Highlights
- •We studied brain changes at early vs late stages of complex regional pain syndrome.
- •Early gray matter volume decrease was found in sensorimotor and parietal cortices.
- •At early stage, cerebral perfusion was reduced in parts of the limbic system.
- •We found higher perfusion in motor cortex but no gray matter changes at late stage.
- •Sensorimotor network changes at both stages showed impairment of motor control.
Abstract
Brain plasticity is demonstrated in complex regional pain syndrome (CRPS), although
it is unclear how it modulates at different stages of CRPS. The observation that symptoms
can progress over time suggests that the pattern of brain changes might also evolve.
We measured structural and functional changes as well as sensorimotor integration
at the early stage (ES) and late stage (LS) of CRPS. Twelve ES patients, 16 LS patients,
and 16 age- and sex-matched controls were recruited. Gray matter (GM) volume was estimated
using voxel-based morphometry. Cerebral perfusion was measured using arterial spin
labeling, because it provides a measure of resting neural activity. Connectivity to
sensorimotor regions was evaluated using blood-oxygen level-dependent images. The
ES group showed reduced GM volume and perfusion in areas associated with spatial body
perception, somatosensory cortex, and the limbic system, whereas the LS group exhibited
increased perfusion in the motor cortex but no changes in GM volume. However, in the
LS group, GM volume in areas associated with pain processing was negatively correlated
with average pain levels, likely reflecting a response to ongoing pain. Furthermore,
connectivity to sensorimotor cortex showed disruptions in regions associated with
motor control and planning, implying impairment of higher-order motor control.
Perspective
This article presents brain changes at ES and LS of CRPS. We found different patterns
of brain changes between these 2 stages. Understanding modulation of brain plasticity
at different stages of CRPS could help understand the diversity in outcomes and treatment
response and hopefully improve treatment planning.
Key words
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References
- Efficacy of stellate ganglion blockade for the management of type 1 complex regional pain syndrome.South Med J. 2006; 99: 1084-1088
- A fast diffeomorphic image registration algorithm.Neuroimage. 2007; 38: 95-113
- Voxel-based morphometry—The methods.Neuroimage. 2000; 11: 805-821
- Functional reorganization of the default mode network across chronic pain conditions.PLoS One. 2014; 9 (e106133)
- Brain morphological signatures for chronic pain.PLoS One. 2011; 6 (e26010)
- Intended and unintended (sensory-)motor coupling between the affected and unaffected upper limb in complex regional pain syndrome.Eur J Pain. 2015; 19: 1021-1034
- Complex regional pain syndrome is associated with structural abnormalities in pain-related regions of the human brain.J Pain. 2014; 15: 197-203
- The outcome of complex regional pain syndrome type 1: A systematic review.J Pain. 2014; 15: 677-690
- Intrinsic brain networks normalize with treatment in pediatric complex regional pain syndrome.Neuroimage Clin. 2014; 6: 347-369
- A component based noise correction method (CompCor) for BOLD and perfusion based fMRI.Neuroimage. 2007; 37: 90-101
- Complex regional pain syndrome an optimistic perspective.Neurology. 2014; 84: 89-96
- Complex regional pain syndrome—Significant progress in understanding.Pain. 2015; 156: 94-103
- Altered resting-state functional connectivity in complex regional pain syndrome.J Pain. 2013; 14: 1107-1115
- Causalgia and other reflex sympathetic dystrophies.in: Bonica J. Loeser J. Chapman C. Fordyce W. The Management of Pain. 2nd ed. Lea & Febiger London, Philadelphia1990: 220-243
- Artefactual subcortical hyperperfusion in PET studies normalized to global mean: Lessons from Parkinson's disease.Neuroimage. 2009; 45: 249-257
- Complex regional pain syndrome: Are there distinct subtypes and sequential stages of the syndrome?.Pain. 2002; 95: 119-124
- Cognitive and emotional control of pain and its disruption in chronic pain.Nat Rev Neurosci. 2013; 14: 502-511
- Pain assessment: Global use of the Brief Pain Inventory.Ann Acad Med Singapore. 1994; 23: 129-138
- Continuous flow-driven inversion for arterial spin labeling using pulsed radio frequency and gradient fields.Magn Reson Med. 2008; 60: 1488-1497
- The human parietal operculum. II. Stereotaxic maps and correlation with functional imaging results.Cereb Cortex. 2006; 16: 268-279
- The human parietal operculum. I. Cytoarchitectonic mapping of subdivisions.Cereb Cortex. 2006; 16: 254-267
- The Oswestry Disability Index.Spine. 2000; 25: 2940-2953
- Cerebral blood flow imaging with 3D GRASE ASL sequence increases SNR and shortens acquisition time.MAGNETOM Flash. 2009; : 62-69
- Continuous arterial spin labeling perfusion measurements using single shot 3D GRASE at 3 T.Magn Reson Med. 2005; 54: 1241-1247
- Contralateral thalamic perfusion in patients with reflex sympathetic dystrophy syndrome. Reduced bone formation after exposure to organophosphates.Lancet. 1999; 354: 1790-1791
