1
|
Batalla MAP, Lewis JS. Cognitive Multisensory Rehabilitation, a novel approach for Complex Regional Pain Syndrome: case series. Physiother Theory Pract 2024:1-15. [PMID: 39267348 DOI: 10.1080/09593985.2024.2393213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 07/25/2024] [Accepted: 08/11/2024] [Indexed: 09/17/2024]
Abstract
INTRODUCTION Effective treatment for Complex Regional Pain Syndrome (CRPS), a chronic pain condition, is challenging. Cognitive Multisensory Rehabilitation (CMR) is a cognitive and sensorimotor treatment approach aimed at restoring function that targets cognitive, somatosensory, and multisensory functions through sensory discrimination tasks. PURPOSE We aimed to apply CMR to treat CRPS within our clinical practice. Clinically, we have found promising results in reducing pain and other common features of CRPS, such as Body Perception Disturbances (BPD). METHODS In this clinical case series, four CRPS patients who participated in a two-week interdisciplinary CRPS rehabilitation program at the National Complex Regional Pain Syndrome Service in Bath, UK received CMR as part of their treatment. A combination of self-reported measures and clinical outcomes were collected pre and post-rehabilitation program. RESULTS Functional improvements and a reduction on BPD were observed in all clinical cases. DISCUSSION We demonstrate how CMR may improve several CRPS-related features that often hinder rehabilitation in people living with CRPS. CONCLUSION Research involving larger cohorts are necessary to provide empirical evidence of the application of CMR in treating CRPS.
Collapse
Affiliation(s)
- Marc A Pique Batalla
- National Complex Regional Pain Syndrome Service, Royal United Hospital Bath NHS Trust, Bath, UK
- School of Health and social Wellbeing, University of the West of England, Bristol, UK
| | - Jennifer S Lewis
- National Complex Regional Pain Syndrome Service, Royal United Hospital Bath NHS Trust, Bath, UK
- School of Health and social Wellbeing, University of the West of England, Bristol, UK
| |
Collapse
|
2
|
Tomić A, Ječmenica Lukić M, Petrović I, Korkut V, Kresojević N, Marković V, Dragašević Mišković N, Svetel M, Kostić VS. Motor imagery ability in patients with functional dystonia. J Psychosom Res 2024; 187:111911. [PMID: 39244967 DOI: 10.1016/j.jpsychores.2024.111911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 08/06/2024] [Accepted: 08/31/2024] [Indexed: 09/10/2024]
Abstract
INTRODUCTION Motor imagery (MI) involves recreating a movement mentally without physically performing the movement itself. MI has a positive impact on motor performance, motor learning and neural plasticity. We analysed the connection between motor imagination and altered movement execution in individuals with dystonia, a complex sensorimotor disorder. The aim of our study was to examine MI ability in patients with functional dystonia (FD) in comparison to organic dystonia (OD). METHODS Our case-control study involved 46 patients, 22 with FD and 24 with OD. The assessment consisted of specific questionnaire and standardized motor, cognitive and psychiatric scales. The KVIQ-20 was used to test MI in each patient. RESULTS Patients with FD scored lower on both global visual and kinaesthetic scales of the KVIQ-20 exam compared to patients with OD (63.1 ± 18.5 vs. 73.7 ± 13.2, and 54.9 ± 21.9 vs. 68.8 ± 18.2, respectively). Patients with FD also exhibited visual and/or kinaesthetic MI impairment in different body segments. The internal perspective when imagining movements was preferred in both patients with FD and OD. CONCLUSION FD patients showed global dysfunction of visual and kinaesthetic MI abilities. Techniques for MI improvements might have a potential role in dystonia rehabilitation.
Collapse
Affiliation(s)
- Aleksandra Tomić
- Movement Disorders Department, Clinic for Neurology, University Clinical Center of Serbia, Dr Subotića starijeg 6, 11000 Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Dr Subotića starijeg 8, 11000 Belgrade, Serbia
| | - Milica Ječmenica Lukić
- Movement Disorders Department, Clinic for Neurology, University Clinical Center of Serbia, Dr Subotića starijeg 6, 11000 Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Dr Subotića starijeg 8, 11000 Belgrade, Serbia
| | - Igor Petrović
- Movement Disorders Department, Clinic for Neurology, University Clinical Center of Serbia, Dr Subotića starijeg 6, 11000 Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Dr Subotića starijeg 8, 11000 Belgrade, Serbia
| | - Vladimir Korkut
- Faculty of Medicine, University of Belgrade, Dr Subotića starijeg 8, 11000 Belgrade, Serbia
| | - Nikola Kresojević
- Movement Disorders Department, Clinic for Neurology, University Clinical Center of Serbia, Dr Subotića starijeg 6, 11000 Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Dr Subotića starijeg 8, 11000 Belgrade, Serbia
| | - Vladana Marković
- Movement Disorders Department, Clinic for Neurology, University Clinical Center of Serbia, Dr Subotića starijeg 6, 11000 Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Dr Subotića starijeg 8, 11000 Belgrade, Serbia
| | - Nataša Dragašević Mišković
- Movement Disorders Department, Clinic for Neurology, University Clinical Center of Serbia, Dr Subotića starijeg 6, 11000 Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Dr Subotića starijeg 8, 11000 Belgrade, Serbia
| | - Marina Svetel
- Movement Disorders Department, Clinic for Neurology, University Clinical Center of Serbia, Dr Subotića starijeg 6, 11000 Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Dr Subotića starijeg 8, 11000 Belgrade, Serbia
| | - Vladimir S Kostić
- Movement Disorders Department, Clinic for Neurology, University Clinical Center of Serbia, Dr Subotića starijeg 6, 11000 Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Dr Subotića starijeg 8, 11000 Belgrade, Serbia; Serbian Academy of Sciences and Arts, Kneza Mihaila 35, 11000 Belgrade, Serbia.
| |
Collapse
|
3
|
Vittersø AD, Halicka M, Buckingham G, Proulx MJ, Bultitude JH. The sensorimotor theory of pathological pain revisited. Neurosci Biobehav Rev 2022; 139:104735. [PMID: 35705110 DOI: 10.1016/j.neubiorev.2022.104735] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/13/2022] [Accepted: 06/07/2022] [Indexed: 01/31/2023]
Abstract
Harris (1999) proposed that pain can arise in the absence of tissue damage because changes in the cortical representation of the painful body part lead to incongruences between motor intention and sensory feedback. This idea, subsequently termed the sensorimotor theory of pain, has formed the basis for novel treatments for pathological pain. Here we review the evidence that people with pathological pain have changes to processes contributing to sensorimotor function: motor function, sensory feedback, cognitive representations of the body and its surrounding space, multisensory processing, and sensorimotor integration. Changes to sensorimotor processing are most evident in the form of motor deficits, sensory changes, and body representations distortions, and for Complex Regional Pain Syndrome (CRPS), fibromyalgia, and low back pain. Many sensorimotor changes are related to cortical processing, pain, and other clinical characteristics. However, there is very limited evidence that changes in sensorimotor processing actually lead to pain. We therefore propose that the theory is more appropriate for understanding why pain persists rather than how it arises.
Collapse
Affiliation(s)
- Axel D Vittersø
- Centre for Pain Research, University of Bath, Bath, Somerset, United Kingdom; Department of Psychology, University of Bath, Bath, Somerset, United Kingdom; Department of Sport & Health Sciences, University of Exeter, Exeter, Devon, United Kingdom; Department of Psychology, Oslo New University College, Oslo, Norway.
| | - Monika Halicka
- Centre for Pain Research, University of Bath, Bath, Somerset, United Kingdom; Department of Psychology, University of Bath, Bath, Somerset, United Kingdom
| | - Gavin Buckingham
- Department of Sport & Health Sciences, University of Exeter, Exeter, Devon, United Kingdom
| | - Michael J Proulx
- Department of Psychology, University of Bath, Bath, Somerset, United Kingdom; Centre for Real and Virtual Environments Augmentation Labs, Department of Computer Science, University of Bath, Bath, Somerset, United Kingdom
| | - Janet H Bultitude
- Centre for Pain Research, University of Bath, Bath, Somerset, United Kingdom; Department of Psychology, University of Bath, Bath, Somerset, United Kingdom
| |
Collapse
|
4
|
Lee B, Di Pietro F, Henderson LA, Austin PJ. Altered basal ganglia infraslow oscillation and resting functional connectivity in complex regional pain syndrome. J Neurosci Res 2022; 100:1487-1505. [PMID: 35441738 PMCID: PMC9543905 DOI: 10.1002/jnr.25057] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/03/2022] [Accepted: 04/05/2022] [Indexed: 11/06/2022]
Abstract
Complex regional pain syndrome (CRPS) is a painful condition commonly accompanied by movement disturbances and often affects the upper limbs. The basal ganglia motor loop is central to movement, however, non-motor basal ganglia loops are involved in pain, sensory integration, visual processing, cognition, and emotion. Systematic evaluation of each basal ganglia functional loop and its relation to motor and non-motor disturbances in CRPS has not been investigated. We recruited 15 upper limb CRPS and 45 matched healthy control subjects. Using functional magnetic resonance imaging, infraslow oscillations (ISO) and resting-state functional connectivity in motor and non-motor basal ganglia loops were investigated using putamen and caudate seeds. Compared to controls, CRPS subjects displayed increased ISO power in the putamen contralateral to the CRPS affected limb, specifically, in contralateral putamen areas representing the supplementary motor area hand, motor hand, and motor tongue. Furthermore, compared to controls, CRPS subjects displayed increased resting connectivity between these putaminal areas as well as from the caudate body to cortical areas such as the primary motor cortex, supplementary and cingulate motor areas, parietal association areas, and the orbitofrontal cortex. These findings demonstrate changes in basal ganglia loop function in CRPS subjects and may underpin motor disturbances of CRPS.
