain, neglect-like symptoms, physical self-disgust, body shadow intervention, body image

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