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Atypical influence of biomechanical knowledge in Complex Regional Pain Syndrome-towards a different perspective on body representation. Sci Rep 2023; 13:520. [PMID: 36627332 PMCID: PMC9832000 DOI: 10.1038/s41598-023-27733-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 01/06/2023] [Indexed: 01/12/2023] Open
Abstract
Part of the multifaceted pathophysiology of Complex Regional Pain Syndrome (CRPS) is ascribed to lateralized maladaptive neuroplasticity in sensorimotor cortices, corroborated by behavioral studies indicating that patients present difficulties in mentally representing their painful limb. Such difficulties are widely measured with hand laterality judgment tasks (HLT), which are also used in the rehabilitation of CRPS to activate motor imagery and restore the cortical representation of the painful limb. The potential of these tasks to elicit motor imagery is critical to their use in therapy, yet, the influence of the body's biomechanical constraints (BMC) on HLT reaction time, supposed to index motor imagery activation, is rarely verified. Here we investigated the influence of BMC on the perception of hand postures and movements in upper-limb CRPS. Patients were slower than controls in judging hand laterality, whether or not stimuli corresponded to their painful hand. Reaction time patterns reflecting BMC were mostly absent in CRPS and controls. A second experiment therefore directly investigated the influence of implicit knowledge of BMC on hand movement judgments. Participants judged the perceived path of movement between two depicted hand positions, with only one of two proposed paths that was biomechanically plausible. While the controls mostly chose the biomechanically plausible path, patients did not. These findings show non-lateralized body representation impairments in CRPS, possibly related to difficulties in using correct knowledge of the body's biomechanics. Importantly, they demonstrate the challenge of reliably measuring motor imagery with the HLT, which has important implications for the rehabilitation with these tasks.
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Biran I, Book A, Aviram L, Bregman N, Bahagali E, Tripto A. Body Structural Description Impairment in Complex Regional Pain Syndrome Type I. Front Psychol 2022; 13:853641. [PMID: 35756256 PMCID: PMC9226898 DOI: 10.3389/fpsyg.2022.853641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background Complex Regional Pain Syndrome (CRPS) is a clinical syndrome composed of chronic pain, motor impairment, and autonomic dysfunction, usually affecting a limb. Although CRPS seems to be a peripheral disorder, it is accompanied by parietal alterations leading to body schema impairments (the online representations of the body). Impairments to body structural description (the topographical bodily map) were not assessed systematically in CRPS. A patient we encountered with severe disruption to her bodily structural description led us to study this domain further. Aims To document aberrant body structural description in subjects with CRPS using an object assembly task. Methods Body Schema Study: 6 subjects with CRPS-I and six age and sex-matched healthy controls completed visual puzzles taken from WAIS-III and WAIS-R. The puzzles were either related to the human body or non-human body objects. Mann–Whitney U-tests were performed to compare groups’ performances. Results The CRPS group received relatively lower scores compared to controls for human body objects (u = 3, p < 0.05), whereas the non-human object scoring did not reveal significant differences between groups (u = 9, p > 0.05). Conclusion CRPS subjects suffer from impaired body structural description, taking the form of body parts disassembly and body parts discontinuity. This impairment can serve as a nidus for aberrant psychological representation of the body.
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Affiliation(s)
- Iftah Biran
- Neurological Institute, Tel Aviv Medical Center, Tel Aviv-Yafo, Israel.,Division of Psychiatry, Tel Aviv Medical Center, Tel Aviv-Yafo, Israel.,The Rehabilitation Hospital, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Andrea Book
- The Rehabilitation Hospital, Chaim Sheba Medical Center, Ramat Gan, Israel.,Department of Psychology, Ari'el University, Ari'el, Israel
| | - Liron Aviram
- Department of Psychology, The Academic College of Tel Aviv - Yaffo, Tel Aviv-Yafo, Israel
| | - Noa Bregman
- Neurological Institute, Tel Aviv Medical Center, Tel Aviv-Yafo, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Einat Bahagali
- Department of Psychology, Ari'el University, Ari'el, Israel
| | - Assaf Tripto
- The Rehabilitation Hospital, Chaim Sheba Medical Center, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel.,Be'eri Clinic, Clalit Health Services, Bnei Brak, Israel
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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.
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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.