Collapse
Affiliation(s)
- Barbara Lee
- School of Medical Sciences and Brain and Mind Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Flavia Di Pietro
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia.,Curtin Health Innovation Research Institute, Curtin University, Bentley, Western Australia, Australia
| | - Luke A Henderson
- School of Medical Sciences and Brain and Mind Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Paul J Austin
- School of Medical Sciences and Brain and Mind Centre, University of Sydney, Camperdown, New South Wales, Australia
| |
Collapse
|
5
|
Strauss S, Barby S, Härtner J, Neumann N, Moseley GL, Lotze M. Modifications in fMRI Representation of Mental Rotation Following a 6 Week Graded Motor Imagery Training in Chronic CRPS Patients. THE JOURNAL OF PAIN 2021; 22:680-691. [PMID: 33421590 DOI: 10.1016/j.jpain.2020.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/23/2020] [Accepted: 12/11/2020] [Indexed: 10/22/2022]
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.
Collapse
Affiliation(s)
- Sebastian Strauss
- Functional Imaging Unit, Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Germany; Department of Neurology, University Medicine Greifswald, Germany
| | - Silke Barby
- Functional Imaging Unit, Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Germany
| | - Jonas Härtner
- Functional Imaging Unit, Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Germany
| | - Nicola Neumann
- Functional Imaging Unit, Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Germany
| | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Adelaide, Australia
| | - Martin Lotze
- Functional Imaging Unit, Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Germany.
| |
Collapse
|
6
|
Abstract
Complex regional pain syndrome (CRPS) develops after-limb injury, with persistent pain and deficits in movement frequently co-occurring. The striatum is critical for mediating multiple mechanisms that are often aberrant in CRPS, which includes sensory and pain processing, motor function, and goal-directed behaviors associated with movement. Yet, much remains unknown with regards to the morphological and functional properties of the striatum and its subregions in this disease. Thus, we investigated 20 patients (15 female, age 58 ± 9 years, right-handed) diagnosed with chronic (6+ months of pain duration) CRPS in the right hand and 20 matched, healthy controls with anatomical and resting-state, functional magnetic resonance imaging. In addition, a comprehensive clinical and behavioral evaluation was performed, where each participant's pain, motor function, and medical history were assessed. Complex regional pain syndrome patients harbored significant abnormalities in hand coordination, dexterity, and strength. These clinical pain- and movement-related findings in CRPS patients were concomitant with bilateral decreases in gray matter density in the putamen as well as functional connectivity increases and decreases among the putamen and pre-/postcentral gyri and cerebellum, respectively. Importantly, higher levels of clinical pain and motor impairment were associated with increased putamen-pre-/postcentral gyri functional connectivity strengths. Collectively, these findings suggest that putaminal alterations, specifically the functional interactions with sensorimotor structures, may underpin clinical pain and motor impairment in chronic CRPS patients.
Collapse
|
7
|
Hirakawa Y, Fujiwara A, Imai R, Hiraga Y, Morioka S. Clinical Intervention Using Body Shadows for a Patient with Complex Regional Pain Syndrome Who Reported Severe Pain and Self-Disgust Toward the Affected Site: A Case Report. J Pain Res 2020; 13:971-977. [PMID: 32440203 PMCID: PMC7213788 DOI: 10.2147/jpr.s236786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 04/10/2020] [Indexed: 11/27/2022] Open
Abstract
A woman in her thirties developed complex regional pain syndrome in her left shoulder due to a traffic accident. She demonstrated autonomic nervous symptoms (swelling, sweating, and skin color asymmetry) in her left hand, severe allodynia, neglect-like symptoms (NLS), impaired body image associated with impaired body awareness, and functional impairment of the left shoulder and elbow. She also reported physical self-disgust toward her affected limb, describing it as “reptilian,” as well as aversion to touching others; this body awareness exacerbated her pain and NLS. We therefore conducted stepwise interventions using body shadows. The intervention did not trigger physical self-disgust, enabling formation of body ownership and a body image unaccompanied by pain. Consequently, the patient showed improvements in pain, NLS, and autonomic nervous symptoms.
Collapse
Affiliation(s)
- Yoshiyuki Hirakawa
- Department of Rehabilitation, Fukuoka Rehabilitation Hospital, Fukuoka City, Fukuoka, Japan
| | - Akira Fujiwara
- Department of Orthopedics, Fukuoka Reha Orthopedic Clinic, Fukuoka City, Fukuoka, Japan
| | - Ryota Imai
- School of Rehabilitation, Osaka Kawasaki Rehabilitation University, Kaizuka City, Osaka, Japan.,Department of Occupational Therapy, International Univesrity of Health and Welfare, Okawa,Fukuoka, Japan
| | - Yuki Hiraga
- Department of Rehabilitation, Fukuoka Rehabilitation Hospital, Fukuoka City, Fukuoka, Japan.,Neurorehabilitation Research Centre, Kio University, Nara, City, Nara, Japan
| | - Shu Morioka
- Department of Occupational Therapy, International Univesrity of Health and Welfare, Okawa,Fukuoka, Japan.,Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, Nara City, Nara, Japan
| |
Collapse
|
8
|
Abstract
In this chapter, we provide an overview of neuroimaging studies in chronic pain. We start with an introduction about the phenomenology of pain. In the following section, the application of functional and structural imaging techniques is shown in selected chronic pain syndromes (chronic back pain, fibromyalgia syndrome (FMS), phantom limb pain, and complex regional pain syndrome (CRPS)), and commonalities and peculiarities of imaging correlates across different types of chronic pain are discussed. We conclude this chapter with implications for treatments, with focus on behavioral interventions, sensory and motor trainings, and mirror and motor imagery trainings.
Collapse
Affiliation(s)
- Martin Diers
- Clinical and Experimental Behavioral Medicine, Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr University Bochum, Alexandrinenstrasse 1-3, 44791, Bochum, Germany.
| |
Collapse
|
9
|
Popkirov S, Hoeritzauer I, Colvin L, Carson AJ, Stone J. Complex regional pain syndrome and functional neurological disorders - time for reconciliation. J Neurol Neurosurg Psychiatry 2019; 90:608-614. [PMID: 30355604 DOI: 10.1136/jnnp-2018-318298] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 09/27/2018] [Accepted: 09/28/2018] [Indexed: 12/17/2022]
Abstract
There have been many articles highlighting differences and similarities between complex regional pain syndrome (CRPS) and functional neurological disorders (FND) but until now the discussions have often been adversarial with an erroneous focus on malingering and a view of FND as 'all in the mind'. However, understanding of the nature, frequency and treatment of FND has changed dramatically in the last 10-15 years. FND is no longer assumed to be only the result of 'conversion' of psychological conflict but is understood as a complex interplay between physiological stimulus, expectation, learning and attention mediated through a Bayesian framework, with biopsychosocial predisposing, triggering and perpetuating inputs. Building on this new 'whole brain' perspective of FND, we reframe the debate about the 'psychological versus physical' basis of CRPS. We recognise how CRPS research may inform mechanistic understanding of FND and conversely, how advances in FND, especially treatment, have implications for improving understanding and management of CRPS.
Collapse
Affiliation(s)
- Stoyan Popkirov
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - Ingrid Hoeritzauer
- Centre for Clinical Brain Sciences, Western General Hospital, NHS Lothian and University of Edinburgh, Edinburgh, UK
| | - Lesley Colvin
- Division of Population Health Sciences and Genomics, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Alan J Carson
- Centre for Clinical Brain Sciences, Western General Hospital, NHS Lothian and University of Edinburgh, Edinburgh, UK
| | - Jon Stone
- Centre for Clinical Brain Sciences, Western General Hospital, NHS Lothian and University of Edinburgh, Edinburgh, UK
| |
Collapse
|
10
|
Katayama O, Tsukamoto T, Osumi M, Kodama T, Morioka S. Neural Mechanism of Altered Limb Perceptions Caused by Temporal Sensorimotor Incongruence. Front Behav Neurosci 2018; 12:282. [PMID: 30515087 PMCID: PMC6255791 DOI: 10.3389/fnbeh.2018.00282] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 11/05/2018] [Indexed: 12/30/2022] Open
Abstract
Previous studies have demonstrated that patients with strokes or pathological pain suffer distorted limb ownership and an inability to perceive their affected limbs as a part of their bodies. These disturbances are apparent in experiments showing time delays between motor commands and visual feedback. The experimental paradigm manipulating temporal delay is considered possible to clarify, in detail, the degree of altered limb perception, peculiarity and movement disorders that are caused by temporal sensorimotor incongruence. However, the neural mechanisms of these body perceptions, peculiarity and motor control remain unknown. In this experiment, we used exact low-resolution brain electromagnetic tomography (eLORETA) with independent component analysis (ICA) to clarify the neural mechanisms of altered limb perceptions caused by temporal sensorimotor incongruence. Seventeen healthy participants were recruited, and temporal sensorimotor incongruence was systematically evoked using a visual feedback delay system. Participants periodically extended their right wrists while viewing video images of their hands that were delayed by 0, 150, 250, 350 and 600 ms. To investigate neural mechanisms, altered limb perceptions were then rated using the 7-point Likert scale and brain activities were concomitantly examined with electroencephalographic (EEG) analyses using eLORETA-ICA. These experiments revealed that peculiarities are caused prior to perceptions of limb loss and heaviness. Moreover, we show that supplementary motor and parietal association areas are involved in changes of peculiarity, limb loss, heaviness and movement accuracy due to temporal sensorimotor incongruence. We suggest that abnormalities in these areas contribute to neural mechanisms that modify altered limb perceptions and movement accuracy.
