Primary Somatosensory Cortex Function in Complex Regional Pain Syndrome: A Systematic Review and Meta-Analysis

Pietro, Flavia Di; McAuley, James H.; Parkitny, Luke; Lotze, Martín; Wand, Benedict M; Moseley, G. Lorimer; Stanton, Tasha R.

doi:10.1016/j.jpain.2013.04.001

Cited by 149 publications

(99 citation statements)

References 57 publications

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“…23 By contrast, central mechanisms seem to predominate, and not only affect the sensory pathways linked to pain but also result in neuroplastic effects that cause changes in sensory mapping and motor function. [24][25][26] However, Key points ■ Fibromyalgia and complex regional pain syndrome (CRPS) have distinct clinical phenotypes but share features such as pain, allodynia and peripheral dysaesthesia ■ Factors involving the brain and spinal cord lead to central sensitization, which has a dominant role in both disorders ■ Neurogenic inflammation, resulting from the release of proinflammatory neuropeptides from C-fibres, is also prominent in both disorders and contributes to allodynia, tissue swelling and dysaesthesia ■ Neurogenic inflammation involves interactions of the innate immune system with the peripheral and central nervous systems of patients with fibromyalgia or CRPS ■ Although the pathogenesis of both fibromyalgia and CRPS is dominated by central mechanisms, components of neurogenic neuroinflammation might be useful therapeutic targets in patients with these disorders the pathophysiology of CRPS is poorly defined. Although CRPS usually seems to be a highly localized condition, the cause of this localization of the manifestations of CRPS remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Neurogenic neuroinflammation in fibromyalgia and complex regional pain syndrome

2015

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Although fibromyalgia and complex regional pain syndrome (CRPS) have distinct clinical phenotypes, they do share many other features. Pain, allodynia and dysaesthesia occur in each condition and seem to exist on a similar spectrum. Fibromyalgia and CRPS can both be triggered by specific traumatic events, although fibromyalgia is most commonly associated with psychological trauma and CRPS is most often associated with physical trauma, which is frequently deemed routine or minor by the patient. Fibromyalgia and CRPS also seem to share many pathophysiological mechanisms, among which the most important are those involving central effects. Nonetheless, peripheral effects, such as neurogenic neuroinflammation, are also important contributors to the clinical features of each of these disorders. This Review highlights the differing degrees to which neurogenic neuroinflammation might contribute to the multifactorial pathogenesis of both fibromyalgia and CRPS, and discusses the evidence suggesting that this mechanism is an important link between the two disorders, and could offer novel therapeutic targets.

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Section: Introductionmentioning

confidence: 99%

Neurogenic neuroinflammation in fibromyalgia and complex regional pain syndrome

2015

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“…Studies of central nervous function using functional MRI and transcranial magnetic stimulation in both disorders have revealed subtle but comparable abnormalities of brain activations (see Aybek and Vuilleumier16 and Di Pietro et al 37 38 for review). Most studies examining central function in CRPS and FND are too heterogeneous to allow direct comparisons, but there is one group that has tested motor execution and imagery using the same paradigm in both CRPS39 and functional limb weakness (‘conversion paralysis’) 40.…”

Section: The Overlaps Between Crps and Sensorimotor Fndmentioning

confidence: 99%

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

Popkirov

Hoeritzauer

Colvin

et al. 2018

J Neurol Neurosurg Psychiatry

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There have been many articles highlighting differences and similarities between complex regional pain syndrome (CRPS) and functional neurological disorders (FND) but until now the discussions have often been adversarial with an erroneous focus on malingering and a view of FND as ‘all in the mind’. However, understanding of the nature, frequency and treatment of FND has changed dramatically in the last 10–15 years. FND is no longer assumed to be only the result of ‘conversion’ of psychological conflict but is understood as a complex interplay between physiological stimulus, expectation, learning and attention mediated through a Bayesian framework, with biopsychosocial predisposing, triggering and perpetuating inputs. Building on this new ‘whole brain’ perspective of FND, we reframe the debate about the ‘psychological versus physical’ basis of CRPS. We recognise how CRPS research may inform mechanistic understanding of FND and conversely, how advances in FND, especially treatment, have implications for improving understanding and management of CRPS.

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“…Of these patients, five had left arm, three had right arm and five had left leg affected respectively. The mean disease duration was 5.3 years (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14].…”

Section: Participantsmentioning

confidence: 99%

Altered neurocognitive processing of tactile stimuli in patients with Complex Regional Pain Syndrome (CRPS)

Kuttikat

Noreika

Chennu

et al. 2017

Preprint

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Chronic pain in CRPS has been linked to tactile misperceptions and deficits in somatotopic representation of the affected limb. Here, we identify altered cognitive processing of tactile stimuli in CRPS patients that we propose marks heterogeneity in tactile decision-making mechanisms. In a case-control design, we compared middle and late-latency somatosensory-evoked potentials (SEPs) in response to pseudo-randomised mechanical stimulation of the digits of both hands (including CRPS-affected and non-affected sides) between 13 CRPS patients and 13 matched healthy controls. During a task to discriminate the digit simulated, patients (compared to controls) had significantly lower accuracy and slowed response times but with high between-subject variability. At middle latencies (124-132ms), tactile processing in patients relative to controls showed decrements in superior parietal lobe and precuneus (that were independent of task demands) but enhanced activity in superior frontal lobe (that were task-dependent). At late latencies, patients showed an augmented P300-like response under task demands that localised to supplementary motor area (SMA). Source activity in SMA correlated with slowed response times, while its scalp representation intriguingly correlated with better functioning of the affected limb, suggesting a compensatory mechanism. We present evidence of altered but highly variable cognitive processing (124 -268ms latency) in response to mechanical tactile stimuli in patients with CRPS compared to healthy controls. Such mid-to-late latency responses could potentially provide convenient and robust biomarkers of abnormal perceptual decisionmaking mechanisms in CRPS to aid in clinical detection and treatment. Future research should investigate the clinical utility of these putative markers of tactile decision-making mechanisms in CRPS.

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Primary Somatosensory Cortex Function in Complex Regional Pain Syndrome: A Systematic Review and Meta-Analysis

Abstract: The evidence for a difference in function of the primary somatosensory cortex in CRPS compared with controls is clouded by high risk of bias and conflicting results, but reduced representation size seems consistent.

Cited by 149 publications

References 57 publications

Neurogenic neuroinflammation in fibromyalgia and complex regional pain syndrome

Neurogenic neuroinflammation in fibromyalgia and complex regional pain syndrome

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

Altered neurocognitive processing of tactile stimuli in patients with Complex Regional Pain Syndrome (CRPS)

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