Complex regional pain syndrome and functional neurological disorders – time for reconciliation

Popkirov, Stoyan; Hoeritzauer, Ingrid; Colvin, Lesley; Carson, Alan; Stone, Jon

doi:10.1136/jnnp-2018-318298

Cited by 67 publications

(45 citation statements)

References 55 publications

(57 reference statements)

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“…Moreover, the mean BPI score is over 5, which is higher than the mean score reported in a study on cancer patients with bone metastases (Zeng et al, 2011). Stone and Sharpe find a high prevalence of pain in functional weakness (Stone, Warlow, & Sharpe, 2010), and possible interpretations of the association between chronic regional pain syndrome and CD/ FND have been discussed (Popkirov, Hoeritzauer, Colvin, Carson, & Stone, 2019). However, so far, pain has not received much attention in CD/FND research, classification, and guidelines.…”

Section: Summary Of Principal Findingsmentioning

confidence: 99%

Childhood sexual abuse predicts treatment outcome in conversion disorder/functional neurological disorder. An observational longitudinal study

2020

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Objective Explore trauma, stress, and other predictive factors for treatment outcome in conversion disorder/functional neurological disorder (CD/FND). Methods Prospective observational design. Clinical cohort study among consecutive outpatients with DSM‐IV CD/FND in a specialized mental health institution for somatic symptom disorders and related disorders (SSRD), presented between 1 February 2010 and 31 December 2017. Patient files were assessed for early childhood trauma, childhood sexual abuse, current stress, and other predictive factors. Patient‐related routine outcome monitoring (PROM) data were evaluated for treatment outcome at physical (Patient Health Questionnaire [PHQ15], Physical Symptoms Questionnaire [PSQ]) level as primary outcome, and depression (Patient Health Questionnaire [PHQ9]), anxiety (General Anxiety Disorder [GAD7]), general functioning (Short Form 36 Health Survey [SF36]), and pain (Brief Pain Inventory [BPI]) as secondary outcome. Results A total of 64 outpatients were included in the study. 70.3% of the sample reported childhood trauma and 64.1% a recent life event. Mean scores of patients proceeding to treatment improved. Sexual abuse in childhood (F(1, 28) = 30.068, β = 0.608 p < .001) was significantly associated with worse physical (PHQ15, PSQ) treatment outcome. 42.2% reported comorbid depression, and this was significantly associated with worse concomitant depressive (PHQ9) (F[1, 39] = 11.526, β = 0.478, p = .002) and anxiety (GAD7) (F[1,34] = 7.950, β = 0.435, p = .008) outcome. Conclusion Childhood sexual abuse is significantly associated with poor treatment outcome in CD/FND. Randomized clinical trials evaluating treatment models addressing childhood sexual abuse in CD are needed.

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Section: Summary Of Principal Findingsmentioning

confidence: 99%

Childhood sexual abuse predicts treatment outcome in conversion disorder/functional neurological disorder. An observational longitudinal study

2020

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“…10 However, other recent research has suggested that central mechanisms are also involved in the pathophysiology of CRPS and have demonstrated associations between psychological factors and pain outcomes in patients with CRPS. 11,12 Regardless, these results are not conclusive and few studies have specifically investigated this topic. [13][14][15] Several studies that have examined psychological traits in patients with chronic pain using the Minnesota Multiphasic Personality Inventory (MMPI-2) 16,17 and reported that psychological factors modulate pain sensitization by mediating physiological responses to psychological stressors.…”

Section: Introductionmentioning

confidence: 98%

<p>Psychological Characteristics in Patients with Chronic Complex Regional Pain Syndrome: Comparisons with Patients with Major Depressive Disorder and Other Types of Chronic Pain</p>

