Abstract
Spatial integration of parts of the body is impaired in patients with complex regional
pain syndrome (CRPS). Because the training of mental rotation (MR) has been shown
to be among the effective therapy strategies for CRPS, impairment of MR is also important
for the pathophysiological understanding of CRPS. The aim of this study was to evaluate
whether differences in the neural representation of MR occur between patients with
CRPS and healthy controls (HC). Therefore, we included 15 patients with chronic CRPS
and 15 age- and gender-matched HC. We assessed behavioral (accuracy and reaction time
for MR of both hands), clinical (Disabilities of Arm, Shoulder and Hand questionnaire)
and magnetic resonance imaging (T1-weighted, function magnetic resonance imaging during
MR) data. Reaction times in the patient group were delayed compared with HC without
a lateralization effect for the affected hand side. Although both groups showed an
activation pattern typical for MR, only HC showed a highly significant contrast for
the rotated versus unrotated hands in the right intraparietal sulcus. Patients with
CRPS showed a reduction of functional magnetic resonance imaging activation in areas
including the subthalamic nucleus, nucleus accumbens, and putamen. Regression analysis
for the CRPS group emphasized the importance of putamen and nucleus accumbens activation
for MR performance. This study highlights the reduced access of patients with CRPS
for mental resources modulating arousal, emotional response, and subcortical sensorimotor
integration.
Perspective
This study localized the underlying neural responses for impaired mental rotation
in patients with complex regional pain syndrome as a decrease in basal ganglia (putamen)
and nucleus accumbens activation.
Key words
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Article info
Publication history
Published online: January 30, 2019
Accepted:
January 28,
2019
Received in revised form:
January 16,
2019
Received:
September 4,
2018
Footnotes
M.K., S.S., and U.H. contributed equally to this work.
Disclosures: None of the authors received funding or financial support from other resources than the University Medicine of Greifswald.
Supplementary data accompanying this article are available online at www.jpain.org and www.sciencedirect.com.
Identification
Copyright
© 2019 by the American Pain Society