Collapse
Affiliation(s)
- Osamu Katayama
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, Nara, Japan.,Department of Rehabilitation, Watanabe Hospital, Aichi, Japan
| | - Tatsuya Tsukamoto
- Department of Undergraduate School of Health Sciences, Kio University, Nara, Japan
| | - Michihiro Osumi
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, Nara, Japan.,Department of Neurorehabilitation Research Center, Kio University, Nara, Japan
| | - Takayuki Kodama
- Department of Physical Therapy, Graduate School of Health Sciences, Kyoto Tachibana University, Kyoto, Japan
| | - Shu Morioka
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, Nara, Japan.,Department of Neurorehabilitation Research Center, Kio University, Nara, Japan
| |
Collapse
|
11
|
Kim JH, Park JS, Park D. Anti-allodynic effect of interleukin 10 in a mouse model of complex regional pain syndrome through reduction of NK1 receptor expression of microglia in the spinal cord. J Pain Res 2018; 11:1729-1741. [PMID: 30233230 PMCID: PMC6129024 DOI: 10.2147/jpr.s166624] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background To date, there has been no study on the effects of interleukin-10 (IL-10) on complex regional pain syndrome (CRPS) rodent models, despite the anti-allodynic effect of IL-10 in previous studies. Thus, the aim of this study was to investigate the effect of IL-10 in a CRPS mouse model and find whether early inhibition of neuro-inflammation by IL-10 administration, which is considered to be one of the important mechanisms in the generation of central sensitization, could prevent the transition from the acute stage to the chronic stage of CRPS. Method A mouse model of CRPS (n=6/group) involving tibia fracture/cast immobilization to test the efficacy of intrathecal IL-10 (0.3 μg/5 μL-1 day-1 for 7 days) or vehicle during the acute (3 weeks after fracture) stage of CRPS. Results Intrathecal recombinant IL-10 (rIL-10) administration was anti-allodynic in the acute stage of the CRPS mouse model, and these anti-allodynic effects of IL-10 developed by modulating microglial activation and decreasing NK1 receptor expression in the spinal cord. However, intrathecal rIL-10 administration in the acute stage of the CRPS mouse model cannot prevent the transition to the chronic stage of CRPS in the acute stage of CRPS. Conclusion Collectively, these results demonstrate that intrathecally administered rIL-10 attenuates mechanical allodynia in the CRPS mouse model. However, this effect of IL-10 on allodynia in the acute stage of CRPS was not sufficient to prevent the transition to the chronic stage of CRPS. In the future, further studies about the mechanisms of central sensitization in CRPS will be necessary.
Collapse
Affiliation(s)
- Jong-Heon Kim
- Department of Pharmacology, Brain Science and Engineering Institute, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jin-Sung Park
- Department of Neurology, School of Medicine, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Donghwi Park
- Department of Rehabilitation Medicine, Daegu Fatima Hospital, Daegu, Republic of Korea, .,Department of Pharmacology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea,
| |
Collapse
|
12
|
Chang WJ, O'Connell NE, Beckenkamp PR, Alhassani G, Liston MB, Schabrun SM. Altered Primary Motor Cortex Structure, Organization, and Function in Chronic Pain: A Systematic Review and Meta-Analysis. THE JOURNAL OF PAIN 2018; 19:341-359. [DOI: 10.1016/j.jpain.2017.10.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 10/15/2017] [Accepted: 10/19/2017] [Indexed: 01/14/2023]
|
13
|
Merchant SHI. Evidence already exists for motor system reorganization in CRPS. Can J Pain 2018; 2:27-29. [PMID: 35005362 PMCID: PMC8730546 DOI: 10.1080/24740527.2017.1422976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 12/28/2017] [Accepted: 12/28/2017] [Indexed: 11/14/2022]
Abstract
Complex regional pain syndrome (CRPS) is a disabling condition that is usually preceded by trauma or surgical procedure. Involvement of the motor system is a well-known phenomenon in CRPS, though the pathophysiologic mechanisms of motor system affliction in CRPS are poorly understood. Graded motor imagery (GMI) has been proposed to be one of the therapeutic interventions to help improve pain and other disabling symptoms associated with CRPS, though the benefits noted are modest and inconsistent. The neurophysiological mechanisms implicated in motor imagery are intended to target the aberrant prefrontal and sensorimotor integration areas, which may potentially help restore the aberrant cortical plasticity in CRPS. Detailed well-controlled experiments using insights from the existing body of literature on motor system reorganization in CRPS are required to better understand this complicated disorder. Attempts to gain pathophysiologic insights about complicated disorders like CRPS based on case reports with poorly performed and uncontrolled interventions are misguided.
Collapse
Affiliation(s)
- Shabbir Hussain I. Merchant
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| |
Collapse
|
14
|
Upadhyay J, Geber C, Hargreaves R, Birklein F, Borsook D. A critical evaluation of validity and utility of translational imaging in pain and analgesia: Utilizing functional imaging to enhance the process. Neurosci Biobehav Rev 2018; 84:407-423. [PMID: 28807753 PMCID: PMC5729102 DOI: 10.1016/j.neubiorev.2017.08.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 05/22/2017] [Accepted: 08/04/2017] [Indexed: 02/07/2023]
Abstract
Assessing clinical pain and metrics related to function or quality of life predominantly relies on patient reported subjective measures. These outcome measures are generally not applicable to the preclinical setting where early signs pointing to analgesic value of a therapy are sought, thus introducing difficulties in animal to human translation in pain research. Evaluating brain function in patients and respective animal model(s) has the potential to characterize mechanisms associated with pain or pain-related phenotypes and thereby provide a means of laboratory to clinic translation. This review summarizes the progress made towards understanding of brain function in clinical and preclinical pain states elucidated using an imaging approach as well as the current level of validity of translational pain imaging. We hypothesize that neuroimaging can describe the central representation of pain or pain phenotypes and yields a basis for the development and selection of clinically relevant animal assays. This approach may increase the probability of finding meaningful new analgesics that can help satisfy the significant unmet medical needs of patients.
Collapse
Affiliation(s)
| | - Christian Geber
- Department of Neurology, University Medical Centre Mainz, Mainz, Germany; DRK Schmerz-Zentrum Mainz, Mainz, Germany
| | - Richard Hargreaves
- Center for Pain and the Brain, United States; Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston Harvard Medical School, Boston, MA 02115, United States
| | - Frank Birklein
- Department of Neurology, University Medical Centre Mainz, Mainz, Germany
| | - David Borsook
- Center for Pain and the Brain, United States; Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston Harvard Medical School, Boston, MA 02115, United States.
| |
Collapse
|
15
|
Hotta J, Saari J, Koskinen M, Hlushchuk Y, Forss N, Hari R. Abnormal Brain Responses to Action Observation in Complex Regional Pain Syndrome. THE JOURNAL OF PAIN 2016; 18:255-265. [PMID: 27847313 DOI: 10.1016/j.jpain.2016.10.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 08/30/2016] [Accepted: 10/28/2016] [Indexed: 12/29/2022]
Abstract
Patients with complex regional pain syndrome (CRPS) display various abnormalities in central motor function, and their pain is intensified when they perform or just observe motor actions. In this study, we examined the abnormalities of brain responses to action observation in CRPS. We analyzed 3-T functional magnetic resonance images from 13 upper limb CRPS patients (all female, ages 31-58 years) and 13 healthy, age- and sex-matched control subjects. The functional magnetic resonance imaging data were acquired while the subjects viewed brief videos of hand actions shown in the first-person perspective. A pattern-classification analysis was applied to characterize brain areas where the activation pattern differed between CRPS patients and healthy subjects. Brain areas with statistically significant group differences (q < .05, false discovery rate-corrected) included the hand representation area in the sensorimotor cortex, inferior frontal gyrus, secondary somatosensory cortex, inferior parietal lobule, orbitofrontal cortex, and thalamus. Our findings indicate that CRPS impairs action observation by affecting brain areas related to pain processing and motor control. PERSPECTIVE This article shows that in CRPS, the observation of others' motor actions induces abnormal neural activity in brain areas essential for sensorimotor functions and pain. These results build the cerebral basis for action-observation impairments in CRPS.
