Functional Imaging of Central Nervous System Involvement in Complex Regional Pain Syndrome

Schwenkreis, Peter; Maier, Christoph; Tegenthoff, Martin

doi:10.3174/ajnr.a1630

Cited by 83 publications

(48 citation statements)

References 53 publications

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“…These data strongly suggest that cortical impairment of CRPS does not constitute a simple modification of the sensory-motor pathways [33], and involves alterations of more complex and multimodal representations of the bodily space. These data [26] also imply that CRPS patients do not especially neglect the affected limb, but more exactly the side of space where the affected limb normally resides, suggesting an impairment of a reference frame that is not dependent of the somatotopic representation of the body (i.e.…”

Section: An Impaired Perception Of Space In Crpsmentioning

confidence: 89%

Pain, body, and space: What do patients with complex regional pain syndrome really neglect?

Legrain

Bultitude

Paepe

et al. 2012

Pain

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Section: An Impaired Perception Of Space In Crpsmentioning

confidence: 89%

Pain, body, and space: What do patients with complex regional pain syndrome really neglect?

Legrain

Bultitude

Paepe

et al. 2012

Pain

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“…Symptoms such as high levels of spontaneous pain, allodynia, hyperalgesia, changes in motor control (Schilder et al 2012), and limb protection and/or disuse (Bruehl and Chung 2006) may relate to cortical thinning in the SMA, M1, PMC, and PCL as these brain areas are primarily involved in motor function, motor planning, and chronic pain processing and shown to be altered in CRPS (Juottonen et al 2002; Maihöfner et al 2007; Schwenkreis et al 2009; Kirveskari et al 2010; Barad et al 2014; Pleger et al 2014). …”

Section: Discussionmentioning

confidence: 99%

Rapid treatment-induced brain changes in pediatric CRPS

et al. 2014

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To date, brain structure and function changes in children with complex regional pain syndrome (CRPS) as a result of disease and treatment remain unknown. Here, we investigated (a) gray matter (GM) differences between patients with CRPS and healthy controls and (b) GM and functional connectivity (FC) changes in patients following intensive interdisciplinary psychophysical pain treatment. Twenty-three patients (13 females, 9 males; average age ± SD = 13.3 ± 2.5 years) and 21 healthy sex-and age-matched controls underwent magnetic resonance imaging. Compared to controls, patients had reduced GM in the primary motor cortex, premotor cortex, supplementary motor area, midcingulate cortex, orbitofrontal cortex, dorsolateral prefrontal cortex (dlPFC), posterior cingulate cortex, precuneus, basal ganglia, thalamus, and hippocampus. Following treatment, patients had increased GM in the dlPFC, thalamus, basal ganglia, amygdala, and hippocampus, and enhanced FC between the dlPFC and the periaqueductal gray (PAG), two regions involved in descending pain modulation. Accordingly, our results provide novel evidence for GM abnormalities in sensory, motor, emotional, cognitive, and pain modulatory regions in children with CRPS. Furthermore, this is the first study to demonstrate rapid treatment-induced GM and FC changes in areas implicated in sensation, emotion, cognition, and pain modulation.

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“…These abnormalities include edema, autonomic dysfunction, motor symptoms, and trophic changes. 61 There is some evidence of motorcortex reorganization in patients with CRPS-I. Although TMS studies found no significant inter-hemispheric difference in the motor thresholds, 38,40,42 the size of the cortical representation of muscles on the affected side was found to be reduced relative to the unaffected side.…”

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

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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.

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Functional Imaging of Central Nervous System Involvement in Complex Regional Pain Syndrome

Cited by 83 publications

References 53 publications

Pain, body, and space: What do patients with complex regional pain syndrome really neglect?

Pain, body, and space: What do patients with complex regional pain syndrome really neglect?

Rapid treatment-induced brain changes in pediatric CRPS

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

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