Highlights
- •Limited large-scale cortical reorganization was observed after human spinal cord injury.
- •Neuropathic pain was not associated with increased plasticity in the brain.
- •Reorganization in the central nervous system could be an adaptive process preventing development of neuropathic pain.
Abstract
Refractory to most types of treatment, neuropathic pain (NP) is a major problem for
people living with spinal cord injury (SCI). The underlying mechanisms among problems
related to treatment are poorly understood. The aim of the present study was to investigate
the association between cortical reorganization and NP after SCI. Twenty-four individuals
with sensorimotor complete and incomplete paraplegia and tetraplegia (12 with NP,
13 pain free) and 31 healthy individuals were examined. Functional magnetic resonance
imaging was used to assess activation in primary somatosensory and motor cortices
in response to motor (ie, active and passive wrist extension) and sensory (ie, heat
and brushing) tasks applied on the dorsum of the hand. In individuals with SCI, there
were no group-level differences in task-related activation (ie, movement or sensory)
compared with the healthy controls. However, based on the Euclidean distance measure,
individuals with SCI demonstrated a lateral shift of peak activity in primary sensory
and motor cortices (P < .05). Among those with NP, chronic pain intensity inversely correlated with the
magnitude of the shift in the primary motor cortex during active wrist extension.
The findings reveal that NP in motor and sensory tasks at or above the level of the
lesion is not associated with increased plasticity. In line with previous studies,
changes in somatotopy and activation after SCI are rather limited and the influence
of NP on plasticity remains controversial.
Perspective
Using functional magnetic resonance imaging, we have provided novel evidence that
reorganization (i.e., topographical shifts in peak activity) in the primary motor
cortex after spinal cord injury is limited to individuals without neuropathic pain.
Key words
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Article info
Publication history
Published online: September 18, 2015
Accepted:
August 21,
2015
Received in revised form:
July 24,
2015
Received:
May 20,
2015
Footnotes
The study was supported by the Swiss National Science Foundation (SNF Grant Nr. 320030 135558) and the Clinical Research Priority Program “Neurorehab” of the University of Zurich, Switzerland. John Kramer was supported by postdoctoral funding from the International Foundation for Paraplegia – Zurich, a Michael Smith Foundation for Health Research and Rick Hansen Scholar Award, and a North American Spine Society Clinical Travel Fellowship. The authors report no conflict of interests in this work.
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Copyright
© 2015 American Pain Society. Published by Elsevier Inc. All rights reserved.
