scholarly journals Disputing space-based biases in unilateral complex regional pain syndrome

2020 ◽  
Author(s):  
Monika Halicka ◽  
Axel D Vittersø ◽  
Hayley McCullough ◽  
Andreas Goebel ◽  
Leila Heelas ◽  
...  
Keyword(s):  
Spatial Cognition ◽  
Complex Regional Pain Syndrome ◽  
Motor Function ◽  
Motor Impairment ◽  
Pain Syndrome ◽  
Body Representation ◽  
Visuospatial Attention ◽  
Unaffected Side ◽  
Affected Relative ◽  
Pathological Pain

AbstractThere is some evidence that people with Complex Regional Pain Syndrome (CRPS) show reduced attention to the affected relative to unaffected limb and its surrounding space, resembling hemispatial neglect after brain injury. These neuropsychological symptoms could be related to central mechanisms of pathological pain and contribute to its clinical manifestation. However, the existing evidence of changes in spatial cognition is limited and often inconsistent. We examined visuospatial attention, the mental representation of space, and spatially-defined motor function in 54 people with unilateral upper-limb CRPS and 22 pain-free controls. Contrary to our hypotheses and previous evidence, individuals with CRPS did not show any systematic spatial biases in visuospatial attention to or representation of the side of space corresponding to their affected limb (relative to the unaffected side). We found very little evidence of directional slowing of movements towards the affected relative to unaffected side that would be consistent with motor neglect. People with CRPS were, however, slower than controls to initiate and execute movements with both their affected and unaffected hands, which suggests disrupted central motor networks. Finally, we found no evidence of any clinical relevance of changes in spatial cognition because there were no relationships between the magnitude of spatial biases and the severity of pain or other CRPS symptoms. The results did reveal potential relationships between CRPS pain and symptom severity, subjective body perception disturbance, and extent of motor impairment, which would support treatments focused on normalizing body representation and improving motor function. Our findings suggest that previously reported spatial biases in CRPS might have been overstated.

Muscle Hyperalgesia Correlates With Motor Function in Complex Regional Pain Syndrome Type 1

2013 ◽  
Vol 14 (5) ◽  
pp. 446-454 ◽  
Author(s):  
Diana E. van Rooijen ◽  
Johan Marinus ◽  
Alfred C. Schouten ◽  
Lucas P.J.J. Noldus ◽  
Jacobus J. van Hilten
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Motor Function ◽  
Pain Syndrome ◽  
Syndrome Type

scholarly journals Ignoring space around a painful limb? No evidence for a body-related visuospatial attention bias in Complex Regional Pain Syndrome

Cortex ◽  
2020 ◽  
Author(s):  
Antonia F. Ten Brink ◽  
Monika Halicka ◽  
Axel D. Vittersø ◽  
Edmund Keogh ◽  
Janet H. Bultitude
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Attention Bias ◽  
Pain Syndrome ◽  
Visuospatial Attention

scholarly journals Normal manual straight ahead pointing in Complex Regional Pain Syndrome

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261614
Author(s):  
Axel D. Vittersø ◽  
Gavin Buckingham ◽  
Antonia F. Ten Brink ◽  
Monika Halicka ◽  
Michael J. Proulx ◽  
...  
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Visual Feedback ◽  
Upper Limb ◽  
Pain Syndrome ◽  
Body Representation ◽  
Clinical Parameters ◽  
Body Representations ◽  
Moderate Evidence ◽  
Pointing Errors ◽  
Straight Ahead

There is evidence to suggest that people with Complex Regional Pain Syndrome (CRPS) can have altered body representations and spatial cognition. One way of studying these cognitive functions is through manual straight ahead (MSA) pointing, in which participants are required to point straight ahead of their perceived body midline without visual feedback of the hand. We therefore compared endpoint errors from MSA pointing between people with CRPS (n = 17) and matched controls (n = 18), and examined the effect of the arm used (Side of Body; affected/non-dominant, non-affected/dominant). For all participants, pointing errors were biased towards the hand being used. We found moderate evidence of no difference between Groups on endpoint errors, and moderate evidence of no interaction with Side of Body. The differences in variability between Groups were non-significant/inconclusive. Correlational analyses showed no evidence of a relationship between MSA endpoint errors and clinical parameters (e.g. CRPS severity, duration, pain) or questionnaire measures (e.g. body representation, “neglect-like symptoms”, upper limb disability). This study is consistent with earlier findings of no difference between people with CRPS and controls on MSA endpoint errors, and is the first to provide statistical evidence of similar performance of these two groups. Our results do not support a relationship between clinical or self-reported measures (e.g. “neglect-like symptoms”) and any directional biases in MSA. Our findings may have implications for understanding neurocognitive changes in CRPS.