Collapse
Affiliation(s)
- Jaakko Hotta
- Systems and Clinical Neuroscience, Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland; Aalto NeuroImaging, Aalto University School of Science, Espoo, Finland; Department of Neurology, Helsinki University Hospital, and Clinical Neurosciences, Neurology, University of Helsinki, Finland.
| | - Jukka Saari
- Systems and Clinical Neuroscience, Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland
| | - Miika Koskinen
- Systems and Clinical Neuroscience, Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland; Department of Physiology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Yevhen Hlushchuk
- Systems and Clinical Neuroscience, Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland; HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Nina Forss
- Systems and Clinical Neuroscience, Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland; Department of Neurology, Helsinki University Hospital, and Clinical Neurosciences, Neurology, University of Helsinki, Finland
| | - Riitta Hari
- Systems and Clinical Neuroscience, Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland; Department of Art, Aalto University School of Arts, Design and Architecture, Helsinki, Finland
| |
Collapse
|
16
|
Wolny T, Saulicz E, Linek P, Myśliwiec A. Two-point discrimination and kinesthetic sense disorders in productive age individuals with carpal tunnel syndrome. J Occup Health 2016; 58:289-96. [PMID: 27108640 PMCID: PMC5356953 DOI: 10.1539/joh.15-0108-oa] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Objectives: The aim of this study was to evaluate two-point discrimination (2PD) sense and kinesthetic sense dysfunctions in carpal tunnel syndrome (CTS) patients compared with a healthy group. Methods: The 2PD sense, muscle force, and kinesthetic differentiation (KD) of strength; the range of motion in radiocarpal articulation; and KD of motion were assessed. Results: The 2PD sense assessment showed significantly higher values in all the examined fingers in the CTS group than in those in the healthy group (p<0.01). There was a significant difference in the percentage value of error in KD of pincer and cylindrical grip (p<0.01) as well as in KD of flexion and extension movement in the radiocarpal articulation (p<0.01) between the studied groups. Conclusions: There are significant differences in the 2PD sense and KD of strength and movement between CTS patients compared with healthy individuals.
Collapse
Affiliation(s)
- Tomasz Wolny
- Department of Kinesiotherapy and Special Physiotherapy Methods, The Jerzy Kukuczka Academy of Physical Education
| | | | | | | |
Collapse
|
17
|
de Souza NS, Martins ACG, Bastos VHDV, Orsini M, Leite MAA, Teixeira S, Velasques B, Ribeiro P, Bittencourt J, Matta APDC, Filho PM. Motor Imagery and Its Effect on Complex Regional Pain Syndrome: An Integrative Review. Neurol Int 2015; 7:5962. [PMID: 26788264 PMCID: PMC4704470 DOI: 10.4081/ni.2015.5962] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 08/21/2015] [Accepted: 11/12/2015] [Indexed: 01/15/2023] Open
Abstract
The motor imagery (MI) has been proposed as a treatment in the complex regional pain syndrome type 1 (CRPS-1), since it seems to promote a brain reorganization effect on sensory-motor areas of pain perception. The aim of this paper is to investigate, through an integrative critical review, the influence of MI on the CRPS-1, correlating their evidence to clinical practice. Research in PEDro, Medline, Bireme and Google Scholar databases was conducted. Nine randomized controlled trials (level 2), 1 non-controlled clinical study (level 3), 1 case study (level 4), 1 systematic review (level 1), 2 review articles and 1 comment (level 5) were found. We can conclude that MI has shown effect in reducing pain and functionality that remains after 6 months of treatment. However, the difference between the MI strategies for CRPS-1 is unknown as well as the intensity of mental stress influences the painful response or effect of MI or other peripheral neuropathies.
Collapse
Affiliation(s)
- Nélio Silva de Souza
- University Center Serra dos Órgãos, Teresópolis; Science of Rehabilitation, Centro Universitário Augusto Motta, Rio de Janeiro
| | - Ana Carolina Gomes Martins
- University Center Serra dos Órgãos, Teresópolis; Integrated Health of Women and Children, Fluminense Federal University, Niterói
| | - Victor Hugo do Vale Bastos
- Science of Rehabilitation, Centro Universitário Augusto Motta, Rio de Janeiro; Department of Neurology, Antônio Pedro University Hospital, Fluminense Federal University, Niterói; Biomedical Sciences stricto sensu, Federal University of Piauí
| | - Marco Orsini
- Science of Rehabilitation, Centro Universitário Augusto Motta, Rio de Janeiro; Severino Sombra University Center, Medicine Department, Vassouras, Rio de Janeiro
| | - Marco Antônio A Leite
- Fluminense Federal University Medical School, Niterói; Movement Disorders Unit, Antônio Pedro University Hospital, Fluminense Federal University, Niterói
| | | | - Bruna Velasques
- Brain Mapping and Sensory Motor Integration, Institute of Psychiatry of Federal University of Rio de Janeiro; Institute of Applied Neuroscience, Rio de Janeiro, Brazil
| | - Pedro Ribeiro
- Brain Mapping and Sensory Motor Integration, Institute of Psychiatry of Federal University of Rio de Janeiro; Institute of Applied Neuroscience, Rio de Janeiro, Brazil
| | - Juliana Bittencourt
- Brain Mapping and Sensory Motor Integration, Institute of Psychiatry of Federal University of Rio de Janeiro
| | | | - Pedro Moreira Filho
- Department of Neurology, Antônio Pedro University Hospital, Fluminense Federal University , Niterói
| |
Collapse
|
18
|
Imai R, Osumi M, Morioka S. Influence of illusory kinesthesia by vibratory tendon stimulation on acute pain after surgery for distal radius fractures: a quasi-randomized controlled study. Clin Rehabil 2015. [PMID: 26198893 DOI: 10.1177/0269215515593610] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: We investigated the effects of inducing an illusion of motion by tendon vibration on sensory and emotional aspects of pain and range of motion in patients with fractures of the distal radius. Design: A quasi-randomized controlled trial. Setting: Kawachi General Hospital, Japan. Subjects: A total of 26 patients with fractures of the distal radius were distributed quasi-randomly to either the illusory kinesthesia group ( n = 13) or control group ( n = 13). Intervention: The intervention was performed on seven consecutive days from postoperative Day 1. Evaluation was performed at seven days, one month, and two months after the surgery. Main measures: Data were collected for pain at rest, movement pain, the pain catastrophizing scale, the Hospital Anxiety and Depression Scale, and range of motion. Results: The illusory kinesthesia group reported improved pain at rest ( p < 0.001), movement pain ( p < 0.001), pain catastrophizing scale ( p < 0.001), Hospital Anxiety and Depression Scale ( p < 0.01), and range of motion ( p < 0.05) compared with the control group at seven days, one month, and two months after the surgery. The mean (SD) score of the visual analogue scale of pain at rest was 51.3 (16.8) at one day and 4.2 (4.7) at seven days in the illusory kinesthesia group, and 56.8 (22.1) at one day and 35.5 (16.2) at seven days in the control group. Conclusion: Illusory kinesthesia group improves the sensory and emotion aspects of pain in patients with fractures of the distal radius.
Collapse
Affiliation(s)
- Ryota Imai
- Department of Neurorehabilitation, Graduate School of Health Science, Kio University, Nara, Japan
- Department of Rehabilitation, Kawachi General Hospital, Osaka, Japan
| | - Michihiro Osumi
- Department of Neurorehabilitation, Graduate School of Health Science, Kio University, Nara, Japan
- Neuro Rehabilitation Research Center, Kio University, Nara, Japan
| | - Shu Morioka
- Department of Neurorehabilitation, Graduate School of Health Science, Kio University, Nara, Japan
- Neuro Rehabilitation Research Center, Kio University, Nara, Japan
| |
Collapse
|
19
|
|
20
|
Lee WH. Complex regional pain syndrome: time to study the supraspinal role? Korean J Pain 2015; 28:1-3. [PMID: 25589940 PMCID: PMC4293501 DOI: 10.3344/kjp.2015.28.1.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 12/17/2014] [Indexed: 01/15/2023] Open
Affiliation(s)
- Won Hyung Lee
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea
| |
Collapse
|
21
|
van Velzen GA, Marinus J, van Dijk JG, van Zwet EW, Schipper IB, van Hilten JJ. Motor Cortical Activity During Motor Tasks Is Normal in Patients With Complex Regional Pain Syndrome. THE JOURNAL OF PAIN 2015; 16:87-94. [DOI: 10.1016/j.jpain.2014.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 10/11/2014] [Accepted: 10/21/2014] [Indexed: 10/24/2022]
|
22
|
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.
