Complex regional pain syndrome: The matter of white matter?

Hotta, Jaakko; Zhou, Guangyu; Harno, Hanna; Forss, Nina; Hari, Riitta

doi:10.1002/brb3.647

Cited by 18 publications

(15 citation statements)

References 45 publications

(53 reference statements)

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“…The patients were recruited mainly from the Pain Clinic of the Helsinki University Hospital and from two other Hospitals at the Uusimaa district as part of a larger CRPS study which included MRI and video experiments [16][17][18][19]. Inclusion criteria were age from 18 to 65, CRPS type 1 (Budapest criteria [1]) in the upper limb for at least 6 months, and during the past week the maximum intensity of pain more than four on a 11-point numeric rating scale (NRS 0-10, 0 = no pain, 10 = extreme pain).…”

Section: Patientsmentioning

confidence: 99%

Symptom reduction and improved function in chronic CRPS type 1 after 12-week integrated, interdisciplinary therapy

Elomaa

Hotta

Williams

et al. 2019

Scandinavian Journal of Pain

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Abstract Background and aims Complex Regional Pain Syndrome (CRPS) often recovers spontaneously within the first year, but when it becomes chronic, available rehabilitative therapies (pharmacological management, physiotherapy, and psychological intervention) have limited effectiveness. This study examined the effect of a 12-week intensive outpatient rehabilitation on pain relief and function in chronic CRPS patients. Rehabilitation program included memantine and morphine treatment (added to patient’s prior pain medication) and concurrent psychological and physiotherapeutic intervention. Primary outcome measure was a change in CRPS symptom count and secondary outcomes were motor performance, psychological factors, pain intensity, and quality of life. Methods Ten patients with chronic upper limb CRPS I (median 2.9 years, range 8 months to 12 years) were recruited to the study and were assessed before and after the intervention. Hand motor function of the patients was evaluated by an independent physiotherapist. There were standardized questionnaires for depression, pain anxiety, pain acceptance, quality of life, and CRPS symptom count. In addition, psychological factors were evaluated by a semi-structured interview. Severity of experienced pain was rated at movement and at rest. In addition, a video experiment of a hand action observation was conducted pre- and post-intervention to study possible change in neuronal maladaptation. Intervention consisted of pharmacological, psychological and physiotherapeutic treatment. First, 10 mg daily morphine was started and increased gradually to 30 mg daily, if tolerated. After 30 mg/day or tolerated dose of morphine was achieved, 5 mg daily memantine was started and increased gradually to 40 mg, if tolerated. Psychological intervention consisted of weekly group sessions, using cognitive and behavioral methods (relaxation, behavioral activation, and exposure) and acceptance and commitment therapy (ACT) and daily home practice. Physiotherapeutic intervention consisted of graded motor imagery and physiotherapy exercises with weekly group sessions and/or individual guidance by the physiotherapist, and individual exercise of the affected upper limb. Results Multimodal intensive intervention resulted in significant decrease in CRPS symptom count. The effect was strongest in motor and trophic symptoms (19% decrease after intervention) and in sensory symptoms (18% decrease). Additionally, improvement was seen in some, but not all, secondary outcomes (movement pain, motor symptoms, change in perceptions during video experiment of hand actions, and summary index with motor functioning, pain, and psychological factors). There were no dropouts. Conclusions Intensive 12-week multimodal intervention reduced some CRPS symptoms but was not sufficient to alter patients’ rest pain, distress, or quality of life. Implications These results support the efficacy of an interdisciplinary rehabilitation program for pain and function in chronic CRPS patients. After intervention, some CRPS symptoms reduced and function improved, but distress and quality of life were unchanged. This may be due to the relatively short duration of this program; to delayed effects; to particular cognitive problems of CPRS patients; and/or to low distress levels at baseline that make statistically significant reduction less likely.