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Halicka M, Vittersø AD, McCullough H, Goebel A, Heelas L, Proulx MJ, Bultitude JH. Prism adaptation treatment for upper-limb complex regional pain syndrome: a double-blind randomized controlled trial. Pain 2021; 162:471-489. [PMID: 32833791 PMCID: PMC7808368 DOI: 10.1097/j.pain.0000000000002053] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 07/14/2020] [Accepted: 08/03/2020] [Indexed: 12/17/2022]
Abstract
ABSTRACT Initial evidence suggested that people with complex regional pain syndrome (CRPS) have reduced attention to the affected side of their body and the surrounding space, which might be related to pain and other clinical symptoms. Three previous unblinded, uncontrolled studies showed pain relief after treatment with prism adaptation, an intervention that has been used to counter lateralised attention bias in brain-lesioned patients. To provide a robust test of its effectiveness for CRPS, we conducted a double-blind randomized controlled trial of prism adaptation for unilateral upper-limb CRPS-I. Forty-nine eligible adults with CRPS were randomized to undergo 2 weeks of twice-daily home-based prism adaptation treatment (n = 23) or sham treatment (n = 26). Outcomes were assessed in person 4 weeks before and immediately before treatment, and immediately after and 4 weeks after treatment. Long-term postal follow-ups were conducted 3 and 6 months after treatment. We examined the effects of prism adaptation vs sham treatment on current pain intensity and the CRPS symptom severity score (primary outcomes), as well as sensory, motor, and autonomic functions, self-reported psychological functioning, and experimentally tested neuropsychological functions (secondary outcomes). We found no evidence that primary or secondary outcomes differed between the prism adaptation and sham treatment groups when tested at either time point after treatment. Overall, CRPS severity significantly decreased over time for both groups, but we found no benefits of prism adaptation beyond sham treatment. Our findings do not support the efficacy of prism adaptation treatment for relieving upper-limb CRPS-I. This trial was prospectively registered (ISRCTN46828292).
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Affiliation(s)
- Monika Halicka
- Centre for Pain Research, University of Bath, Bath, United Kingdom
- Department of Psychology, University of Bath, Bath, United Kingdom
| | - Axel D. Vittersø
- Centre for Pain Research, University of Bath, Bath, United Kingdom
- Department of Psychology, University of Bath, Bath, United Kingdom
- Department of Sport and Health Sciences, University of Exeter, Exeter, United Kingdom
| | - Hayley McCullough
- Department of Translational Medicine, Pain Research Institute, University of Liverpool, Liverpool, United Kingdom
| | - Andreas Goebel
- Department of Translational Medicine, Pain Research Institute, University of Liverpool, Liverpool, United Kingdom
- Department of Pain Medicine, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Leila Heelas
- Optimise Pain Rehabilitation Unit, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Michael J. Proulx
- Department of Psychology, University of Bath, Bath, United Kingdom
- Department of Computer Science, Centre for Real & Virtual Environments Augmentation Labs, University of Bath, Bath, United Kingdom
| | - Janet H. Bultitude
- Centre for Pain Research, University of Bath, Bath, United Kingdom
- Department of Psychology, University of Bath, Bath, United Kingdom
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5
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Altered updating of bodily and spatial representations after tool-use in complex regional pain syndrome. Pain 2020; 161:1609-1628. [DOI: 10.1097/j.pain.0000000000001845] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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6
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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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Verfaille C, Filbrich L, Cordova Bulens D, Lefèvre P, Berquin A, Barbier O, Libouton X, Fraselle V, Mouraux D, Legrain V. Robot-assisted line bisection in patients with Complex Regional Pain Syndrome. PLoS One 2019; 14:e0213732. [PMID: 31048861 PMCID: PMC6497371 DOI: 10.1371/journal.pone.0213732] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 02/27/2019] [Indexed: 11/18/2022] Open
Abstract
Complex Regional Pain Syndrome (CRPS) is characterized by pain, motor and inflammatory symptoms usually affecting one limb. Cognitive difficulties have been reported to affect patients’ ability to represent, perceive and use their affected limb. It is debated whether these difficulties result from deficits in controlling goal-directed movements in space or from a learned strategy to protect the affected limb. In order to dissociate the two hypotheses, patients with upper-limb CRPS were asked to move with their unaffected hand towards visual targets projected at different positions on a horizontal semi-reflexive mirror. By means of a robotic handle placed below the screen, they were asked to move a cursor, to reach and cross lines at their estimated midpoint. In some of the stimulation series, the affected hand was placed below the mirror so that some lines appeared projected onto that hand. Vision of the hands and the robotic handle was preserved or prevented by opening or closing a shutter below the mirror. Lines were displayed on the mirror according to which part of the body was affected (ispi- vs. contralateral) and the actual position of the affected hand (inside vs. outside the workspace). Comparatively to control participants, CRPS patients generally biased their estimation by bisecting the lines towards their left side, irrelative of which part of the body was affected and the position of the affected hand, both in ipsi- and contralateral space, with only a few exceptions. Our results are in line with previous studies having described a visuospatial deficit in CRPS patients and discard the explanation of observed symptoms in terms of learned nonuse strategies, as only the unaffected hand was used to perform the task. It is suggested that CRPS patients can display difficulties to perform tasks requesting visuo-motor coordination, reflecting the complex cortical reorganization occurring in CRPS.