Collapse
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
| |
Collapse
|
23
|
Perruchoud D, Murray MM, Lefebvre J, Ionta S. Focal dystonia and the Sensory-Motor Integrative Loop for Enacting (SMILE). Front Hum Neurosci 2014; 8:458. [PMID: 24999327 PMCID: PMC4064702 DOI: 10.3389/fnhum.2014.00458] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 06/04/2014] [Indexed: 12/12/2022] Open
Abstract
Performing accurate movements requires preparation, execution, and monitoring mechanisms. The first two are coded by the motor system, the latter by the sensory system. To provide an adaptive neural basis to overt behaviors, motor and sensory information has to be properly integrated in a reciprocal feedback loop. Abnormalities in this sensory-motor loop are involved in movement disorders such as focal dystonia, a hyperkinetic alteration affecting only a specific body part and characterized by sensory and motor deficits in the absence of basic motor impairments. Despite the fundamental impact of sensory-motor integration mechanisms on daily life, the general principles of healthy and pathological anatomic–functional organization of sensory-motor integration remain to be clarified. Based on the available data from experimental psychology, neurophysiology, and neuroimaging, we propose a bio-computational model of sensory-motor integration: the Sensory-Motor Integrative Loop for Enacting (SMILE). Aiming at direct therapeutic implementations and with the final target of implementing novel intervention protocols for motor rehabilitation, our main goal is to provide the information necessary for further validating the SMILE model. By translating neuroscientific hypotheses into empirical investigations and clinically relevant questions, the prediction based on the SMILE model can be further extended to other pathological conditions characterized by impaired sensory-motor integration.
Collapse
Affiliation(s)
- David Perruchoud
- Laboratory for Investigative Neurophysiology, Department of Radiology and Department of Clinical Neurosciences, University Hospital Center and University of Lausanne Lausanne, Switzerland
| | - Micah M Murray
- Laboratory for Investigative Neurophysiology, Department of Radiology and Department of Clinical Neurosciences, University Hospital Center and University of Lausanne Lausanne, Switzerland ; The Electroencephalography Brain Mapping Core, Center for Biomedical Imaging Lausanne, Switzerland
| | - Jeremie Lefebvre
- Laboratory for Investigative Neurophysiology, Department of Radiology and Department of Clinical Neurosciences, University Hospital Center and University of Lausanne Lausanne, Switzerland
| | - Silvio Ionta
- Laboratory for Investigative Neurophysiology, Department of Radiology and Department of Clinical Neurosciences, University Hospital Center and University of Lausanne Lausanne, Switzerland
| |
Collapse
|
24
|
Cerebral activations related to audition-driven performance imagery in professional musicians. PLoS One 2014; 9:e93681. [PMID: 24714661 PMCID: PMC3979724 DOI: 10.1371/journal.pone.0093681] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 03/10/2014] [Indexed: 11/18/2022] Open
Abstract
Functional Magnetic Resonance Imaging (fMRI) was used to study the activation of cerebral motor networks during auditory perception of music in professional keyboard musicians (n = 12). The activation paradigm implied that subjects listened to two-part polyphonic music, while either critically appraising the performance or imagining they were performing themselves. Two-part polyphonic audition and bimanual motor imagery circumvented a hemisphere bias associated with the convention of playing the melody with the right hand. Both tasks activated ventral premotor and auditory cortices, bilaterally, and the right anterior parietal cortex, when contrasted to 12 musically unskilled controls. Although left ventral premotor activation was increased during imagery (compared to judgment), bilateral dorsal premotor and right posterior-superior parietal activations were quite unique to motor imagery. The latter suggests that musicians not only recruited their manual motor repertoire but also performed a spatial transformation from the vertically perceived pitch axis (high and low sound) to the horizontal axis of the keyboard. Imagery-specific activations in controls were seen in left dorsal parietal-premotor and supplementary motor cortices. Although these activations were less strong compared to musicians, this overlapping distribution indicated the recruitment of a general 'mirror-neuron' circuitry. These two levels of sensori-motor transformations point towards common principles by which the brain organizes audition-driven music performance and visually guided task performance.
Collapse
|
25
|
Lecours A, Piché M. Complex regional pain syndrome: From diagnosis to rehabilitation. World J Anesthesiol 2014; 3:46-60. [DOI: 10.5313/wja.v3.i1.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 09/25/2013] [Accepted: 12/16/2013] [Indexed: 02/07/2023] Open
Abstract
Complex regional pain syndrome (CRPS) is a debilitating pathology characterised by intense chronic pain associated with vasomotor, sensory and motor dysfunction of the affected limb. Although the pathophysiology of CRPS is not fully understood, it is recognised that inflammatory processes and autonomic dysfunction are involved. These processes are associated with peripheral and central sensitisation as well as changes in brain structure and function, and are reflected in the clinical presentation of CRPS. CRPS management requires an interdisciplinary team and requires the therapeutic approach to be individualised. With regard to pharmacological treatment, bisphosphonates, corticosteroids, ketamine and anticonvulsants have been demonstrated to be effective for CRPS management. Psychotherapy, including cognitive-behavioural therapy, has produced promising results but more studies are needed to confirm its efficacy. Among rehabilitation interventions, there is evidence of the efficacy of physiotherapy and occupational therapy in diminishing CRPS symptoms and achieving a higher level of functioning. In this regard, the rehabilitation modality that seems the most promising according to the actual literature is graded motor imagery, which can help to reverse the maladaptive neuroplasticity occurring in CRPS.
Collapse
|
26
|
Borchers A, Gershwin M. Complex regional pain syndrome: A comprehensive and critical review. Autoimmun Rev 2014; 13:242-65. [DOI: 10.1016/j.autrev.2013.10.006] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2013] [Indexed: 12/19/2022]
|
27
|
Schilder JC, Sigtermans MJ, Schouten AC, Putter H, Dahan A, Noldus LP, Marinus J, van Hilten JJ. Pain Relief Is Associated With Improvement in Motor Function in Complex Regional Pain Syndrome Type 1: Secondary Analysis of a Placebo-Controlled Study on the Effects of Ketamine. THE JOURNAL OF PAIN 2013; 14:1514-21. [DOI: 10.1016/j.jpain.2013.07.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 07/09/2013] [Accepted: 07/11/2013] [Indexed: 01/24/2023]
|
28
|
Di Pietro F, McAuley JH, Parkitny L, Lotze M, Wand BM, Moseley GL, Stanton TR. Primary Motor Cortex Function in Complex Regional Pain Syndrome: A Systematic Review and Meta-Analysis. THE JOURNAL OF PAIN 2013; 14:1270-88. [DOI: 10.1016/j.jpain.2013.07.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 06/25/2013] [Accepted: 07/02/2013] [Indexed: 02/09/2023]
|
29
|
Erpelding N, Borsook D. Capturing brain metrics of neuropathic pain using nuclear magnetic resonance. Pain Manag 2013; 3:395-409. [PMID: 24654873 DOI: 10.2217/pmt.13.42] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
SUMMARY Neuropathic pain is typically caused by a lesion or dysfunction in the nervous system that results in both negative (i.e., reduced sensitivity) and positive symptoms (i.e., paraesthesia, spontaneous ongoing pain with shooting, electric shock-like sensations and abnormal responses to evoked pain). Intriguingly, chronic pain disorders manifest profound alterations in brain structure and function, and thus, modern nuclear magnetic resonance (NMR) techniques have allowed us to begin to dissect the complexities of how neuropathic pain affects the brain. NMR approaches can be used as an independent measure to improve our understanding of key changes in brain structure, function and chemistry in chronic neuropathic pain. Accordingly, NMR techniques provide neurobiological metrics that allow us to understand the neurobiological basis of chronic neuropathic pain. Additionally, although at an early stage, NMR methods can also be useful to define clinical metrics to predict chronification of neuropathic pain and responses to drugs. This article provides a review of NMR techniques and their capacity to study spontaneous pain and evoked pain, as well as structural, functional and neurochemical alterations that have repeatedly been associated with chronic neuropathic pain. Finally, the importance for quantifying disease state and treatment efficacy in neuropathic pain using NMR techniques is discussed.
Collapse
Affiliation(s)
- Nathalie Erpelding
- P.A.I.N. Group, Boston Children's Hospital, 9 Hope Avenue, Waltham, MA 02453, USA
| | | |
Collapse
|
30
|
Shin NY, Kang DH, Jang JH, Park SY, Hwang JY, Kim SN, Byun MS, Park HY, Kim YC. Impaired recognition of social emotion in patients with complex regional pain syndrome. THE JOURNAL OF PAIN 2013; 14:1304-9. [PMID: 23876283 DOI: 10.1016/j.jpain.2013.05.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 05/15/2013] [Accepted: 05/17/2013] [Indexed: 01/17/2023]
Abstract
UNLABELLED Multiple brain areas involved in nociceptive, autonomic, and social-emotional processing are disproportionally changed in patients with complex regional pain syndrome (CRPS). Little empirical evidence is available involving social cognitive functioning in patients with chronic pain conditions. We investigated the ability of patients with CRPS to recognize the mental/emotional states of other people. Forty-three patients with CRPS and 30 healthy controls performed the Reading Mind in the Eyes Test, which consists of photos in which human eyes express various emotional and mental states. Neuropsychological tests, including the Wisconsin Card Sorting Test, the stop-signal test, and the reaction time test, were administered to evaluate other cognitive functions. Patients with CRPS were significantly less accurate at recognizing emotional states in other persons, but not on other cognitive tests, compared with control subjects. We found a significant association between the deficit in social-emotion recognition and the affective dimension of pain, whereas this deficit was not related to the sensory dimension of pain. Our findings suggest a disrupted ability to recognize others' mental/emotional states in patients with CRPS. PERSPECTIVE This article demonstrated a deficit in inferring mental/emotional states of others in patients with CRPS that was related to pain affect. Our study suggests that additional interventions directed toward reducing distressful affective pain may be helpful to restore social cognitive processing in patients with CRPS.
