ORCID Profile
0000-0001-8715-654X
Current Organisations
University of Leeds
,
University of Cambridge
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Publisher: Society for Neuroscience
Date: 30-09-2019
DOI: 10.1523/JNEUROSCI.2005-18.2019
Abstract: It has long been thought that severe chronic pain conditions, such as complex regional pain syndrome (CRPS), are not only associated with, but even maintained by a reorganization of the somatotopic representation of the affected limb in primary somatosensory cortex (S1). This notion has driven treatments that aim to restore S1 representations in CRPS patients, such as sensory discrimination training and mirror therapy. However, this notion is based on both indirect and incomplete evidence obtained with imaging methods with low spatial resolution. Here, we used fMRI to characterize the S1 representation of the affected and unaffected hand in humans (of either sex) with unilateral CRPS. The cortical area, location, and geometry of the S1 representation of the CRPS hand were largely comparable with those of both the unaffected hand and healthy controls. We found no differential relation between affected versus unaffected hand map measures and clinical measures (pain severity, upper limb disability, disease duration). Thus, if any map reorganization occurs, it does not appear to be directly related to pain and disease severity. These findings compel us to reconsider the cortical mechanisms underlying CRPS and the rationale for interventions that aim to “restore” somatotopic representations to treat pain. SIGNIFICANCE STATEMENT This study shows that the spatial map of the fingers in somatosensory cortex is largely preserved in chronic complex regional pain syndrome (CRPS). These findings challenge the treatment rationale for restoring somatotopic representations in complex regional pain syndrome patients.
Publisher: Wiley
Date: 09-02-2022
DOI: 10.1111/SPOL.12803
Abstract: Local state and third sector actors routinely provide support to help people navigate their right to social security and mediate their chequered relationship to it. COVID‐19 has not only underlined the significance of these actors in the claims‐making process, but also just how vulnerable those working within ‘local ecosystems of support’ are to external shocks and their own internal pressures. Drawing on qualitative fieldwork with organisations providing support to benefit claimants and those financially struggling during COVID‐19, this paper examines the increasingly situated nature of the claims‐making process across four local areas in the United Kingdom. We do so to consider what bearing ‘local ecosystems of support’ have on income adequacy, access and universality across social security systems. Our analysis demonstrates how local state and third sector actors risk lifying inequalities that at best disadvantage, and at worst altogether exclude, particular social groups from adequate (financial) assistance. Rather than conceiving of social security as a unitary collection of social transfers, we argue that its operation needs to be understood as much more fragmented and contingent. Practitioners exhibit considerable professional autonomy and moral agency in their discretionary practice, arbitrating between competing organisational priorities, local disinvestment, and changing community needs. Our findings offer broader lessons for understanding the contemporary governance of social security across welfare states seeking to responsibilise low‐income households through the modernisation of public services, localism, and welfare reforms.
Publisher: Wiley
Date: 22-10-2015
DOI: 10.1002/EJP.801
Abstract: The spatial precision of expectancy effects on pain is unclear. We hypothesized that expecting nociceptive stimuli at particular skin sites would have an analgesic effect on nociceptive stimuli presented between them (middle zone). Laser stimuli (evoking pin-prick pain) were delivered to three discrete skin zones on the forearm, under two conditions. During 'Localization', participants' expectation of stimuli was spatially ided between two locations (expected stimuli in only the outer two skin zones): pain intensity and stimulus location were judged. During 'No-localization' (control condition), participants had no expectation concerning stimulus location only pain intensity was rated. Additional experiments assessed the importance of the actual location on the forearm by: shifting all skin zones proximally towards the elbow (control for joint proximity, Experiment 2) adding a fourth zone distally (control for interaction between joint proximity and enhanced distal inhibition, Experiment 3). All experiments demonstrated spatially specific pain modulation, but only Experiment 2 (near elbow) supported our hypothesis: middle zone pain intensity was significantly lower (p = 0.02) during Localization than No-localization. Experiment 1 (near wrist) found reduced pain intensity during Localization only for the distal zone (p = 0.04). Experiment 3 confirmed this effect: reduced pain during Localization occurred only for the most distal zone (p = 0.046). Expecting a painful stimulus in non-adjacent skin sites has spatially specific effects on pain modulation, but this reflects an interaction between the expected location of stimulation and the actual location. This suggests a more complex connection between somatotopic maps and nociceptive modulation than previously thought several distinct mechanisms likely contribute.
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Daniel Edmiston.