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Affiliation(s)
- Charlotte Verfaille
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
- * E-mail:
| | - Lieve Filbrich
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
- Psychological Sciences Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - David Cordova Bulens
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
- Institute of Information and Communication Technologies, Electronics and Applied Mathematics, Louvain-la-Neuve, Belgium
| | - Philippe Lefèvre
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
- Institute of Information and Communication Technologies, Electronics and Applied Mathematics, Louvain-la-Neuve, Belgium
| | - Anne Berquin
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
- Saint-Luc University Hospital, Brussels, Belgium
| | - Olivier Barbier
- Saint-Luc University Hospital, Brussels, Belgium
- Institute of Experimental and Clinical Research, Université catholique de Louvain, Brussels, Belgium
| | - Xavier Libouton
- Saint-Luc University Hospital, Brussels, Belgium
- Institute of Experimental and Clinical Research, Université catholique de Louvain, Brussels, Belgium
| | - Virginie Fraselle
- Saint-Luc University Hospital, Brussels, Belgium
- Faculty of Motor Sciences, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Dominique Mouraux
- Faculty of Motor Sciences, Université libre de Bruxelles, Brussels, Belgium
- Erasme University Hospital, Brussels, Belgium
| | - Valéry Legrain
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
- Psychological Sciences Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium
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Kohler M, Strauss S, Horn U, Langner I, Usichenko T, Neumann N, Lotze M. Differences in Neuronal Representation of Mental Rotation in Patients With Complex Regional Pain Syndrome and Healthy Controls. THE JOURNAL OF PAIN 2019; 20:898-907. [PMID: 30710707 DOI: 10.1016/j.jpain.2019.01.330] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 01/16/2019] [Accepted: 01/28/2019] [Indexed: 12/12/2022]
Abstract
Spatial integration of parts of the body is impaired in patients with complex regional pain syndrome (CRPS). Because the training of mental rotation (MR) has been shown to be among the effective therapy strategies for CRPS, impairment of MR is also important for the pathophysiological understanding of CRPS. The aim of this study was to evaluate whether differences in the neural representation of MR occur between patients with CRPS and healthy controls (HC). Therefore, we included 15 patients with chronic CRPS and 15 age- and gender-matched HC. We assessed behavioral (accuracy and reaction time for MR of both hands), clinical (Disabilities of Arm, Shoulder and Hand questionnaire) and magnetic resonance imaging (T1-weighted, function magnetic resonance imaging during MR) data. Reaction times in the patient group were delayed compared with HC without a lateralization effect for the affected hand side. Although both groups showed an activation pattern typical for MR, only HC showed a highly significant contrast for the rotated versus unrotated hands in the right intraparietal sulcus. Patients with CRPS showed a reduction of functional magnetic resonance imaging activation in areas including the subthalamic nucleus, nucleus accumbens, and putamen. Regression analysis for the CRPS group emphasized the importance of putamen and nucleus accumbens activation for MR performance. This study highlights the reduced access of patients with CRPS for mental resources modulating arousal, emotional response, and subcortical sensorimotor integration. PERSPECTIVE: This study localized the underlying neural responses for impaired mental rotation in patients with complex regional pain syndrome as a decrease in basal ganglia (putamen) and nucleus accumbens activation.
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Affiliation(s)
| | - Sebastian Strauss
- Functional Imaging Unit, Center for Diagnostic Radiology, and; Department of Neurology, University of Greifswald, Germany
| | - Ulrike Horn
- Functional Imaging Unit, Center for Diagnostic Radiology, and
| | - Inga Langner
- Division of Hand Surgery and Functional Microsurgery, Department of Trauma and Reconstructive Surgery, and
| | - Taras Usichenko
- Department of Anesthesiology, University Medicine Greifswald, Greifswald, Germany
| | - Nicola Neumann
- Functional Imaging Unit, Center for Diagnostic Radiology, and
| | - Martin Lotze
- Functional Imaging Unit, Center for Diagnostic Radiology, and.
