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Breimhorst M, Dellen C, Wittayer M, Rebhorn C, Drummond PD, Birklein F. Mental load during cognitive performance in complex regional pain syndrome I. Eur J Pain 2018; 22:1343-1350. [PMID: 29635839 DOI: 10.1002/ejp.1223] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Complex regional pain syndrome (CRPS) is associated with deficits in limb recognition. The purpose of our study was to determine whether mental load during this task affected performance, sympathetic nervous system activity or pain in CRPS patients. METHODS We investigated twenty CRPS-I patients with pain in the upper extremity and twenty age- and sex-matched healthy controls. Each participant completed a limb recognition task. To experimentally manipulate mental load, the presentation time for each picture varied from 2 s (greatest mental load), 4, 6 to 10 s (least mental load). Before and after each run, pain intensity was assessed. Skin conductance was recorded continuously. RESULTS Patients with CRPS did not differ from controls in terms of limb recognition and skin conductance reactivity. However, patients with CRPS reported an increase in pain during the task, particularly during high mental load and during the latter stages of the task. Interestingly, state anxiety and depressive symptoms were also associated with increases in pain intensity during high mental load. CONCLUSIONS These findings indicate that high mental load intensifies pain in CRPS. The increase of pain in association with anxiety and depression indicates a detrimental effect of negative affective states in situations of high stress and mental load in CRPS. SIGNIFICANCE The effects of mental load need to be considered when patients with CRPS-I are investigated for diagnostic or therapeutic reasons.
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Affiliation(s)
- M Breimhorst
- Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.,Celenus Klinik Kinzigtal, Gengenbach, Germany
| | - C Dellen
- Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - M Wittayer
- Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - C Rebhorn
- Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - P D Drummond
- School of Psychology and Exercise Science, Murdoch University, Perth, WA, Australia
| | - F Birklein
- Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.,School of Psychology and Exercise Science, Murdoch University, Perth, WA, Australia
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Hendrickson JE, Hendrickson ET, Gehrie EA, Sidhu D, Wallukat G, Schimke I, Tormey CA. Complex regional pain syndrome and dysautonomia in a 14-year-old girl responsive to therapeutic plasma exchange. J Clin Apher 2015; 31:368-74. [DOI: 10.1002/jca.21407] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 05/01/2015] [Indexed: 01/19/2023]
Affiliation(s)
- Jeanne E. Hendrickson
- Department of Laboratory Medicine; Yale University School of Medicine; New Haven Connecticut
- Department of Pediatrics; Yale University School of Medicine; New Haven Connecticut
| | | | - Eric A. Gehrie
- Department of Laboratory Medicine; Yale University School of Medicine; New Haven Connecticut
| | - Davinder Sidhu
- Department of Laboratory Medicine; Yale University School of Medicine; New Haven Connecticut
| | - Gerd Wallukat
- Berlin Cures GmbH; Berlin Germany
- Max Delbrück Center for Moleculare Medicine; Berlin Germany
| | | | - Christopher A. Tormey
- Department of Laboratory Medicine; Yale University School of Medicine; New Haven Connecticut
- VA Connecticut Healthcare System; West Haven Connecticut
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Erpelding N, Simons L, Lebel A, Serrano P, Pielech M, Prabhu S, Becerra L, Borsook D. Rapid treatment-induced brain changes in pediatric CRPS. Brain Struct Funct 2014; 221:1095-111. [PMID: 25515312 DOI: 10.1007/s00429-014-0957-8] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 12/03/2014] [Indexed: 11/25/2022]
Abstract
To date, brain structure and function changes in children with complex regional pain syndrome (CRPS) as a result of disease and treatment remain unknown. Here, we investigated (a) gray matter (GM) differences between patients with CRPS and healthy controls and (b) GM and functional connectivity (FC) changes in patients following intensive interdisciplinary psychophysical pain treatment. Twenty-three patients (13 females, 9 males; average age ± SD = 13.3 ± 2.5 years) and 21 healthy sex- and age-matched controls underwent magnetic resonance imaging. Compared to controls, patients had reduced GM in the primary motor cortex, premotor cortex, supplementary motor area, midcingulate cortex, orbitofrontal cortex, dorsolateral prefrontal cortex (dlPFC), posterior cingulate cortex, precuneus, basal ganglia, thalamus, and hippocampus. Following treatment, patients had increased GM in the dlPFC, thalamus, basal ganglia, amygdala, and hippocampus, and enhanced FC between the dlPFC and the periaqueductal gray, two regions involved in descending pain modulation. Accordingly, our results provide novel evidence for GM abnormalities in sensory, motor, emotional, cognitive, and pain modulatory regions in children with CRPS. Furthermore, this is the first study to demonstrate rapid treatment-induced GM and FC changes in areas implicated in sensation, emotion, cognition, and pain modulation.
