Complex Interaction of Sensory and Motor Signs and Symptoms in Chronic CRPS

Abstract

Spontaneous pain, hyperalgesia as well as sensory abnormalities, autonomic, trophic, and motor disturbances are key features of Complex Regional Pain Syndrome (CRPS). This study was conceived to comprehensively characterize the interaction of these symptoms in 118 patients with chronic upper limb CRPS (duration of disease: 43±23 months). Disease-related stress, depression, and the degree of accompanying motor disability were likewise assessed. Stress and depression were measured by Posttraumatic Stress Symptoms Score and Center for Epidemiological Studies Depression Test. Motor disability of the affected hand was determined by Sequential Occupational Dexterity Assessment and Michigan Hand Questionnaire. Sensory changes were assessed by Quantitative Sensory Testing according to the standards of the German Research Network on Neuropathic Pain. Almost two-thirds of all patients exhibited spontaneous pain at rest. Hand force as well as hand motor function were found to be substantially impaired. Results of Quantitative Sensory Testing revealed a distinct pattern of generalized bilateral sensory loss and hyperalgesia, most prominently to blunt pressure. Patients reported substantial motor complaints confirmed by the objective motor disability testings. Interestingly, patients displayed clinically relevant levels of stress and depression. We conclude that chronic CRPS is characterized by a combination of ongoing pain, pain-related disability, stress and depression, potentially triggered by peripheral nerve/tissue damage and ensuing sensory loss. In order to consolidate the different dimensions of disturbances in chronic CRPS, we developed a model based on interaction analysis suggesting a complex hierarchical interaction of peripheral (injury/sensory loss) and central factors (pain/disability/stress/depression) predicting motor dysfunction and hyperalgesia.

The Major Brain Endocannabinoid 2-AG Controls Neuropathic Pain and Mechanical Hyperalgesia in Patients with Neuromyelitis Optica

“…Similar to previous findings, we consistently found significantly reduced scores in three of the eight dimensions of the SF 36 reflecting impaired Health Related Quality of Life, [10], [49], and distinct signs of depression even exceeding those found in patients with chronic Complex Regional Pain Syndrome (CRPS), where depression was substantially correlated to the level of ongoing pain [50]. However, levels of stress were not considerably increased in NMO patients.…”

Intrinsic brain networks normalize with treatment in pediatric complex regional pain syndrome

“…Limitations in motor function due to pain have been shown (Sterling et al, 2001; Huge et al, 2011) and were present in all of our CRPS patients. Indeed, a large difference in connectivity was observed in patients compared to controls indicative of an abnormality in the SMN that was normalized following treatment (Figs.…”

Comparison of operant escape and reflex tests of nociceptive sensitivity

“…Escape testing shows that early recovery of sensitivity within rostral projecting pain pathways does not occur following bilateral CCI. These results are consistent with the long duration of neuropathic pain and pain sensitization that can be experienced by nerve-injured humans (Belfrage et al, 1995;Correa-Illanes et al, 2012;Ducic et al, 2010;Fernandez-de-las-Penas et al, 2011;Huge et al, 2011;Schon et al, 2001;Sjolund et al, 2001). Therefore, mechanisms for disordered pain processing should be sought several months or later following nerve injury.…”