- The brain in chronic CRPS pain: Abnormal gray-white matter interactions in emotional and autonomic regions.Neuron. 2008; 60: 570-581
- Two different areas within the primary motor cortex of man.Nature. 1996; 382: 805-807
- Areas 3a, 3b, and 1 of human primary somatosensory cortex.Neuroimage. 1999; 10: 63-83
- Human somatosensory area 2: Observer-independent cytoarchitectonic mapping, interindividual variability, and population map.Neuroimage. 2001; 14: 617-631
- Complex regional pain syndrome: Are the IASP diagnostic criteria valid and sufficiently comprehensive?.Pain. 1999; 83: 211-219
- Complex regional pain syndrome: Practical diagnostic and treatment guidelines.Pain Med. 2013; 14: 180-229
- Shape shifting pain: Chronification of back pain shifts brain representation from nociceptive to emotional circuits.Brain. 2013; 136: 2751-2768
- Alterations in resting-state regional cerebral blood flow demonstrate ongoing pain in osteoarthritis: An arterial spin-labeled magnetic resonance imaging study.Arthritis Rheum. 2012; 64: 3936-3946
- Pain-related deactivation of medial prefrontal cortical neurons involves mGluR1 and GABA A receptors.J Neurophysiol. 2011; 106: 2642-2652
- Brain imaging in fibromyalgia.Curr Pain Headache Rep. 2012; 16: 388-398
- Spatial orientation and the representation of space with parietal lobe lesions.Philos Trans R Soc Lond B Biol Sci. 1997; 352: 1411-1419
- Arterial spin-labeled MRI study of migraine attacks treated with rizatriptan.J Headache Pain. 2010; 11: 255-258
- Central opioidergic neurotransmission in complex regional pain syndrome.Neurology. 2010; 75: 129-136
- Enhanced medial prefrontal-default mode network functional connectivity in chronic pain and its association with pain rumination.J Neurosci. 2014; 34: 3969-3975
- Brain alterations and neurocognitive dysfunction in patients with complex regional pain syndrome.J Pain. 2015; 16: 580-586
- Body perception disturbance: A contribution to pain in complex regional pain syndrome (CRPS).Pain. 2007; 133: 111-119
- Quantitative cerebral blood flow mapping and functional connectivity of postherpetic neuralgia pain: A perfusion fMRI study.Pain. 2013; 154: 110-118
- The motor system shows adaptive changes in complex regional pain syndrome.Brain. 2007; 130: 2671-2687
- Complex regional pain syndromes: New pathophysiological concepts and therapies.Eur J Neurol. 2010; 17: 649-660
- Patterns of spread in complex regional pain syndrome, type I (reflex sympathetic dystrophy).Pain. 2000; 88: 259-266
- Differential effect of double-pulse TMS applied to dorsal premotor cortex and precuneus during internal operation of visuospatial information.Neuroimage. 2010; 49: 1108-1115
- Measuring the neural response to continuous intramuscular infusion of hypertonic saline by perfusion MRI.J Magn Reson Imaging. 2012; 35: 669-677
- Complex regional pain syndrome type I affects brain structure in prefrontal and motor cortex.PLoS One. 2014; 9 (e85372)
- Impaired spatial body representation in complex regional pain syndrome type 1 (CRPS I).Pain. 2012; 153: 2174-2181
- Diagnosis, mechanisms and treatment of complex regional pain syndrome.Curr Opin Anaesthesiol. 2014; 27: 494-500
- Bilateral motor cortex disinhibition in complex regional pain syndrome (CRPS) type I of the hand.Neurology. 2003; 61: 515-519
- Functional imaging of central nervous system involvement in complex regional pain syndrome.AJNR Am J Neuroradiol. 2009; 30: 1279-1284
- Cerebral glucose metabolism change in patients with complex regional pain syndrome: A PET study.Radiat Med. 2006; 24: 335-344
- Prism adaptation to optical deviation alleviates pathologic pain.Neurology. 2007; 68: 128-133
- Alterations of contralateral thalamic perfusion in neuropathic pain.Open Neuroimag J. 2010; 4: 182-186
- Spreading of complex regional pain syndrome: Not a random process.J Neural Transm. 2011; 118: 1301-1309
- Is the brain of complex regional pain syndrome patients truly different?.Eur J Pain. 2016; 20: 1622-1633
- Arterial transit time imaging with flow encoding arterial spin tagging (FEAST).Magn Reson Med. 2003; 50: 599-607
- Neural correlates of chronic low back pain measured by arterial spin labeling.Anesthesiology. 2011; 115: 364-374
- The role of anterior cingulate cortex and precuneus in the coordination of motor behaviour.Eur J Neurosci. 2005; 22: 235-246
- A theoretical and experimental investigation of the tagging efficiency of pseudocontinuous arterial spin labeling.Magn Reson Med. 2007; 58: 1020-1027
- Noise reduction in 3D perfusion imaging by attenuating the static signal in arterial spin tagging (ASSIST).Magn Reson Med. 2000; 44: 92-100
Article info
Publication history
Published online: October 13, 2017
Accepted:
September 30,
2017
Received in revised form:
September 12,
2017
Received:
April 23,
2017
Footnotes
This work was supported by an operating grant from the Canadian Institutes of Health Research, grant number: MOP-119453.
The authors have no conflicts of interest to declare.
Supplementary data accompanying this article are available online at www.jpain.org and www.sciencedirect.com.
Identification
Copyright
© 2017 by the American Pain Society
