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Halicka M, Cousins OR, Ten Brink AF, Vittersø AD, Proulx MJ, Bultitude JH. Reduced Visuospatial Attention in Personal Space is Not Limited to the Affected Limb in Complex Regional Pain Syndrome. J Pain Res 2024; 17:1519-1529. [PMID: 38686102 PMCID: PMC11056436 DOI: 10.2147/jpr.s437366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 11/27/2023] [Indexed: 05/02/2024] Open
Abstract
Purpose Alterations in spatial attention have been reported in people with chronic pain and may be relevant to understanding its cortical mechanisms and developing novel treatments. There is conflicting evidence as to whether people with Complex Regional Pain Syndrome (CRPS) have reduced visuospatial attention to their affected limb and/or its surrounding space, with some evidence that these deficits may be greater in personal (bodily) space. We aimed to test the competing hypotheses of whether the visuospatial attentional bias is specific to the personal space of the affected limb or generalizes to the personal space of other parts of the affected side of the body. Patients and Methods Using visual Temporal Order Judgement tasks, we measured spatial attention in the personal space of the hands and feet of patients with upper (n=14) or lower (n=14) limb CRPS and pain-free controls (n=17). Participants judged the order of two light flashes presented at different temporal offsets on each of their hands or feet. Slower processing of the flash on one side relative to the other reflects reduced attention to that side of space. Results Controls prioritized stimuli on the non-dominant (left) relative to dominant side, consistent with the well-documented normal leftward bias of attention (ie "pseudoneglect"). Regardless of the location (upper or lower limb) of the pain or visual stimuli, people with CRPS showed no such asymmetry, representing reduced attention to the affected side (compared to the greater attention of controls to their non-dominant side). More severe CRPS symptoms were associated with a greater tendency to deprioritize stimuli on the affected side. Conclusion Our findings suggest that relative visuospatial bias in CRPS is generalized to the personal space of the affected side of the body, rather than being specific to the personal space of the CRPS-affected limb.
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Affiliation(s)
- Monika Halicka
- Institute of Neuroscience, Universite catholique de Louvain, Brussels, Belgium
- Centre for Pain Research, University of Bath, Bath, UK
- Department of Psychology, University of Bath, Bath, UK
| | | | - Antonia F Ten Brink
- Centre for Pain Research, University of Bath, Bath, UK
- Department of Psychology, University of Bath, Bath, UK
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, the Netherlands
| | - Axel D Vittersø
- Centre for Pain Research, University of Bath, Bath, UK
- Department of Psychology, University of Bath, Bath, UK
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | | | - Janet H Bultitude
- Centre for Pain Research, University of Bath, Bath, UK
- Department of Psychology, University of Bath, Bath, UK
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Limerick G, Christo DK, Tram J, Moheimani R, Manor J, Chakravarthy K, Karri J, Christo PJ. Complex Regional Pain Syndrome: Evidence-Based Advances in Concepts and Treatments. Curr Pain Headache Rep 2023; 27:269-298. [PMID: 37421541 DOI: 10.1007/s11916-023-01130-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 07/10/2023]
Abstract
PURPOSE OF REVIEW This review presents the most current information about the epidemiology of complex regional pain syndrome (CRPS), classification and diagnostic criteria, childhood CRPS, subtypes, pathophysiology, conventional and less conventional treatments, and preventive strategies. RECENT FINDINGS CRPS is a painful disorder with multifactorial pathophysiology. The data describe sensitization of the central and peripheral nervous systems, inflammation, possible genetic factors, sympatho-afferent coupling, autoimmunity, and mental health factors as contributors to the syndrome. In addition to conventional subtypes (type I and type II), cluster analyses have uncovered other proposed subtypes. Prevalence of CRPS is approximately 1.2%, female gender is consistently associated with a higher risk of development, and substantial physical, emotional, and financial costs can result from the syndrome. Children with CRPS seem to benefit from multifaceted physical therapy leading to a high percentage of symptom-free patients. The best available evidence along with standard clinical practice supports pharmacological agents, physical and occupational therapy, sympathetic blocks for engaging physical restoration, steroids for acute CRPS, neuromodulation, ketamine, and intrathecal baclofen as therapeutic approaches. There are many emerging treatments that can be considered as a part of individualized, patient-centered care. Vitamin C may be preventive. CRPS can lead to progressively painful sensory and vascular changes, edema, limb weakness, and trophic disturbances, all of which substantially erode healthy living. Despite some progress in research, more comprehensive basic science investigation is needed to clarify the molecular mechanisms of the disease so that targeted treatments can be developed for better outcomes. Incorporating a variety of standard therapies with different modes of action may offer the most effective analgesia. Introducing less conventional approaches may also be helpful when traditional treatments fail to provide sufficient improvement.
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Affiliation(s)
- Gerard Limerick
- Division of Pain Medicine, Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
- Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Dana K Christo
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Jennifer Tram
- Department of Anesthesiology, University of California, San Diego, CA, USA
| | | | - John Manor
- Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, USA
| | | | - Jay Karri
- Division of Pain Medicine, Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
- Department of Orthopedic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Paul J Christo
- Division of Pain Medicine, Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA.