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Jung YH, Kim H, Lee D, Lee JY, Lee WJ, Moon JY, Kim YC, Choi SH, Kang DH. Disruption of Homeostasis Based on the Right and Left Hemisphere in Patients with Complex Regional Pain Syndrome. Neuroimmunomodulation 2019; 26:276-284. [PMID: 31865325 DOI: 10.1159/000504140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 10/14/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Although the clinical features and pathophysiology of complex regional pain syndrome (CRPS) have been studied in the peripheral and central nervous systems, few plausible pathological interactions are known among the metabolites in these systems. Thus, the purpose of this study was to investigate abnormal relationships and interactions between peripheral metabolites and central neurometabolites in patients with CRPS. METHODS Various metabolites and molecules were measured in the peripheral blood, and central neurometabolites in the right and left thalamus using proton magnetic resonance spectroscopy in 12 patients with CRPS and 11 healthy controls. Interactions between peripheral metabolites in blood and central neurometabolites in the right and left thalamus were also investigated. RESULTS The interactions between peripheral and central metabolites were different in the right and left hemispheres of healthy subjects, suggesting the presence of right hemisphere-dependent energy homeostasis and left hemisphere-dependent acid-base homeostasis that enables effective functioning. The interactions between central and peripheral metabolites in CRPS patients were distinct from those in healthy individuals, supporting the possibility of abnormal interactions and disrupted homeostasis between peripheral and central metabolites, which may result from neuroinflammation and immune system dysfunction. CONCLUSION To the authors' knowledge, this is the first report describing abnormal metabolic dysfunction and disrupted homeostasis in interactions between metabolites of the peripheral and central nervous systems in CRPS. The approach used to uncover hidden pathophysiologies will improve understanding of how chronic pain can disrupt homeostasis in interactions between two systems and how alternative metabolites can be activated to recover and compensate for pathological dysfunctions in patients with CRPS.
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Affiliation(s)
- Ye-Ha Jung
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyeonjin Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dasom Lee
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Emotional Information and Communication Technology Association, Seoul, Republic of Korea
| | - Jae-Yeon Lee
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Won Joon Lee
- Department of Psychiatry, Kangdong Sacred Heart Hospital, Seoul, Republic of Korea
| | - Jee Youn Moon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yong Chul Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Soo-Hee Choi
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine and Institute of Human Behavioral Medicine, SNU-MRC, Seoul, Republic of Korea
| | - Do-Hyung Kang
- Emotional Information and Communication Technology Association, Seoul, Republic of Korea,
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11
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A new hypothesis for the pathophysiology of complex regional pain syndrome. Med Hypotheses 2018; 119:41-53. [DOI: 10.1016/j.mehy.2018.07.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/18/2018] [Accepted: 07/27/2018] [Indexed: 12/21/2022]
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12
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Hausteiner-Wiehle C, Henningsen P. Do we have to rethink Complex Regional Pain Syndrome? J Psychosom Res 2018; 111:13-14. [PMID: 29935746 DOI: 10.1016/j.jpsychores.2018.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 05/08/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Constanze Hausteiner-Wiehle
- Neurocenter, BG Trauma Center Murnau, Murnau, Germany; Dept. of Psychosomatic Medicine and Psychotherapy, Technical University of Munich, Munich, Germany.
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The effects of a dopamine agonist (apomorphine) on experimental and spontaneous pain in patients with chronic radicular pain: A randomized, double-blind, placebo-controlled, cross-over study. PLoS One 2018; 13:e0195287. [PMID: 29621293 PMCID: PMC5886417 DOI: 10.1371/journal.pone.0195287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 02/15/2018] [Indexed: 11/29/2022] Open
Abstract
Background Although evidence suggests that dopaminergic systems are involved in pain processing, the effects of dopaminergic interventions on pain remains questionable. This randomized, double blinded, placebo-controlled, cross-over study was aimed at exploring the effect of the dopamine agonist apomorphine on experimental pain evoked by cold stimulation and on spontaneous pain in patients with lumbar radicular (neuropathic) pain. Methods Data was collected from 35 patients with chronic lumbar radiculopathy (18 men, mean age 56.2±13 years). The following parameters were evaluated before (baseline) and 30, 75 and 120 minutes subsequent to a subcutaneous injection of 1.5 mg apomorphine or placebo: cold pain threshold and tolerance in the painful site (ice pack, affected leg) and in a remote non-painful site (12°C water bath, hand), and spontaneous (affected leg) pain intensity (NPS, 0–100). Results One-hundred and twenty minutes following apomorphine (but not placebo) injection, cold pain threshold and tolerance in the hand increased significantly compared to baseline (from a median of 8.0 seconds (IQR = 5.0) to 10 seconds (IQR = 9.0), p = 0.001 and from a median of 19.5 seconds (IQR = 30.2) to 27.0 seconds (IQR = 37.5), p<0.001, respectively). In addition, apomorphine prolonged cold pain tolerance but not threshold in the painful site (from a median of 43.0 seconds (IQR = 63.0) at baseline to 51.0 seconds (IQR = 78.0) at 120 min, p = 0.02). Apomorphine demonstrated no superiority over placebo in reducing spontaneous pain intensity. Conclusion These findings are in line with previous results in healthy subjects, showing that apomorphine increases the ability to tolerate cold pain and therefore suggesting that dopaminergic interventions can have potential clinical relevance.