Collapse
Affiliation(s)
- Na Young Shin
- Interdisciplinary Cognitive Science Program, Seoul National University, Seoul, Republic of Korea
| | | | | | | | | | | | | | | | | |
Collapse
|
31
|
van Rooijen DE, Marinus J, Schouten AC, Noldus LP, van Hilten JJ. Muscle Hyperalgesia Correlates With Motor Function in Complex Regional Pain Syndrome Type 1. THE JOURNAL OF PAIN 2013; 14:446-54. [DOI: 10.1016/j.jpain.2012.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 11/20/2012] [Accepted: 12/10/2012] [Indexed: 01/21/2023]
|
32
|
Linnman C, Becerra L, Lebel A, Berde C, Grant PE, Borsook D. Transient and persistent pain induced connectivity alterations in pediatric complex regional pain syndrome. PLoS One 2013; 8:e57205. [PMID: 23526938 PMCID: PMC3602432 DOI: 10.1371/journal.pone.0057205] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 01/22/2013] [Indexed: 12/16/2022] Open
Abstract
Evaluation of pain-induced changes in functional connectivity was performed in pediatric complex regional pain syndrome (CRPS) patients. High field functional magnetic resonance imaging was done in the symptomatic painful state and at follow up in the asymptomatic pain free/recovered state. Two types of connectivity alterations were defined: (1) Transient increases in functional connectivity that identified regions with increased cold-induced functional connectivity in the affected limb vs. unaffected limb in the CRPS state, but with normalized connectivity patterns in the recovered state; and (2) Persistent increases in functional connectivity that identified regions with increased cold-induced functional connectivity in the affected limb as compared to the unaffected limb that persisted also in the recovered state (recovered affected limb versus recovered unaffected limb). The data support the notion that even after symptomatic recovery, alterations in brain systems persist, particularly in amygdala and basal ganglia systems. Connectivity analysis may provide a measure of temporal normalization of different circuits/regions when evaluating therapeutic interventions for this condition. The results add emphasis to the importance of early recognition and management in improving outcome of pediatric CRPS.
Collapse
Affiliation(s)
- Clas Linnman
- Pain and Analgesia Imaging Neuroscience P.A.I.N. Group, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, United States of America.
| | | | | | | | | | | |
Collapse
|
33
|
Cohen HE, Hall J, Harris N, McCabe CS, Blake DR, Jänig W. Enhanced pain and autonomic responses to ambiguous visual stimuli in chronic Complex Regional Pain Syndrome (CRPS) type I. Eur J Pain 2012; 16:182-95. [PMID: 22323371 DOI: 10.1016/j.ejpain.2011.06.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Cortical reorganisation of sensory, motor and autonomic systems can lead to dysfunctional central integrative control. This may contribute to signs and symptoms of Complex Regional Pain Syndrome (CRPS), including pain. It has been hypothesised that central neuroplastic changes may cause afferent sensory feedback conflicts and produce pain. We investigated autonomic responses produced by ambiguous visual stimuli (AVS) in CRPS, and their relationship to pain. Thirty CRPS patients with upper limb involvement and 30 age and sex matched healthy controls had sympathetic autonomic function assessed using laser Doppler flowmetry of the finger pulp at baseline and while viewing a control figure or AVS. Compared to controls, there were diminished vasoconstrictor responses and a significant difference in the ratio of response between affected and unaffected limbs (symmetry ratio) to a deep breath and viewing AVS. While viewing visual stimuli, 33.5% of patients had asymmetric vasomotor responses and all healthy controls had a homologous symmetric pattern of response. Nineteen (61%) CRPS patients had enhanced pain within seconds of viewing the AVS. All the asymmetric vasomotor responses were in this group, and were not predictable from baseline autonomic function. Ten patients had accompanying dystonic reactions in their affected limb: 50% were in the asymmetric sub-group. In conclusion, there is a group of CRPS patients that demonstrate abnormal pain networks interacting with central somatomotor and autonomic integrational pathways.
Collapse
Affiliation(s)
- H E Cohen
- Royal National Hospital for Rheumatic Diseases, Upper Borough Walls, Bath, BA1 1RL, UK.
| | | | | | | | | | | |
Collapse
|
34
|
Inflaming the brain: CRPS a model disease to understand neuroimmune interactions in chronic pain. J Neuroimmune Pharmacol 2012. [PMID: 23188523 DOI: 10.1007/s11481-012-9422-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
We review current concepts in CRPS from a neuroimaging perspective and point out topics and potential mechanisms that are suitable to be investigated in the next step towards understanding the pathophysiology of CRPS. We have outlined functional aspects of the syndrome, from initiating lesion via inflammatory mechanisms to CNS change and associated sickness behavior, with current evidence for up-regulation of immunological factors in CRPS, neuroimaging of systemic inflammation, and neuroimaging findings in CRPS. The initiation, maintenances and CNS targets implicated in CRPS and in the neuro-inflammatory reflex are discussed in terms of CRPS symptoms and recent preclinical studies. Potential avenues for investigating CRPS with PET and fMRI are described, along with roles of inflammation, treatment and behavior in CRPS. It is our hope that this outline will provoke discussion and promote further empirical studies on the interactions between central and peripheral inflammatory pathways manifest in CRPS.
Collapse
|
35
|
Cohen H, McCabe C, Harris N, Hall J, Lewis J, Blake DR. Clinical evidence of parietal cortex dysfunction and correlation with extent of allodynia in CRPS type 1. Eur J Pain 2012; 17:527-38. [PMID: 23132624 DOI: 10.1002/j.1532-2149.2012.00213.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND Unusual symptoms such as digit misidentification and neglect-like phenomena have been reported in complex regional pain syndrome (CRPS), which we hypothesized could be explained by parietal lobe dysfunction. METHODS Twenty-two patients with chronic CRPS attending an in-patient rehabilitation programme underwent standard neurological examination followed by clinical assessment of parietal lobe function and detailed sensory testing. RESULTS Fifteen (68%) patients had evidence of parietal lobe dysfunction. Six (27%) subjects failed six or more test categories and demonstrated new clinical signs consistent with their parietal testing impairments, which were impacting significantly on activities of daily living. A higher incidence was noted in subjects with >1 limb involvement, CRPS affecting the dominant side and in left-handed subjects. Eighteen patients (82%) had mechanical allodynia covering 3-57.5% of the body surface area. Allochiria (unilateral tactile stimulation perceived only in the analogous location on the opposite limb), sensory extinction (concurrent bilateral tactile stimulation perceived only in one limb), referred sensations (unilateral tactile stimulation perceived concurrently in another discrete body area) and dysynchiria (unilateral non-noxious tactile stimulation perceived bilaterally as noxious) were present in some patients. Greater extent of body surface allodynia was correlated with worse parietal function (Spearman's rho = -0.674, p = 0.001). CONCLUSION In patients with chronic CRPS, detailed clinical examination may reveal parietal dysfunction, with severity relating to the extent of allodynia.
Collapse
Affiliation(s)
- H Cohen
- Royal National Orthopaedic Hospital, Stanmore, UK.
| | | | | | | | | | | |
Collapse
|
36
|
de Vries PM, de Jong BM, Bohning DE, Hinson VK, George MS, Leenders KL. Reduced parietal activation in cervical dystonia after parietal TMS interleaved with fMRI. Clin Neurol Neurosurg 2012; 114:914-21. [DOI: 10.1016/j.clineuro.2012.02.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 02/04/2012] [Accepted: 02/06/2012] [Indexed: 10/28/2022]
|
37
|
Effectiveness of the gaze direction recognition task for chronic neck pain and cervical range of motion: a randomized controlled pilot study. Rehabil Res Pract 2012; 2012:570387. [PMID: 22645685 PMCID: PMC3356945 DOI: 10.1155/2012/570387] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 01/26/2012] [Indexed: 11/18/2022] Open
Abstract
We developed a mental task with gaze direction recognition (GDR) by which subjects observed neck rotation of another individual from behind and attempted to recognize the direction of gaze. A randomized controlled trial was performed in test (n = 9) and control (n = 8) groups of subjects with chronic neck pain undergoing physical therapy either with or without the GDR task carried out over 12 sessions during a three-week period. Primary outcome measures were defined as the active range of motion and pain on rotation of the neck. Secondary outcome measures were reaction time (RT) and response accuracy in the GDR task group. ANOVA indicated a main effect for task session and group, and interaction of session. Post hoc testing showed that the GDR task group exhibited a significant simple main effect upon session, and significant sequential improvement of neck motion and relief of neck pain. Rapid effectiveness was significant in both groups. The GDR task group had a significant session-to-session reduction of RTs in correct responses. In conclusion, the GDR task we developed provides a promising rehabilitation measure for chronic neck pain.
