Neuropsychological Changes in Complex Regional Pain Syndrome (CRPS)

Abstract

Complex Regional Pain Syndrome (CRPS) is a poorly understood chronic pain condition of multifactorial origin. CRPS involves sensory, motor, and autonomic symptoms primarily affecting one extremity. Patients can also present with neuropsychological changes such as reduced attention to the CRPS-affected extremity, reminiscent of hemispatial neglect, yet in the absence of any brain lesions. However, this “neglect-like” framework is not sufficient to characterise the range of higher cognitive functions that can be altered in CRPS. This comprehensive literature review synthesises evidence of neuropsychological changes in CRPS in the context of potential central mechanisms of the disorder. The affected neuropsychological functions constitute three distinct but not independent groups: distorted body representation, deficits in lateralised spatial cognition, and impairment of non-spatially-lateralised higher cognitive functions. We suggest that many of these symptoms appear to be consistent with a broader disruption to parietal function beyond merely what could be considered “neglect-like.” Moreover, the extent of neuropsychological symptoms might be related to the clinical signs of CRPS, and rehabilitation methods that target the neuropsychological changes can improve clinical outcomes in CRPS and other chronic pain conditions. Based on the limitations and gaps in the reviewed literature, we provide several suggestions to improve further research on neuropsychological changes in chronic pain.

Attentional Modulation of Neural Dynamics in Tactile Perception of Complex Regional Pain Syndrome Patients

“…Altogether, the puzzle of symptoms and neural information patters characterizing this enigmatic condition seems to point to a difficulty with the body mental representation (Kuttikat et al, 2016;Halicka et al, 2020), rather than a mere deficit in peripheral transmission (Yvon et al, 2018) Tables Table 1. Summary of all preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in…”

The Role of Nonmedical Therapeutic Approaches in the Rehabilitation of Complex Regional Pain Syndrome

“…Research has also begun to explore neurophysiological approaches. Evidence from a number of studies suggests a structural reorganisation of the brain is associated with chronic pain [70,71]. Such reorganisation has been recognised in CRPS and its association with pain experience is supported by studies of how CRPS patients represent and attend to their affected limb [72,73] and of the consequent impacts of visual neglect and emotional changes about the painful limb on motor and autonomic function [74][75][76].…”

“…The use of mediated virtual reality with patients with recalcitrant CRPS is promising, with a recent study finding therapeutic effect from a single exposure to a digitally manipulated image of the affected limb, both in terms of pain and body perception disturbance [90]. Use of the rubber hand illusion [91] has progressed our understanding of body dis-ownership in CRPS [92] and has similarly been proposed as a potential means of working toward the toleration of touch on a CRPS-affected limb [71].…”

The Experience of Post-Stroke Pain and The Impact on Quality of Life: An Integrative Review

“…Given the above evidence, it is important that further review-based research is undertaken and brings together understanding on the factors which influence PSP. It is also important that such research documents qualitative evidence and insight to lived experiences [ 14 ]. An integrative or mixed studies review may be best placed to achieve this.…”