Bilateral motor cortex disinhibition in complex regional pain syndrome (CRPS) type I of the hand

Schwenkreis, Peter; Janssen, Frank; Rommel, O.; Pleger, Burkhard; Völker, Birgit; Hosbach, Ingolf; Dertwinkel, Roman; Maier, Christoph; Tegenthoff, Martin

doi:10.1212/wnl.61.4.515

Cited by 253 publications

(174 citation statements)

References 49 publications

Supporting

Mentioning

148

Contrasting

Unclassified

Order By: Relevance

“…The analgesic effect of M1 tDCS could be related to the mechanisms of chronic pain in patients with SCI, such as central sensitization and deficient inhibitory process, as observed in previous tDCS studies focusing on pain management [33][34][35]. In a previous longitudinal study, the majority of SCI patients reporting chronic pain had their pain onset within six weeks post-injury and 80% of them stated that their pain started on the day of the injury [36].…”

Section: Tdcs To Prevent the Mechanisms Of Chronic Painmentioning

confidence: 71%

Delayed pain decrease following M1 tDCS in spinal cord injury: A randomized controlled clinical trial

Thibaut

Carvalho

Morse

et al. 2017

Neuroscience Letters

View full text Add to dashboard Cite

Section: Tdcs To Prevent the Mechanisms Of Chronic Painmentioning

confidence: 71%

Delayed pain decrease following M1 tDCS in spinal cord injury: A randomized controlled clinical trial

Thibaut

Carvalho

Morse

et al. 2017

Neuroscience Letters

View full text Add to dashboard Cite

“…42 In addition, intra-cortical inhibition has been found to be decreased in the motor cortex contralateral to the affected limb or bilaterally. 38,40 Interestingly, in one study this reduction in intra-cortical inhibition of the motor cortex contralateral to the affected limb was linked with pain severity. 38 Consistent with this decreased inhibition, an fMRI study showed greater activation within the motor cortex (among other regions) during a fingertapping task performed with the affected hand relative to activations for the unaffected hand or activations seen in healthy controls.…”

Section: Complex Regional Pain Syndrome and Motor Reorganizationmentioning

confidence: 99%

“…38,40 Interestingly, in one study this reduction in intra-cortical inhibition of the motor cortex contralateral to the affected limb was linked with pain severity. 38 Consistent with this decreased inhibition, an fMRI study showed greater activation within the motor cortex (among other regions) during a fingertapping task performed with the affected hand relative to activations for the unaffected hand or activations seen in healthy controls. 62 Moreover, the degree of activation within the motor cortex was correlated with the amount of motor impairment evaluated during reach-to-grasp movements.…”

Section: Complex Regional Pain Syndrome and Motor Reorganizationmentioning

confidence: 99%

Interactions between Pain and the Motor Cortex: Insights from Research on Phantom Limb Pain and Complex Regional Pain Syndrome

Mercier

Léonard²

2011

Physiotherapy Canada

View full text Add to dashboard Cite

Purpose: Pain is a significantly disabling problem that often interacts with other deficits during the rehabilitation process. The aim of this paper is to review evidence of interactions between pain and the motor cortex in order to attempt to answer the following questions: (1) Does acute pain interfere with motorcortex activity? (2) Does chronic pain interfere with motor-cortex activity, and, conversely, does motor-cortex plasticity contribute to chronic pain? (3) Can the induction of motor plasticity by means of motor-cortex stimulation decrease pain? (4) Can motor training result in both motor-cortex reorganization and pain relief? Summary of Key Points: Acute experimental pain has been clearly shown to exert an inhibitory influence over the motor cortex, which can interfere with motor learning capacities. Current evidence also suggests a relationship between chronic pain and motor-cortex reorganization, but it is still unclear whether one causes the other. However, there is growing evidence that interventions aimed at normalizing motor-cortex organization can lead to pain relief. Conclusions: Interactions between pain and the motor cortex are complex, and more studies are needed to understand these interactions in our patients, as well as to develop optimal rehabilitative strategies.Key Words: motor control, motor cortex, pain, plasticity, rehabilitation RÉ SUMÉObjectif : La douleur est considé rablement invalidante et pré sente souvent des interactions avec d'autres dé ficits au cours du processus de ré adaptation. L'objectif de cet article est d'analyser donné e supportant la pré sence d'interactions entre la douleur et le cortex moteur afin de tenter de ré pondre aux questions suivantes : (1) La douleur aiguë nuit-elle à l'activité du cortex moteur? (2) La douleur chronique altè re-t-elle l'activité du cortex moteur et, ré ciproquement, la ré organisation du cortex moteur contribue-t-elle à la douleur chronique? (3) L'induction de la plasticité motrice par stimulation du cortex moteur peut-elle ré duire la douleur? (4) L'entraînement moteur peut-il amener à la fois une ré organisation du cortex moteur et un soulagement de la douleur? Ré sumé des principaux points : Il a é té clairement dé montré que la douleur aiguë expé rimentale exerce une influence inhibitoire sur le cortex moteur, qui peut entraver les capacité s d'apprentissage moteur. Les donné e actuelles suggè rent é galement qu'il existe une relation entre la douleur chronique et la ré organisation du cortex moteur, mais il n'est pas clair que l'un provoque l'autre. Il existe toutefois des preuves de plus en plus nombreuses que les interventions visant à normaliser l'organisation du cortex peuvent amener un soulagement de la douleur. Conclusions : Les interactions entre la douleur et le cortex moteur sont complexes et d'autres é tudes sont né cessaires pour comprendre ces interactions chez nos patients et pour concevoir des straté gies de ré adaptation optimales.