Park¹,

Jang²,

Oh³

et al. 2020

JPR

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Objective: This study investigated psychological characteristics of patients with chronic complex regional pain syndrome (CRPS) and examined relationships between psychosocial factors and pain severity. Methods: In total, 76 patients with CRPS, 95 patients with other types of chronic pain, 171 healthy controls, and 66 patients with major depressive disorder (MDD) were included. Minnesota Multiphasic Personality Inventory (MMPI-2) profiles and scores on the Beck Depression Inventory and State-Trait Anxiety Inventory were calculated. Pain intensity was measured using a visual analog scale (VAS). Results: Patients with CRPS scored higher on the Hypochondriasis (Hs), Depression (D), Hysteria (Hy), Paranoia (Pa), and Psychasthenia (Pt) scales of the MMPI-2 compared to healthy controls. The CRPS group scored lower on the D, Psychopathic deviate (Pd), Pa, Pt, Schizophrenia (Sc), and Social introversion (Si) scales compared to the MDD group. Although CRPS patients reported higher levels of pain than patients with other types of pain, the MMPI profiles of the two pain groups did not differ significantly. Linear regression analyses revealed that pain severity was significantly associated with depression and scores on the Masculinity-Femininity (Mf) scale. Conclusion: This is the first comparative study of the psychological characteristics of chronic CRPS patients, healthy controls, and patients with MDD. The neurotic profiles of CRPS patients were more psychologically adaptable than were those of patients with MDD; however, this profile was shared by both pain groups. The present findings further showed that, although pain severity was not a major contributor to depression, patients with CRPS should be evaluated for depressive symptoms.

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“…However, more recent high-resolution functional Magnetic Resonance Imaging (fMRI) studies have failed to replicate somatotopic abnormalities of S1 (Di Pietro et al, 2015; Mancini et al, 2018; van Velzen et al, 2016). This has led to further hypotheses of deficits in higher-order mechanisms to explain sensory symptoms in CRPS (Kuttikat et al, 2016a; Popkirov et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

Sub-Optimal Learning of Tactile-Spatial Predictions in Patients with Complex Regional Pain Syndrome

Brown

Scholtes

Shenker

et al. 2019

Preprint

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In Complex Regional Pain Syndrome (CRPS), tactile sensory deficits have motivated the therapeutic use of sensory discrimination training. However, the hierarchical organisation of the brain is such that low-level sensory processing can be dynamically influenced by higherlevel knowledge, e.g. knowledge learnt from statistical regularities in the environment. It is unknown whether the learning of such statistical regularities is impaired in CRPS. Here, we employed a hierarchical Bayesian model of predictive coding to investigate statistical learning of tactile-spatial predictions in CRPS. Using a sensory change-detection task, we manipulated bottom-up (spatial displacement of a tactile stimulus) and top-down (probabilistic structure of occurrence) factors to estimate hierarchies of prediction and prediction error signals, as well as their respective precisions or reliability. Behavioural responses to spatial changes were influenced by both the magnitude of spatial displacement (bottom-up) and learnt probabilities of change (top-down). The Bayesian model revealed that patients' predictions (of spatial displacements) were found to be less precise, deviating further from the ideal (statistical optimality) compared to healthy controls. This imprecision was less contextdependent, i.e. more enduring across changes in probabilistic context and less finely-tuned to statistics of the environment. This caused greater precision on prediction errors, resulting in predictions that were driven more by momentary spatial changes and less by the history of spatial changes. These results suggest inefficiencies in higher-order statistical learning in CRPS. This may have implications for therapies based on sensory re-training whose effects may be more short-lived if success depends on higher-order learning. AUTHOR CONTRIBUTIONSCB, NS and MCL substantially contributed to the conception of this work; CB and MCL designed the experiments and wrote the paper; NS, IS and MCL substantially contributed to the recruitment of participants; IS conducted the experiments. All authors gave final approval to the version of the paper to be published.

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Complex regional pain syndrome and functional neurological disorders – time for reconciliation

Cited by 67 publications

References 55 publications

Childhood sexual abuse predicts treatment outcome in conversion disorder/functional neurological disorder. An observational longitudinal study

Childhood sexual abuse predicts treatment outcome in conversion disorder/functional neurological disorder. An observational longitudinal study

<p>Psychological Characteristics in Patients with Chronic Complex Regional Pain Syndrome: Comparisons with Patients with Major Depressive Disorder and Other Types of Chronic Pain</p>

Sub-Optimal Learning of Tactile-Spatial Predictions in Patients with Complex Regional Pain Syndrome

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