Collapse
|
38
|
Raffin E, Mattout J, Reilly KT, Giraux P. Disentangling motor execution from motor imagery with the phantom limb. ACTA ACUST UNITED AC 2012; 135:582-95. [PMID: 22345089 DOI: 10.1093/brain/awr337] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Amputees can move their phantom limb at will. These 'movements without movements' have generally been considered as motor imagery rather than motor execution, but amputees can in fact perform both executed and imagined movements with their phantom and they report distinct perceptions during each task. Behavioural evidence for this dual ability comes from the fact that executed movements are associated with stump muscle contractions whereas imagined movements are not, and that phantom executed movements are slower than intact hand executed movements whereas the speed of imagined movements is identical for both hands. Since neither execution nor imagination produces any visible movement, we hypothesized that the perceptual difference between these two motor tasks relies on the activation of distinct cerebral networks. Using functional magnetic resonance imaging and changes in functional connectivity (dynamic causal modelling), we examined the activity associated with imagined and executed movements of the intact and phantom hands of 14 upper-limb amputees. Distinct but partially overlapping cerebral networks were active during both executed and imagined phantom limb movements (both performed at the same speed). A region of interest analysis revealed a 'switch' between execution and imagination; during execution there was more activity in the primary somatosensory cortex, the primary motor cortex and the anterior lobe of the cerebellum, while during imagination there was more activity in the parietal and occipital lobes, and the posterior lobe of the cerebellum. In overlapping areas, task-related differences were detected in the location of activation peaks. The dynamic causal modelling analysis further confirmed the presence of a clear neurophysiological distinction between imagination and execution, as motor imagery and motor execution had opposite effects on the supplementary motor area-primary motor cortex network. This is the first imaging evidence that the neurophysiological network activated during phantom limb movements is similar to that of executed movements of intact limbs and differs from the phantom limb imagination network. The dual ability of amputees to execute and imagine movements of their phantom limb and the fact that these two tasks activate distinct cortical networks are important factors to consider when designing rehabilitation programmes for the treatment of phantom limb pain.
Collapse
Affiliation(s)
- Estelle Raffin
- Service de Médecine Physique et de Réadaptation, Hôpital Bellevue, CHU de Saint-Etienne, F-42055 Saint-Etienne, France
| | | | | | | |
Collapse
|
39
|
Beudel M, Zijlstra S, Mulder T, Zijdewind I, de Jong BM. Secondary sensory area SII is crucially involved in the preparation of familiar movements compared to movements never made before. Hum Brain Mapp 2012; 32:564-79. [PMID: 21391247 DOI: 10.1002/hbm.21044] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Secondary sensorimotor regions are involved in sensorimotor integration and movement preparation. These regions take part in parietal-premotor circuitry that is not only active during motor execution but also during movement observation and imagery. This activation particularly occurs when observed movements belong to one's own motor repertoire, consistent with the finding that motor imagery only improves performance when one can actually make such movement. We aimed to investigate whether imagery or observation of a movement that was never made before causes parietal-premotor activation or that the ability to perform this movement is indeed a precondition. Nine subjects [group Already Knowing It (AKI)] could abduct their hallux (moving big toe outward). Seven subjects initially failed to make such movement (Absolute Zero A0 group). They had to imagine, observe, or execute this movement, whereas fMRI data were obtained both before and after training. Contrasting abduction observation between the AKI-group and A0-group showed increased left SII and supplementary motor area activation. Comparing the observation of hallux flexion with abduction showed increased bilateral SII activation in the A0 and not in the AKI group. Prolonged training resulted in equal performance and similar cerebral activation patterns in the two groups. Thereby, conjunction analysis of the correlations on subject's range of abduction during execution, imagery, and observation of hallux abduction showed exclusive bilateral SII activation. The reduced SII involvement in A0 may imply that effective interplay between sensory predictions and feedback does not take place without actual movement experience. However, this can be acquired by training.
Collapse
Affiliation(s)
- M Beudel
- Department of Neurology, University Medical Center Groningen, The Netherlands.
| | | | | | | | | |
Collapse
|
40
|
Castrop F, Dresel C, Hennenlotter A, Zimmer C, Haslinger B. Basal ganglia-premotor dysfunction during movement imagination in writer's cramp. Mov Disord 2012; 27:1432-9. [PMID: 22328061 DOI: 10.1002/mds.24944] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 12/05/2011] [Accepted: 01/12/2012] [Indexed: 11/06/2022] Open
Abstract
The pathophysiology of idiopathic focal hand dystonia (writer's cramp) is characterized by deficient inhibitory basal ganglia function and altered cortical sensorimotor processing. To explore if this is already a primary finding in dystonia for internal movement simulation independent of dystonic motor output or abnormal sensory input, we investigated the neural correlates of movement imagination and observation in patients with writer's cramp. Event-related fMRI was applied during kinesthetic motor imagery of drawing simple geometric figures (imagination task) and passively observing videos of hands drawing identical figures (observation task). Compared with healthy controls, patients with writer's cramp showed deficient activation of the left primary sensorimotor cortex, mesial and left dorsal premotor cortex, bilateral putamen, and bilateral thalamus during motor imagery. No significant signal differences between both groups were found during the observation task. We conclude that internal movement simulation and planning as tested during imagination of hand movements appear to be dysfunctional in patients with writer's cramp, whereas visual signal processing and observation-induced activation are unaffected. Deficient basal ganglia-premotor activation could be a correlate of impaired basal ganglia inhibition and focusing during the selection of motor programs in dystonia. This finding seems to be an intrinsic deficit, as it is found during motor imagery in the absence of dystonic symptoms.
Collapse
Affiliation(s)
- Florian Castrop
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Germany
| | | | | | | | | |
Collapse
|
41
|
Abstract
The etiology of medically unexplained symptoms such as conversion disorder is poorly understood. This is partly because the interpretation of neuroimaging results in conversion paresis has been complicated by the use of different control groups, tasks and statistical comparisons. The present study includes these different aspects in a single data set. In our study we included both normal controls and feigners to control for conversion paresis. We studied both movement execution and imagery, and we contrasted both within-group and between-group activation. Moreover, to reveal hemisphere-specific effects that have not been reported before, we performed these analyses using both flipped and unflipped data. This approach resulted in the identification of abnormal parietal activation which was specific for conversion paresis patients. Patients also showed reduced activity in the prefrontal cortex, supramarginal gyrus and precuneus, including hemisphere-specific activation that is lateralized in the same hemisphere, regardless of right- or left-sided paresis. We propose that these regions are candidates for an interface between psychological mechanisms and disturbed higher-order motor control. Our study presents an integrative neurophysiological view of the mechanisms that contribute to the etiology of this puzzling psychological disorder, which can be further investigated with other types of conversion symptoms.
Collapse
|
42
|
Peltz E, Seifert F, Lanz S, Müller R, Maihöfner C. Impaired hand size estimation in CRPS. THE JOURNAL OF PAIN 2011; 12:1095-101. [PMID: 21741321 DOI: 10.1016/j.jpain.2011.05.001] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Revised: 04/21/2011] [Accepted: 05/12/2011] [Indexed: 02/07/2023]
Abstract
UNLABELLED A triad of clinical symptoms, ie, autonomic, motor and sensory dysfunctions, characterizes complex regional pain syndromes (CRPS). Sensory dysfunction comprises sensory loss or spontaneous and stimulus-evoked pain. Furthermore, a disturbance in the body schema may occur. In the present study, patients with CRPS of the upper extremity and healthy controls estimated their hand sizes on the basis of expanded or compressed schematic drawings of hands. In patients with CRPS we found an impairment in accurate hand size estimation; patients estimated their own CRPS-affected hand to be larger than it actually was when measured objectively. Moreover, overestimation correlated significantly with disease duration, neglect score, and increase of two-point-discrimination-thresholds (TPDT) compared to the unaffected hand and to control subjects' estimations. In line with previous functional imaging studies in CRPS patients demonstrating changes in central somatotopic maps, we suggest an involvement of the central nervous system in this disruption of the body schema. Potential cortical areas may be the primary somatosensory and posterior parietal cortices, which have been proposed to play a critical role in integrating visuospatial information. PERSPECTIVE CRPS patients perceive their affected hand to be bigger than it is. The magnitude of this overestimation correlates with disease duration, decreased tactile thresholds, and neglect-score. Suggesting a disrupted body schema as the source of this impairment, our findings corroborate the current assumption of a CNS involvement in CRPS.