show abstract

“…What's more, previous data suggest that pain would inhibit, rather than enhance, motor cortex excitability (Farina et al, 2001;Le Pera et al, 2001). A recent TMS study reported motor cortex disinhibition in patients with complex regional pain syndrome of the hand (Schwenkreis et al, 2003), a clinical condition which represent a model of chronic pain related to neurogenic inflammation. These Authors reported bilateral reduction of ICI, while unilateral hyperexcitability to paired-TMS was found in our group of patients.…”

Section: Mechanisms Of Motor Cortex Hyperexcitabilitymentioning

confidence: 99%

Modulation of motor cortex excitability after upper limb immobilization

Zanette

Manganotti

Fiaschi

et al. 2004

Clinical Neurophysiology

102

View full text Add to dashboard Cite

Objective: To examine the mechanisms of disuse-induced plasticity following long-term limb immobilization. Methods: We studied 9 subjects, who underwent left upper limb immobilization for unilateral wrist fractures. All subjects were examined immediately after splint removal. Cortical motor maps, resting motor threshold (RMT), motor evoked potential (MEP) latency and MEP recruitment curves were studied from abductor pollicis brevis (APB) and flexor carpi radialis (FCR) muscles with single pulse transcranial magnetic stimulation (TMS). Paired pulse TMS was used to study intracortical inhibition and facilitation. Compound muscle action potentials (CMAPs) and F waves were obtained after median nerve stimulation. In 4/9 subjects the recording was repeated after 35 -41 days.Results: CMAP amplitude and RMT were reduced in APB muscle on the immobilized sides in comparison to the non-immobilized sides and controls after splint removal. CMAP amplitude and RMT were unchanged in FCR muscle. MEP latency and F waves were unchanged. MEP recruitment was significantly greater on the immobilized side at rest, but the asymmetry disappeared during voluntary muscle contraction. Paired pulse TMS showed an imbalance between inhibitory and excitatory networks, with a prevalence of excitation on the immobilized sides. A slight, non-significant change in the strength of corticospinal projections to the non-immobilized sides was found. TMS parameters were not correlated with hand dexterity. These abnormalities were largely normalized at the time of retesting in the four patients who were followed-up.Conclusions: Hyperexcitability occurs within the representation of single muscles, associated with changes in RMT and with an imbalance between intracortical inhibition and facilitation. These findings may be related to changes in the sensory input from the immobilized upper limb and/or in the discharge properties of the motor units.Significance: Different mechanisms may contribute to the reversible neuroplastic changes, which occur in response to long-term immobilization of the upper-limbs.

show abstract

Bilateral motor cortex disinhibition in complex regional pain syndrome (CRPS) type I of the hand

Cited by 253 publications

References 49 publications

Delayed pain decrease following M1 tDCS in spinal cord injury: A randomized controlled clinical trial

Delayed pain decrease following M1 tDCS in spinal cord injury: A randomized controlled clinical trial

Interactions between Pain and the Motor Cortex: Insights from Research on Phantom Limb Pain and Complex Regional Pain Syndrome

Modulation of motor cortex excitability after upper limb immobilization

Contact Info

Product

Resources

About