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

Abstract

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.

White matter microstructure predicts measures of clinical symptoms in chronic back pain patients

“…The corpus callosum is a major WM throughfare connecting the hemispheres of the brain. DTI has typically shown decreased FA in various parts of the CC with chronic pain, which varied by study ( Buckalew et al, 2010 , Geha et al, 2008 , Im et al, 2021 , Kim et al, 2014 , Li et al, 2021b , Moayedi et al, 2012 ); in migraine, by contrast, multiple studies found lower FA in all regions of CC ( Li et al, 2011 , Yu et al, 2013 ). Some of these FA changes have been correlated with clinical measures: decreased FA in the CC body of fibromyalgia patients ( Kim et al, 2014 ) and the genu of trigeminal neuralgia patients ( Li et al, 2021b ) were both negatively associated with pain intensity, mirroring our results ( Fig.…”

“…The relationship between WM microstructure and pain catastrophizing has seldom been investigated, though one recent DTI study in complex regional pain syndrome (CRPS) found weakening in the PFC of patients versus controls, which in turn correlated with pain catastrophizing ( Im et al, 2021 ). Functional studies, meanwhile, have found that connectivity between medial PFC or PCC and the rest of the DMN were related to pain catastrophizing and rumination ( Kucyi et al, 2014 , Lee et al, 2018 ).…”

“…Most other studies have found no correlation between FA in the rest of the CC and CP duration ( Kim et al, 2014 , Li et al, 2021b , Li et al, 2011 ), with the exception of Buckalew et al (2010) , who observed strong correlations between FA in both the splenium and the right centrum semiovale and CBP duration. At least one study ( Im et al, 2021 ) reported no relationship between FA in any part of the brain and CP duration. Our own findings – an association between CBP duration and FD in the bilateral superior thalamic radiations and FDC in the right anterior thalamic radiation – are seemingly unique in this context and thus warrant a more targeted follow-up.…”

Senso-Immunologic Prospects for Complex Regional Pain Syndrome Treatment

“…These psychological stress responses lead to increased catecholamine secretion, a lower threshold for noxious stimuli, and sympathetic nerve overdrive. Pain catastrophizing affects CRPS development profoundly ( 36 ), and patients with such psychological tendencies have persistently higher pain scores ( 37 ).…”

Comparison of subjective motor imagery abilities in CRPS compared to chronic limb pain and healthy controls: a cross sectional study

“…Furthermore, a reduced activation of cortical areas during the motor imagery (MI) task in the affected side 15 has been observed, and changes in motor areas such as the premotor cortex that is involved in MI abilities 7,16,17 .…”