Highlights
- •Slower response times during digit discrimination in complex regional pain syndrome patients.
- •Response times correlated with late-latency tactile processing in supplementary motor area.
- •This P300-like activity was paradoxically related to better limb functioning.
- •Responses in parietal lobe were decreased in complex regional pain syndrome regardless of task demands.
Abstract
Chronic pain in complex regional pain syndrome (CRPS) has been linked to tactile misperceptions
and deficits in somatotopic representation of the affected limb. In this study, 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 in response
to pseudorandomized mechanical stimulation of the digits of both hands (including
CRPS-affected and nonaffected sides) between 13 CRPS patients and 13 matched healthy
controls. During a task to discriminate the digit simulated, patients (compared with
controls) had significantly lower accuracy and slowed response times but with high
between-subject variability. At middle latencies (124–132 ms), 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 localized to the supplementary motor area. Source
activity in the supplementary motor area correlated with slowed response times, although
its scalp representation intriguingly correlated with better functioning of the affected
limb, suggesting a compensatory mechanism. Future research should investigate the
clinical utility of these putative markers of tactile decision-making mechanisms in
CRPS.
Perspective
We present evidence of altered but highly variable cognitive processing (124–268 ms
latency) in response to mechanical tactile stimuli in patients with CRPS compared
with healthy controls. Such mid- to late-latency responses could potentially provide
convenient and robust biomarkers of abnormal perceptual decision-making mechanisms
in CRPS to aid in clinical detection and treatment.
Key words
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Article info
Publication history
Published online: December 08, 2017
Accepted:
November 27,
2017
Received in revised form:
October 6,
2017
Received:
June 7,
2017
Footnotes
The research was supported by funding from Cambridge Arthritis Research Endeavour. The study was sponsored by Cambridge University Hospitals NHS Foundation Trust and supported by its Rheumatology department.
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