Collapse
Affiliation(s)
- Elena Peltz
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | | | | | | | | |
Collapse
|
43
|
Huge V, Lauchart M, Magerl W, Beyer A, Moehnle P, Kaufhold W, Schelling G, Azad SC. Complex interaction of sensory and motor signs and symptoms in chronic CRPS. PLoS One 2011; 6:e18775. [PMID: 21559525 PMCID: PMC3084711 DOI: 10.1371/journal.pone.0018775] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Accepted: 03/18/2011] [Indexed: 12/29/2022] Open
Abstract
Spontaneous pain, hyperalgesia as well as sensory abnormalities, autonomic, trophic, and motor disturbances are key features of Complex Regional Pain Syndrome (CRPS). This study was conceived to comprehensively characterize the interaction of these symptoms in 118 patients with chronic upper limb CRPS (duration of disease: 43±23 months). Disease-related stress, depression, and the degree of accompanying motor disability were likewise assessed. Stress and depression were measured by Posttraumatic Stress Symptoms Score and Center for Epidemiological Studies Depression Test. Motor disability of the affected hand was determined by Sequential Occupational Dexterity Assessment and Michigan Hand Questionnaire. Sensory changes were assessed by Quantitative Sensory Testing according to the standards of the German Research Network on Neuropathic Pain. Almost two-thirds of all patients exhibited spontaneous pain at rest. Hand force as well as hand motor function were found to be substantially impaired. Results of Quantitative Sensory Testing revealed a distinct pattern of generalized bilateral sensory loss and hyperalgesia, most prominently to blunt pressure. Patients reported substantial motor complaints confirmed by the objective motor disability testings. Interestingly, patients displayed clinically relevant levels of stress and depression. We conclude that chronic CRPS is characterized by a combination of ongoing pain, pain-related disability, stress and depression, potentially triggered by peripheral nerve/tissue damage and ensuing sensory loss. In order to consolidate the different dimensions of disturbances in chronic CRPS, we developed a model based on interaction analysis suggesting a complex hierarchical interaction of peripheral (injury/sensory loss) and central factors (pain/disability/stress/depression) predicting motor dysfunction and hyperalgesia.
Collapse
Affiliation(s)
- Volker Huge
- Department of Anaesthesiology, Ludwig-Maximilians-Universität München, Munich, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Abstract
The relationship between peripheral trauma and dystonia has been debated for more than a century but the issue still remains controversial. There are passionate supporters and detractors of the association and both the groups have their own arguments. This review aims to critically evaluate those arguments and presents current understanding of this association. In the process, the relevant case series and scientific papers exploring this subject have been discussed. Upon careful review of available literature coupled with their own experience, the authors believe that peripheral trauma can predispose to abnormal posturing of a body part after variable intervals. To call this posturing a "post-traumatic dystonia" might be premature and the term "post-traumatic syndrome" can be used instead. More work is needed to unravel the pathophysiology of this post-traumatic syndrome.
Collapse
|
45
|
Abstract
About 25% of the patients with complex regional pain syndrome (CRPS) suffer movement disorders, including loss of voluntary control, bradykinesia, dystonia, myoclonus, and tremor. These movement disorders are generally difficult to manage and add considerably to the disease burden. Over the last years, interesting findings have emerged that show how tissue or nerve injury may induce spinal plasticity (central sensitization), which alters sensory transmission and sensorimotor processing in the spinal cord and is associated with disinhibition. These changes, in turn, set the stage for the development of movement disorders seen in CRPS. There are no randomized control studies on the treatment of movement disorders in CRPS but findings from fundamental and clinical research suggest that strategies that enhance the central inhibitory state may benefit these patients.
Collapse
Affiliation(s)
- Jacobus J van Hilten
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.
| |
Collapse
|
46
|
Different activation of opercular and posterior cingulate cortex (PCC) in patients with complex regional pain syndrome (CRPS I) compared with healthy controls during perception of electrically induced pain: a functional MRI study. Clin J Pain 2010; 26:339-47. [PMID: 20393270 DOI: 10.1097/ajp.0b013e3181cb4055] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Although the etiology of complex regional pain syndrome type 1 (CRPS 1) is still debated, many arguments favor central maladaptive changes in pain processing as an important causative factor. METHODS To look for the suspected alterations, 10 patients with CRPS affecting the left hand were explored with functional magnetic resonance imaging during graded electrical painful stimulation of both hands subsequently and compared with healthy participants. RESULTS Activation of the anterior insula, posterior cingulate cortex (PCC), and caudate nucleus was seen in patients during painful stimulation. Compared with controls, CRPS patients had stronger activation of the PCC during painful stimulation of the symptomatic hand. The comparison of insular/opercular activation between controls and patients with CRPS I during painful stimulation showed stronger (posterior) opercular activation in controls than in patients. DISCUSSION Stronger PCC activation during painful stimulation may be interpreted as a correlate of motor inhibition during painful stimuli different from controls. Also, the decreased opercular activation in CRPS patients shows less sensory-discriminative processing of painful stimuli.These results show that changed cerebral pain processing in CRPS patients is less sensory-discriminative but more motor inhibition during painful stimuli. These changes are not limited to the diseased side but show generalized alterations of cerebral pain processing in chronic pain patients.
Collapse
|
47
|
Schott GD. Colored illustrations of the brain: some conceptual and contextual issues. Neuroscientist 2010; 16:508-18. [PMID: 20530253 DOI: 10.1177/1073858409355817] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Illustrations of the brain are increasingly often colored, both on depictions of brain structure and on displays representing brain function. As in many other areas of science, illustrations may have considerable influence on how neuroscientific concepts are envisaged and presented, and color being such a dominant feature of many illustrations of the brain, the rationale, methodology, and implications of using color merit exploration. The different ways of harnessing color depending on whether brain structure or function is being illustrated; the selection of particular colors and color scale; the advantages and disadvantages of color compared to black and white, including the detection of just noticeable differences in the display; the consequences of incorporating color and the attribution of importance; and also the contribution and perceptions of the viewer raise important issues. Consideration of these and a number of related issues, including the wider context of color in illustration, leads to the conclusion that the addition of color represents a powerful and at times unrivalled technique that can be employed in the study of the brain, yet adding color is sometimes ill considered and can prove superfluous, ambiguous, or misleading.
Collapse
|
48
|
Abstract
We sought to elucidate the existence of neuropsychological subtypes in Complex Regional Pain Syndrome (CRPS). One hundred thirty seven patients with CRPS were administered tests that assess executive control, naming/lexical retrieval, and declarative memory. A 2-step cluster analysis that does not require any a priori specification regarding the number of clusters, classified patients into three groups. Group 1 obtained scores that were in the average range on all tests (n = 48; normal CRSP group). Group 2 (n = 58; dysexecutive CRSP group) presented with mild impairment or statistically low average test performance on working memory/verbal fluency tests. Group 3 (n = 31; global CRSP group) produced scores in the statistically low average/borderline range on all tests with particularly reduced scores on naming/declarative memory tests. Between-group analyses found that the CRPS group 1 obtained higher scores than CRPS groups 2 and 3 on all tests. However, groups 2 and 3 were equally impaired on executive tests. CRPS group 3 was impaired on tests of naming/memory tests compared to the other groups. Significant neuropsychological deficits are present in 65% of patients, with many patients presenting with elements of a dysexecutive syndrome and some patients presenting with global cognitive impairment.
Collapse
|
49
|
Sato K, Fukumori S, Matsusaki T, Maruo T, Ishikawa S, Nishie H, Takata K, Mizuhara H, Mizobuchi S, Nakatsuka H, Matsumi M, Gofuku A, Yokoyama M, Morita K. Nonimmersive Virtual Reality Mirror Visual Feedback Therapy and Its Application for the Treatment of Complex Regional Pain Syndrome: An Open-Label Pilot Study. PAIN MEDICINE 2010; 11:622-9. [DOI: 10.1111/j.1526-4637.2010.00819.x] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
50
|
Abstract
In the last few centuries, there has been a constant sway between organic and psychogenic explanations for dystonia. In the current study, we investigate this history, assuming the perspective of a spectrum from organic to psychogenic, between which ideas were moving. We have focussed on (i) primary generalized dystonia, (ii) cervical dystonia, (iii) writer's cramp and (iv) fixed dystonia related to complex regional pain syndrome. We have studied medical texts published since the 19th century and their references. Jean-Martin Charcot advocated the concept of hysteria, disorders in which, besides predisposition, environmental factors were involved in their pathogenesis. Sigmund Freud introduced psychoanalysis as an explanatory therapy for psychic disorders. Previous theories, together with the lack of an organic substrate for dystonia, made a strong case for psychogenic explanations. Consequently, many dystonia patients were told that they suffered from psychological conflicts and were treated for them. However, after the description of new hereditary cases in the 1950s, the limited efficacy of psychotherapy in torsion dystonia, the effects of surgical treatments and the lesion studies in the 1960s, more physicians became convinced of the organic nature. The culminating point was the discovery of the DYT1 gene in 1997. In the meantime, experts had already convinced the neurological community that cervical dystonia and writer's cramp were focal dystonias, i.e. minor forms of generalized dystonia, and therefore organic disorders. In contrast, the pathophysiology of fixed dystonia related to complex regional pain syndrome remained controversial. Knowledge of this history, which played on the border between neurology and psychiatry, is instructive and reflects the difficulty in discriminating between them. Today, new insights from functional imaging and neurophysiological studies again challenge the interpretation of these disorders, while the border between psychogenic and organic has become more blurred. Abnormalities of sensorimotor integration and cortical excitability that are currently supposed to be the underlying cause of dystonia bring us back to Sherringtonian physiology. We suggest that this may lead to a common explanation of the four afflictions of which we have traced the history.
Collapse
Affiliation(s)
- Alexander G Munts
- Department of Neurology, Kennemer Gasthuis, PO Box 417, 2000 AK Haarlem, The Netherlands.
| | | |
Collapse
|