scholarly journals Attentional Modulation of Neural Dynamics in Tactile Perception of Complex Regional Pain Syndrome Patients

2020 ◽  
Author(s):  
Serena Defina ◽  
Maria Niedernhuber ◽  
Nicholas Shenker ◽  
Christopher Brown ◽  
Tristan A. Bekinschtein
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Pain Syndrome ◽  
Stimulus Onset ◽  
Task Demands ◽  
The Body ◽  
Neural Representation ◽  
Neural Dynamics ◽  
Control Mechanisms ◽  
Clinical Markers ◽  
Unaffected Side

AbstractBody perceptual disturbances are an increasingly acknowledged set of symptoms and possible clinical markers of Complex Regional Pain Syndrome (CRPS), but the neurophysiological and neurocognitive changes that underlie them are still far from being clear. We adopted a novel multivariate and neurodynamical approach to the analysis of EEG modulations evoked by touch, to highlight differences between patients and healthy controls, between affected and unaffected side of the body, and between “passive” (i.e. no task demands and equiprobable digit stimulation) and “active” tactile processing (i.e. where a digit discrimination task was administered and spatial probability manipulated). Contrary to our expectations we found no support for early differences in neural processing between CRPS and healthy participants, however, there was increased decodability in the CRPS group compared to healthy volunteers between 280 and 320 ms after stimulus onset. This group difference seemed to be driven by the affected rather than the unaffected side and was enhanced by attentional demands. These results found support in the exploratory analysis of neural representation dynamics and behavioural modelling, highlighting the need for single participant analyses. Although several limitations impacted the robustness and generalizability of our comparisons, the proposed novel analytical approach yielded promising insights (as well as possible biomarkers based on neural dynamics) into the relatively unexplored alterations of tactile decision-making and attentional control mechanisms in chronic CRPS.

Impaired spatial body representation in complex regional pain syndrome type 1 (CRPS I)

Pain ◽  
2012 ◽  
Vol 153 (11) ◽  
pp. 2174-2181 ◽  
Author(s):  
Annika Reinersmann ◽  
Julia Landwehrt ◽  
Elena K. Krumova ◽  
Sebastian Ocklenburg ◽  
Onur Güntürkün ◽  
...  
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Pain Syndrome ◽  
Body Representation ◽  
Syndrome Type

Complex Regional Pain Syndrome - Diagnosis, Treatment and Future Perspectives

2011 ◽  
Vol 6 (4) ◽  
pp. 270 ◽  
Author(s):  
Sigrid GL Fischer ◽  
Roberto SGM Perez ◽  
◽  
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Motor Function ◽  
Pain Syndrome ◽  
Signs And Symptoms ◽  
Future Research ◽  
Future Perspectives ◽  
Central Sensitisation ◽  
Anti Inflammatory ◽  
Budapest Criteria ◽  
Cortical Reorganisation

Complex regional pain syndrome (CRPS) is a pain syndrome of the extremities that can result in severe disability. CRPS is diagnosed using diagnostic Budapest criteria based on signs and symptoms, whereby sensory, autonomic, vasomotor, motor and trophic disturbances are assessed. Many pathophysiological mechanisms are proposed in the development and disease course of CRPS, starting with exaggerated inflammation and resulting in vascular deregulation, central sensitisation and cortical reorganisation. Treatment is based primarily on reducing inflammation by using medicinal anti-inflammatory therapy and increasing motor function by physiotherapy. Furthermore, pain reduction, normalisation of vasomotor and motor function, and psychological interventions might be needed. Future research should focus on the efficacy of anti-inflammatory therapy, effective rehabilitation programmes, modulating neuropathic pain and cortical reorganisation.

scholarly journals Attentional Modulation of Neural Dynamics in Tactile Perception of Complex Regional Pain Syndrome (CRPS) Patients