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Section: Patientsmentioning

confidence: 99%

Symptom reduction and improved function in chronic CRPS type 1 after 12-week integrated, interdisciplinary therapy

Elomaa

Hotta

Williams

et al. 2019

Scandinavian Journal of Pain

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“…Chronic pain has been associated with structural changes of the brain, including prefrontal, somatosensory and occipital areas and subcortical nuclei (Cauda et al, 2014;Kuner and Flor, 2017;Yuan et al, 2017;Shokouhi et al, 2018). Gray matter structural changes have been observed in chronic pain conditions (Diaz-Piedra et al, 2016;Jia and Yu, 2017;Wang et al, 2017) as well as changes in white matter (Jutzeler et al, 2016;Tian et al, 2016;Hotta et al, 2017;Malfliet et al, 2017;Zhong et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

On the Relationship Between White Matter Structure and Subjective Pain. Lessons From an Acute Surgical Pain Model

Torrecillas-Martínez

Catena

O’Valle

et al. 2020

Front. Hum. Neurosci.

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Background: Pain has been associated with structural changes of the brain. However, evidence regarding white matter changes in response to acute pain protocols is still scarce. In the present study, we assess the existence of differences in brain white matter related to pain intensity reported by patients undergoing surgical removal of a mandibular impacted third molar using diffusion tensor imaging (DTI) analysis.Methods: 30 participants reported their subjective pain using a visual analog scale at three postsurgical stages: under anesthesia, in pain, and after the administration of an analgesic. The diffusion data were acquired prior to surgery.Results: DTI analysis yielded significant positive associations of fractional anisotropy in white matter areas related to pain processing (corticospinal tract, corona radiata, corpus callosum) with the differences in pain between the three postsurgery stages. Extent and location of these associations depended on the magnitude of the subjective pain differences. Tractography analysis indicated that some pain–tract associations are significant only when pain stage is involved in the contrast (posterior corona radiata), while others (middle cerebellar peduncle, pontine crossing) are only when anesthesia is involved in the contrast.Conclusions: The association of white matter fractional anisotropy and connectivity, measured before the pain stages, with subjective pain depends on the magnitude of the differences in pain scores.

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“…The particular fiber tracts corresponding to the clusters with reduced FA were identified as the corpus callosum (genu and body), corona radiata (anterior, superior, posterior), external capsule, and superior longitudinal fasciculus. Notably, the white matter abnormalities in the corpus callosum and corona radiata have been previously reported in CRPS patients, 8,41 although the directions of alteration have been inconsistent.…”

Section: Discussionmentioning

confidence: 93%

Prefrontal White Matter Abnormalities Associated With Pain Catastrophizing in Patients With Complex Regional Pain Syndrome

Kim

Jeong

et al. 2021

Archives of Physical Medicine and Rehabilitation

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To investigate altered prefrontal white matter integrity in complex regional pain syndrome (CRPS) and its relation with the degree of pain catastrophizing. Design: Cross-sectional study. Setting: University hospital. Participants: Twenty-one CRPS patients and 49 patients without CRPS (NZ70). Interventions: Not applicable. Main Outcome Measures: The fractional anisotropy values within the prefrontal regions reflecting the structural integrity of white matter were measured in CRPS patients and patients without CRPS using diffusion tensor imaging. The degree of pain catastrophizing was also evaluated in CRPS patients. Results: The structural integrity of the prefrontal white matter was lower in CRPS patients than in patients without CRPS (PZ.03). In addition, lower structural integrity in the prefrontal cortex was correlated with a higher degree of pain catastrophizing among CRPS patients (rZ À0.54, PZ.01). Conclusions: Our findings suggest that pain catastrophizing, which is frequently reported in patients with CRPS, may be associated with the dysfunction of the prefrontal white matter.

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Complex regional pain syndrome: The matter of white matter?

Cited by 18 publications

References 45 publications

Symptom reduction and improved function in chronic CRPS type 1 after 12-week integrated, interdisciplinary therapy

Symptom reduction and improved function in chronic CRPS type 1 after 12-week integrated, interdisciplinary therapy

On the Relationship Between White Matter Structure and Subjective Pain. Lessons From an Acute Surgical Pain Model

Prefrontal White Matter Abnormalities Associated With Pain Catastrophizing in Patients With Complex Regional Pain Syndrome

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