Highlights
- •Twenty chronic complex regional pain syndrome patients underwent a 6 week graded motor imagery intervention
- •Functional MRI (fMRI) was tested pre and post for the hand lateralization task which improved over graded motor imagery
- •Performance gain was positively related to right parietal fMRI activation
Abstract
Complex regional pain syndrome (CRPS) is a neuropathic pain condition that is difficult
to treat. For behavioral interventions, graded motor imagery (GMI) showed relevant
effects, but underlying neural substrates in patient groups have not been investigated
yet. A previous study investigating differences in the representation of a left/right
hand judgment task demonstrated less recruitment of subcortical structures, such as
the putamen, in CRPS patients than in healthy controls. In healthy volunteers, the
putamen activity increased after a hand judgment task training. In order to test for
longitudinal effects of GMI training, we investigated 20 CRPS patients in a wait-list
crossover design with 3 evaluation time points. Patients underwent a 6 week GMI treatment
and a 6 week waiting period in a randomized group assignment and treatment groups
were evaluated by a blinded rater. When compared to healthy matched controls at baseline,
CRPS patients showed less functional activation in areas processing visual input,
left sensorimotor cortex, and right putamen. Only GMI treatment, but not the waiting
period showed an effect on movement pain and hand judgment task performance. Regression
analyses revealed positive associations of movement pain with left anterior insula
activation at baseline. Right intraparietal sulcus activation change during GMI was
associated with a gain in performance of the hand judgment task. The design used here
is reliable for investigating the functional representation of the hand judgment task
in an intervention study.
Perspective
Twenty chronic CRPS patients underwent a 6 week GMI intervention in a randomized wait-list
crossover design. functional MRI was tested pre and post for the hand lateralization
task which improved over GMI but not over WAITING. Performance gain was positively
related to right parietal functional MRI activation.
Key Words
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Article info
Publication history
Published online: January 06, 2021
Accepted:
December 11,
2020
Received in revised form:
November 23,
2020
Received:
September 24,
2020
Footnotes
Disclosures
The funding organizations did not have an impact on the design of the study and the results reported here. ML was supported by the National Institute for Health & Collaborative Research Australia for travel to Adelaide (Memorise Grand) and the DFG (LO 795/28-1). He receives financial reimbursement for editing a Neuroscience journal by the Thieme Verlag. NN received local funding from the exchange program of the University of Greifswald (International Office). SS was awarded a Gerhard-Domagk fellowship for undertaking this study; he also received a grant by the Else Kröner Fresenius-Stiftung 2019-A24, which enabled to support JH and SB during their doctoral thesis. GLM has received support from: ConnectHealth UK, Seqirus, Kaiser Permanente, Workers’ Compensation Boards in Australia, Europe and North America, AIA Australia, the International Olympic Committee, Port Adelaide Football Club, Arsenal Football Club. Professional and scientific bodies have reimbursed him for travel costs related to presentation of research on pain at scientific conferences/symposia. He has received speaker fees for lectures on pain and rehabilitation. He receives book royalties from NOIgroup publications, Dancing Giraffe Press & OPTP for books on pain and rehabilitation.
Identification
Copyright
© 2021 by United States Association for the Study of Pain, Inc.
