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Effects of a Hardness Discrimination Task in Failed Back Surgery Syndrome with Severe Low Back Pain and Disturbed Body Image: Case study
| Tomohiko Nishigami1,2*, Hiroyuki Okuno3, Hideki Nakano4, Yutaka Omura3, Michihiro Osumi3,4, Shimizu Michele Eisemann1, Motohiro tsujishita1, Akira Mibu5and Takahiro Ushida2 | |
| 1Department of Physical Therapy, Konan Woman’s University, Japan | |
| 2Multidisciplinary Pain Center, Aichi Medical University, Japan | |
| 3Neurocognitive Center, Setsunan General Hospital, Japan | |
| 4Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, Japan | |
| 5Rehablitation Center, Tanabe Orthopaedics, Japan | |
| Corresponding Author : | Tomohiko Nishigami Department of Physical Therapy Konan Woman’s University; 6-2-23 Morikita-machi, Higashinada-ku Kobe, 658-0001, Japan Tel: +81 78 413 3648 Fax: +81 78 413 3742 E-mail: t-nishi@konan-wu.ac.jp |
| Received September 04, 2012; Accepted September 27, 2012; Published September 30, 2012 | |
| Citation: Nishigami T, Okuno H, Nakano H, Omura Y, Osumi M, et al. (2012) Effects of a Hardness Discrimination Task in Failed Back Surgery Syndrome with Severe Low Back Pain and Disturbed Body Image: Case study. J Nov Physiother S1:008. doi: 10.4172/2165-7025.S1-008 | |
| Copyright: © 2012 Nishigami T, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. | |
Abstract
A 20-year-old woman began experiencing low back pain (LBP) in September 2008 and dysesthesia, pain in the left leg, muscle weakness, and gait disturbance in January 2009. Three low back surgery were performed in April, May and July 2009, respectively. However, her symptoms were relieved for only a few days, eventually re-emerging and intensifying. On our initial examination, on physical contact, a sharp increase in pain was experienced in the left lower back (numerical rating scale: NRS = 10). Loss of body image in the left lower back with severe pain was presented. Lying in the supine position, independent upright sitting, and trunk flexion to the left beyond a certain point were impossible. Motor imagery and tactile discrimination training were performed. However the training was not effective. Next, the patient was asked to determine the various degrees of hardness of the sponge material that was placed on the left lower back of another person; she was simultaneously instructed to imagine it being placed on her own left lower back. Hardness discrimination training was performed for 20 min a day, 6 days a week for 4 weeks. EEG was performed to determine the cortical activation in the somatosensory cortex during motor imagery and the hardness discrimination task. Four weeks after hardness discrimination training, on contact with the left lower back, left LBP decreased from 10/10 to 5/10 on the subjective NRS. In addition, perception of body image in the left lower back improved. Lying in the supine position, independent upright sitting, and trunk flexion to the left became possible. Neural activity was observed in the right somatosensory cortex in the hardness discrimination task compared with the control task. These results raised the possibility that hardness discrimination training decreased pain through reorganization of the somatosensory cortex.