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Urits I, Shen AH, Jones MR, Viswanath O, Kaye AD. Complex Regional Pain Syndrome, Current Concepts and Treatment Options. Curr Pain Headache Rep 2018; 22:10. [PMID: 29404787 DOI: 10.1007/s11916-018-0667-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW Complex regional pain syndrome (CRPS) refers to a chronic pain condition that is characterized by progressively worsening spontaneous regional pain without dermatomal distribution. The symptomatology includes pain out of proportion in time and severity to the inciting event. The purpose of this review is to present the most current information concerning epidemiology, diagnosis, pathophysiology, and therapy for CRPS. RECENT FINDINGS In recent years, discovery of pathophysiologic mechanisms of CRPS has led to significant strides in the understanding of the disease process. Continued elucidation of the underlying pathophysiological mechanisms will allow for the development of more targeted and effective evidence-based therapy protocols. Further large clinical trials are needed to investigate mechanisms and treatment of the disorder.
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Affiliation(s)
- Ivan Urits
- Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Mark R Jones
- Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Omar Viswanath
- Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Alan D Kaye
- Department of Anesthesiology, Lousiana State University Health Science Center, 1542 Tulane Avenue Suite 659, New Orleans, LA, 70112, USA.
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Nardone R, Brigo F, Höller Y, Sebastianelli L, Versace V, Saltuari L, Lochner P, Trinka E. Transcranial magnetic stimulation studies in complex regional pain syndrome type I: A review. Acta Neurol Scand 2018; 137:158-164. [PMID: 28971481 DOI: 10.1111/ane.12852] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2017] [Indexed: 01/23/2023]
Abstract
The sensory and motor cortical representation corresponding to the affected limb is altered in patients with complex regional pain syndrome (CRPS). Transcranial magnetic stimulation (TMS) represents a useful non-invasive approach for studying cortical physiology. If delivered repetitively, TMS can also modulate cortical excitability and induce long-lasting neuroplastic changes. In this review, we performed a systematic search of all studies using TMS to explore cortical excitability/plasticity and repetitive TMS (rTMS) for the treatment of CRPS. Literature searches were conducted using PubMed and EMBASE. We identified 8 articles matching the inclusion criteria. One hundred fourteen patients (76 females and 38 males) were included in these studies. Most of them have applied TMS in order to physiologically characterize CRPS type I. Changes in motor cortex excitability and brain mapping have been reported in CRPS-I patients. Sensory and motor hyperexcitability are in the most studies bilateral and likely involve corresponding regions within the central nervous system rather than the entire hemisphere. Conversely, sensorimotor integration and plasticity were found to be normal in CRPS-I. TMS examinations also revealed that the nature of motor dysfunction in CRPS-I patients differs from that observed in patients with functional movement disorders, limb immobilization, or idiopathic dystonia. TMS studies may thus lead to the implementation of correct rehabilitation strategies in CRPS-I patients. Two studies have begun to therapeutically use rTMS. This non-invasive brain stimulation technique could have therapeutic utility in CRPS, but further well-designed studies are needed to corroborate initial findings.