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Affiliation(s)
- Nathalie Erpelding
- P.A.I.N. Group, Boston Children's Hospital, Center for Pain and the Brain, 9 Hope Avenue, Waltham, MA, 02453, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Laura Simons
- P.A.I.N. Group, Boston Children's Hospital, Center for Pain and the Brain, 9 Hope Avenue, Waltham, MA, 02453, USA
- Harvard Medical School, Boston, MA, USA
| | - Alyssa Lebel
- P.A.I.N. Group, Boston Children's Hospital, Center for Pain and the Brain, 9 Hope Avenue, Waltham, MA, 02453, USA
- Harvard Medical School, Boston, MA, USA
| | - Paul Serrano
- P.A.I.N. Group, Boston Children's Hospital, Center for Pain and the Brain, 9 Hope Avenue, Waltham, MA, 02453, USA
| | - Melissa Pielech
- P.A.I.N. Group, Boston Children's Hospital, Center for Pain and the Brain, 9 Hope Avenue, Waltham, MA, 02453, USA
| | - Sanjay Prabhu
- Harvard Medical School, Boston, MA, USA
- Department of Radiology, Boston Children's Hospital, Boston, MA, USA
| | - Lino Becerra
- P.A.I.N. Group, Boston Children's Hospital, Center for Pain and the Brain, 9 Hope Avenue, Waltham, MA, 02453, USA
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
- McLean Hospital, Belmont, MA, USA
| | - David Borsook
- P.A.I.N. Group, Boston Children's Hospital, Center for Pain and the Brain, 9 Hope Avenue, Waltham, MA, 02453, USA
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
- McLean Hospital, Belmont, MA, USA
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Edinger LK, Schwartzman RJ. Gardner-Diamond syndrome associated with complex regional pain syndrome. J Dermatol Case Rep 2013; 7:10-4. [PMID: 23580908 DOI: 10.3315/jdcr.2013.1128] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 08/06/2012] [Indexed: 01/15/2023]
Abstract
BACKGROUND Gardner-Diamond syndrome (GDS) is also known as psychogenic purpura, autoerythrocyte sensitization syndrome and painful bruising syndrome. MAIN OBSERVATION This is a case report of 27-year-old woman who presented with unexplained bruising and intramuscular hematomas after a seven year history of complex regional pain syndrome. Her evaluation consisted of hematological studies, skin and muscle biopsy; it failed to reveal an underlying coagulopathy, vasculitis or other demonstrable cause. In the absence of any other etiology, she was diagnosed as Gardner-Diamond syndrome. CONCLUSIONS This patient is unique because of intramuscular hematomas and the association of Complex regional pain syndrome with Gardner-Diamond syndrome.
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Affiliation(s)
- Lara K Edinger
- Drexel University College of Medicine, Department of Neurology, Philadelphia, PA, USA
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Marinus J, Moseley GL, Birklein F, Baron R, Maihöfner C, Kingery WS, van Hilten JJ. Clinical features and pathophysiology of complex regional pain syndrome. Lancet Neurol 2011; 10:637-48. [PMID: 21683929 DOI: 10.1016/s1474-4422(11)70106-5] [Citation(s) in RCA: 413] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A complex regional pain syndrome (CRPS)--multiple system dysfunction, severe and often chronic pain, and disability--can be triggered by a minor injury, a fact that has fascinated scientists and perplexed clinicians for decades. However, substantial advances across several medical disciplines have recently improved our understanding of CRPS. Compelling evidence implicates biological pathways that underlie aberrant inflammation, vasomotor dysfunction, and maladaptive neuroplasticity in the clinical features of CRPS. Collectively, the evidence points to CRPS being a multifactorial disorder that is associated with an aberrant host response to tissue injury. Variation in susceptibility to perturbed regulation of any of the underlying biological pathways probably accounts for the clinical heterogeneity of CRPS.
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Affiliation(s)
- Johan Marinus
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands, TREND Knowledge Consortium, Leiden, Netherlands.
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