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Visuomotor impairments in complex regional pain syndrome during pointing tasks. Pain 2021; 162:811-822. [PMID: 32890256 DOI: 10.1097/j.pain.0000000000002068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/28/2020] [Indexed: 11/26/2022]
Abstract
ABSTRACT Complex regional pain syndrome (CRPS) is thought to be characterized by cognitive deficits affecting patients' ability to represent, perceive, and use their affected limb as well as its surrounding space. This has been tested, among others, by straight-ahead tasks testing oneself's egocentric representation, but such experiments lead to inconsistent results. Because spatial cognitive abilities encompass various processes, we completed such evaluations by varying the sensory inputs used to perform the task. Complex regional pain syndrome and matched control participants were asked to assess their own body midline either visually (ie, by means of a moving visual cue) or manually (ie, by straight-ahead pointing with one of their upper limbs) and to reach and point to visual targets at different spatial locations. Although the 2 former tasks only required one single sensory input to be performed (ie, either visual or proprioceptive), the latter task was based on the ability to coordinate perception of the position of one's own limb with visuospatial perception. However, in this latter task, limb position could only be estimated by proprioception, as vision of the limb was prevented. Whereas in the 2 former tasks CRPS participants' performance was not different from that of controls, they made significantly more deviations errors during the visuospatial task, regardless of the limb used to point or the direction of pointing. Results suggest that CRPS patients are not specifically characterized by difficulties in representing their body but, more particularly, in integrating somatic information (ie, proprioception) during visually guided movements of the limb.
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Foncelle A, Christophe L, Revol P, Havé L, Jacquin-Courtois S, Rossetti Y, Chabanat E. Prism adaptation effects in complex regional pain syndrome: A therapo-physiological single case experimental design exploratory report. Neuropsychol Rehabil 2021; 32:689-706. [PMID: 33715576 DOI: 10.1080/09602011.2021.1897629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Complex Regional Pain Syndrome (CRPS) is an invalidating chronic condition that can occur after an acute peripheral lesion. Prism adaptation therapy is regarded as a promising tool to improve chronic pain in this syndrome but the mechanisms which lead to pain amelioration remain unknown. In this exploratory report we performed a retrospective analysis of longitudinal data collected from a single, atypical patient, who showed hyper-attention toward her affected (left) hand. Repeated assessments of pain and spatial neglect made during the course of the prism adaptation treatment revealed differential contributions of the two hands to adaptation-induced pain reduction. Treatment response appeared to be associated with a relative modification of the spatial behaviour of the two hands. This case study provides a new example of pain relief following prismatic deviation away from the pathological side.
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Affiliation(s)
- A Foncelle
- INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon (CRNL), Equipe ImpAct, Bron Cedex, France
| | - L Christophe
- INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon (CRNL), Equipe ImpAct, Bron Cedex, France.,Service de médecine physique et réadaptation, Hôpital Henry Gabrielle, Hospices Civils de Lyon, Saint Genis Laval, France
| | - P Revol
- INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon (CRNL), Equipe ImpAct, Bron Cedex, France.,Plate-forme 'Mouvement et Handicap' and Neuro-Immersion, Hôpital Henry-Gabrielle and Hôpital Neurologique, Saint-Genis-Laval, France
| | - L Havé
- INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon (CRNL), Equipe ImpAct, Bron Cedex, France
| | - S Jacquin-Courtois
- INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon (CRNL), Equipe ImpAct, Bron Cedex, France.,Service de médecine physique et réadaptation, Hôpital Henry Gabrielle, Hospices Civils de Lyon, Saint Genis Laval, France
| | - Y Rossetti
- INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon (CRNL), Equipe ImpAct, Bron Cedex, France.,Plate-forme 'Mouvement et Handicap' and Neuro-Immersion, Hôpital Henry-Gabrielle and Hôpital Neurologique, Saint-Genis-Laval, France
| | - E Chabanat
- INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon (CRNL), Equipe ImpAct, Bron Cedex, France
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Halicka M, Vittersø AD, McCullough H, Goebel A, Heelas L, Proulx MJ, Bultitude JH. Disputing space-based biases in unilateral complex regional pain syndrome. Cortex 2020; 127:248-268. [DOI: 10.1016/j.cortex.2020.02.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 02/19/2020] [Accepted: 02/27/2020] [Indexed: 02/02/2023]
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Neuropsychological Changes in Complex Regional Pain Syndrome (CRPS). Behav Neurol 2020; 2020:4561831. [PMID: 32399082 PMCID: PMC7201816 DOI: 10.1155/2020/4561831] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 11/24/2019] [Accepted: 12/11/2019] [Indexed: 01/18/2023] Open
Abstract
Complex Regional Pain Syndrome (CRPS) is a poorly understood chronic pain condition of multifactorial origin. CRPS involves sensory, motor, and autonomic symptoms primarily affecting one extremity. Patients can also present with neuropsychological changes such as reduced attention to the CRPS-affected extremity, reminiscent of hemispatial neglect, yet in the absence of any brain lesions. However, this "neglect-like" framework is not sufficient to characterise the range of higher cognitive functions that can be altered in CRPS. This comprehensive literature review synthesises evidence of neuropsychological changes in CRPS in the context of potential central mechanisms of the disorder. The affected neuropsychological functions constitute three distinct but not independent groups: distorted body representation, deficits in lateralised spatial cognition, and impairment of non-spatially-lateralised higher cognitive functions. We suggest that many of these symptoms appear to be consistent with a broader disruption to parietal function beyond merely what could be considered "neglect-like." Moreover, the extent of neuropsychological symptoms might be related to the clinical signs of CRPS, and rehabilitation methods that target the neuropsychological changes can improve clinical outcomes in CRPS and other chronic pain conditions. Based on the limitations and gaps in the reviewed literature, we provide several suggestions to improve further research on neuropsychological changes in chronic pain.
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