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Affiliation(s)
- R. Nardone
- Department of Neurology Franz Tappeiner Hospital Merano Italy
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience Paracelsus Medical University Salzburg Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg Austria
| | - F. Brigo
- Department of Neurology Franz Tappeiner Hospital Merano Italy
- Department of Neuroscience, Biomedicine and Movement Science University of Verona Verona Italy
| | - Y. Höller
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience Paracelsus Medical University Salzburg Austria
| | - L. Sebastianelli
- Department of Neurorehabilitation Hospital of Vipiteno, and Research Department for Neurorehabilitation South Tyrol Bolzano Italy
| | - V. Versace
- Department of Neurorehabilitation Hospital of Vipiteno, and Research Department for Neurorehabilitation South Tyrol Bolzano Italy
| | - L. Saltuari
- Department of Neurorehabilitation Hospital of Vipiteno, and Research Department for Neurorehabilitation South Tyrol Bolzano Italy
- Department of Neurology Hochzirl Hospital Zirl Austria
| | - P. Lochner
- Department of Neurology Saarland University Medical Center Homburg Germany
| | - E. Trinka
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience Paracelsus Medical University Salzburg Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg Austria
- University for Medical Informatics and Health Technology, UMIT Hall in Tirol Austria
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16
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Harvey MP, Maher-Bussières S, Emery E, Martel M, Houde F, Tousignant-Laflamme Y, Léonard G. Evidence of motor system reorganization in complex regional pain syndrome type 1: A case report. Can J Pain 2018; 2:21-26. [PMID: 35005361 PMCID: PMC8730548 DOI: 10.1080/24740527.2017.1422116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background Central nervous system reorganization, particularly in networks devoted to somatosensation, is thought to be a significant feature of complex regional pain syndrome (CRPS). Aims In the present case report, we evaluated the corticomotor system of a woman suffering from CRPS, as she started and completed her rehabilitation, in order to explore whether CRPS could also be linked to changes in motor networks. Methods The patient, a 58-year-old woman, was diagnosed with right-hand CRPS. Transcranial magnetic stimulation measures, reflecting the strength of the corticospinal projections, were evaluated before, during, and after an 8-week graded motor imagery (GMI) program. Results Before treatment, the patient reported significant pain and disability, and the strength of the corticospinal projections of the first dorsal interosseous of the affected hand was reduced compared to the healthy, unaffected hand. Pain and disability decreased as the patient completed the GMI program. These changes were paralleled by an increase in the strength of the corticospinal projections. Conclusions These observations suggest that corticomotor changes can be observed in individuals suffering from CRPS and that some of the clinical manifestations observed in these patients (e.g., pain, disability) could possibly be linked to these neurophysiological changes.
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Affiliation(s)
- Marie-Philippe Harvey
- Faculty of Medicine and Health Sciences, University of Sherbrooke , Sherbrooke, Québec, Canada
- Research Centre on Aging, University Institute of Geriatrics of Sherbrooke , Sherbrooke, Québec, Canada
| | - Samuel Maher-Bussières
- Faculty of Medicine and Health Sciences, University of Sherbrooke , Sherbrooke, Québec, Canada
| | - Elysa Emery
- Faculty of Medicine and Health Sciences, University of Sherbrooke , Sherbrooke, Québec, Canada
| | - Marylie Martel
- Faculty of Medicine and Health Sciences, University of Sherbrooke , Sherbrooke, Québec, Canada
- Research Centre on Aging, University Institute of Geriatrics of Sherbrooke , Sherbrooke, Québec, Canada
| | - Francis Houde
- Faculty of Medicine and Health Sciences, University of Sherbrooke , Sherbrooke, Québec, Canada
- Research Centre on Aging, University Institute of Geriatrics of Sherbrooke , Sherbrooke, Québec, Canada
| | - Yannick Tousignant-Laflamme
- Clinical Research Centre Étienne–Le Bel-CHUS , Sherbrooke, Québec, Canada
- School of Rehabilitation, Faculty of Medicine and Health Sciences, University of Sherbrooke , Sherbrooke, Québec, Canada
| | - Guillaume Léonard
- Research Centre on Aging, University Institute of Geriatrics of Sherbrooke , Sherbrooke, Québec, Canada
- School of Rehabilitation, Faculty of Medicine and Health Sciences, University of Sherbrooke , Sherbrooke, Québec, Canada
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17
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Filbrich L, Alamia A, Verfaille C, Berquin A, Barbier O, Libouton X, Fraselle V, Mouraux D, Legrain V. Biased visuospatial perception in complex regional pain syndrome. Sci Rep 2017; 7:9712. [PMID: 28852115 PMCID: PMC5574889 DOI: 10.1038/s41598-017-10077-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 08/04/2017] [Indexed: 01/19/2023] Open
Abstract
Complex regional pain syndrome (CRPS) is a chronic pain condition associating sensory, motor, trophic and autonomic symptoms in one limb. Cognitive difficulties have also been reported, affecting the patients’ ability to mentally represent, perceive and use their affected limb. However, the nature of these deficits is still a matter of debate. Recent studies suggest that cognitive deficits are limited to body-related information and body perception, while not extending to external space. Here we challenge that statement, by using temporal order judgment (TOJ) tasks with tactile (i.e. body) or visual (i.e. extra-body) stimuli in patients with upper-limb CRPS. TOJ tasks allow characterizing cognitive biases to the advantage of one of the two sides of space. While the tactile TOJ tasks did not show any significant results, significant cognitive biases were observed in the visual TOJ tasks, affecting mostly the perception of visual stimuli occurring in the immediate vicinity of the affected limb. Our results clearly demonstrate the presence of visuospatial deficits in CRPS, corroborating the cortical contribution to the CRPS pathophysiology, and supporting the utility of developing rehabilitation techniques modifying visuospatial abilities to treat chronic pain.
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Affiliation(s)
- Lieve Filbrich
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.
| | - Andrea Alamia
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Charlotte Verfaille
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Anne Berquin
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.,University Hospital Saint-Luc, Brussels, Belgium
| | - Olivier Barbier
- University Hospital Saint-Luc, Brussels, Belgium.,Institute of Experimental and Clinical Research, Université catholique de Louvain, Brussels, Belgium
| | - Xavier Libouton
- University Hospital Saint-Luc, Brussels, Belgium.,Institute of Experimental and Clinical Research, Université catholique de Louvain, Brussels, Belgium
| | - Virginie Fraselle
- University Hospital Saint-Luc, Brussels, Belgium.,Faculty of Motor Sciences, Université catholique de Louvain, Brussels, Belgium
| | - Dominique Mouraux
- Faculty of Motor Sciences, Université libre de Bruxelles, Brussels, Belgium.,University Hospital Erasme, Brussels, Belgium
| | - Valéry Legrain
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
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18
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Filbrich L, Alamia A, Burns S, Legrain V. Orienting attention in visual space by nociceptive stimuli: investigation with a temporal order judgment task based on the adaptive PSI method. Exp Brain Res 2017; 235:2069-2079. [DOI: 10.1007/s00221-017-4951-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 03/29/2017] [Indexed: 10/19/2022]
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19
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Azqueta-Gavaldon M, Schulte-Göcking H, Storz C, Azad S, Reiners A, Borsook D, Becerra L, Kraft E. Basal ganglia dysfunction in complex regional pain syndrome - A valid hypothesis? Eur J Pain 2016; 21:415-424. [DOI: 10.1002/ejp.975] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2016] [Indexed: 01/27/2023]
Affiliation(s)
- M. Azqueta-Gavaldon
- Interdisciplinary Pain Unit; Medical Centre of University of Munich; Germany
- Department of Orthopaedics, Physical Medicine and Rehabilitation; Medical Centre of University of Munich; Germany
| | - H. Schulte-Göcking
- Interdisciplinary Pain Unit; Medical Centre of University of Munich; Germany
- Department of Orthopaedics, Physical Medicine and Rehabilitation; Medical Centre of University of Munich; Germany
| | - C. Storz
- Department of Orthopaedics, Physical Medicine and Rehabilitation; Medical Centre of University of Munich; Germany
| | - S. Azad
- Interdisciplinary Pain Unit; Medical Centre of University of Munich; Germany
- Department of Anaesthesia; Medical Centre of University of Munich; Germany
| | - A. Reiners
- Department of Rehabilitation; City Hospital Bogenhausen; Munich Germany
| | - D. Borsook
- Centre for Pain and the Brain; Boston Children's Hospital; Harvard Medical School; Boston USA
| | - L. Becerra
- Centre for Pain and the Brain; Boston Children's Hospital; Harvard Medical School; Boston USA
| | - E. Kraft
- Interdisciplinary Pain Unit; Medical Centre of University of Munich; Germany
- Department of Orthopaedics, Physical Medicine and Rehabilitation; Medical Centre of University of Munich; Germany
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20
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Visnjevac O, Costandi S, Patel BA, Azer G, Agarwal P, Bolash R, Mekhail NA. A Comprehensive Outcome-Specific Review of the Use of Spinal Cord Stimulation for Complex Regional Pain Syndrome. Pain Pract 2016; 17:533-545. [PMID: 27739179 DOI: 10.1111/papr.12513] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 06/27/2016] [Accepted: 07/08/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND Complex regional pain syndrome (CRPS) is a painful, debilitating affliction that is often difficult to treat. It has become common international practice to use spinal cord stimulation (SCS) for the treatment of CRPS as other therapies fail to provide adequate relief, quality of life, or improvement in function. This comprehensive outcome-specific systematic review of the use of SCS for CRPS was performed to elucidate the available evidence with focus on clinically relevant patient-specific outcomes. METHODS A systematic review of the literature was conducted to evaluate the effects of SCS on patients with CRPS for the following outcomes and provide summary levels of evidence in regard to each outcome: perceived pain relief, pain score, resolution of CRPS signs, functional status, quality of life, psychological impact, sleep hygiene, analgesic medication utilization, and patient satisfaction with SCS therapy. Search terms included "complex regional pain syndrome," "spinal cord stimulation," and "reflex sympathetic dystrophy," without restriction of language, date, or type of publication, albeit only original data were included in analyses. Of 30 studies selected, seven systematic reviews were excluded, as were four studies reporting combination therapy that included SCS and other therapies (ie, concurrent peripheral nerve stimulation, intrathecal therapy) without clear delineation to the effect of SCS alone on outcomes. A total of 19 manuscripts were evaluated. RESULTS Perceived pain relief, pain score improvement, quality of life, and satisfaction with SCS were all rated 1B+, reflecting positive high-level (randomized controlled trial) evidence favoring SCS use for the treatment of CRPS. Evidence for functional status improvements and psychological effects of SCS was inconclusive, albeit emanating from a randomized controlled trial (evidence level 2B±), and outcomes evidence for both sleep hygiene and resolution of CRPS signs was either nonexistent or of too low quality from which to draw conclusions (evidence level 0). An analgesic sparing effect was observed in nonrandomized reports, reflecting an evidence level of 2C+. CONCLUSIONS Spinal cord stimulation remains a favorable and effective modality for treating CRPS with high-level evidence (1B+) supporting its role in improving CRPS patients' perceived pain relief, pain score, and quality of life. A paucity of evidence for functional improvements, resolution of CRPS signs, sleep hygiene, psychological impact, and analgesic sparing effects mandate further investigation before conclusions can be drawn for these specific outcomes.
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Affiliation(s)
- Ognjen Visnjevac
- Pain Management Department, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Shrif Costandi
- Evidence-Based Pain Management Research, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Bimal A Patel
- Pain Management Department, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Girgis Azer
- Evidence-Based Pain Management Research, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Priya Agarwal
- Pain Management Department, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Robert Bolash
- Evidence-Based Pain Management Research, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Nagy A Mekhail
- Evidence-Based Pain Management Research, Cleveland Clinic, Cleveland, Ohio, U.S.A
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21
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Enax-Krumova EK, Lenz M, Frettlöh J, Höffken O, Reinersmann A, Schwarzer A, Westermann A, Tegenthoff M, Maier C. Changes of the Sensory Abnormalities and Cortical Excitability in Patients with Complex Regional Pain Syndrome of the Upper Extremity After 6 Months of Multimodal Treatment. PAIN MEDICINE 2016; 18:95-106. [DOI: 10.1093/pm/pnw147] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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22
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van Bussel CM, Stronks DL, Huygen FJPM. Phenotypic Variation in Complex Regional Pain Syndrome: Comparison Between Presentation in Knee Alone or in Ankle/Foot. PAIN MEDICINE 2016; 17:2337-2343. [DOI: 10.1093/pm/pnw119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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23
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Complex regional pain syndrome (CRPS) or continuous unilateral distal experimental pain stimulation in healthy subjects does not bias visual attention towards one hemifield. Exp Brain Res 2015; 233:3291-9. [DOI: 10.1007/s00221-015-4397-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 07/27/2015] [Indexed: 12/22/2022]
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24
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Kaur P, Muthuraman A, Kaur J. Ameliorative potential of angiotensin-converting enzyme inhibitor (ramipril) on chronic constriction injury of sciatic nerve induced neuropathic pain in mice. J Renin Angiotensin Aldosterone Syst 2014; 16:103-12. [DOI: 10.1177/1470320314556171] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 08/09/2014] [Indexed: 01/12/2023] Open
Affiliation(s)
- Parneet Kaur
- Department of Pharmacology, Akal College of Pharmacy & Technical Education, Punjab, India
| | - Arunachalam Muthuraman
- Department of Pharmacology, Akal College of Pharmacy & Technical Education, Punjab, India
| | - Jaspreet Kaur
- Department of Pharmacology, Akal College of Pharmacy & Technical Education, Punjab, India
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