2020 ◽  
Author(s):  
Serena Defina ◽  
Maria Niedernhuber ◽  
Nicholas Shenker ◽  
Christopher Brown ◽  
Tristan Bekinschtein
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Pain Syndrome ◽  
Stimulus Onset ◽  
Task Demands ◽  
The Body ◽  
Neural Representation ◽  
Neural Dynamics ◽  
Control Mechanisms ◽  
Clinical Markers ◽  
Unaffected Side

Body perceptual disturbances are an increasingly acknowledged set of symptoms and possible clinical markers of Complex Regional Pain Syndrome (CRPS), but the neurophysiological and neurocognitive changes that underlie them are still far from being clear. We adopted a novel multivariate and neurodynamical approach to the analysis of EEG modulations evoked by touch, to highlight differences between patients and healthy controls, between affected and unaffected side of the body, and between “passive” (i.e. no task demands and equiprobable digit stimulation) and “active” tactile processing (i.e. where a digit discrimination task was administered and spatial probability manipulated). Contrary to our expectations we found no support for early differences in neural processing between CRPS and healthy participants, however, there was increased decodability in the CRPS group compared to healthy volunteers between 280 and 320 ms after stimulus onset. This group difference seemed to be driven by the affected rather than the unaffected side and was enhanced by attentional demands. These results found support in the exploratory analysis of neural representation dynamics and behavioural modelling, highlighting the need for single participant analyses. Although several limitations impacted the robustness and generalizability of our comparisons, the proposed novel analytical approach yielded promising insights (as well as possible biomarkers based on neural dynamics) into the relatively unexplored alterations of tactile decision-making and attentional control mechanisms in chronic CRPS.

scholarly journals Neuropsychological Changes in Complex Regional Pain Syndrome (CRPS)

2020 ◽  
Vol 2020 ◽  
pp. 1-30 ◽  
Author(s):  
Monika Halicka ◽  
Axel D. Vittersø ◽  
Michael J. Proulx ◽  
Janet H. Bultitude
Keyword(s):  
Chronic Pain ◽  
Complex Regional Pain Syndrome ◽  
Cognitive Functions ◽  
Clinical Signs ◽  
Pain Syndrome ◽  
Body Representation ◽  
Neuropsychological Changes ◽  
Neuropsychological Functions ◽  
Higher Cognitive Functions ◽  
Chronic Pain Conditions

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.

scholarly journals Pain Reduction by Inducing Sensory-Motor Adaptation in Complex Regional Pain Syndrome (CRPS PRISMA): Protocol for a Double-blind Randomized Controlled Trial

2019 ◽  
Author(s):  
Monika Halicka ◽  
Axel D Vittersø ◽  
Michael J Proulx ◽  
Janet H Bultitude
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Outcome Measures ◽  
Severity Score ◽  
Pain Syndrome ◽  
Body Representation ◽  
Therapeutic Effects ◽  
Double Blind ◽  
Sham Treatment ◽  
Sensory Motor ◽  
Neuropsychological Changes

AbstractBackgroundComplex Regional Pain Syndrome (CRPS) presents as chronic, continuous pain and sensory, autonomic, and motor abnormalities affecting one or more extremities. People with CRPS can also show changes in their perception of and attention to the affected body part and sensory information in the affected side of space. Prism Adaptation (PA) is a behavioural intervention targeted at reducing attention deficits in post-stroke hemispatial neglect. PA also appears to reduce pain and other CRPS symptoms; however, these therapeutic effects have been demonstrated only in small unblinded studies. This paper describes the protocol for an ongoing double-blind, randomized, sham-controlled clinical trial that will evaluate the efficacy of PA treatment for CRPS. The secondary aims of the study are to examine the relationships between neuropsychological changes (such as spatial attention, space and body representation, and motor spatial performance) and clinical manifestations of CRPS, as well as symptom improvement.MethodsForty-two participants with upper-limb CRPS type I will undergo two weeks of twice-daily PA treatment or sham treatment. The primary outcome measures are current pain intensity and CRPS severity score, measured immediately before and after the treatment period. Secondary outcome measures include the results of self-report questionnaires about pain, movement, symptoms interference, and body representation; clinical assessments of sensory, motor, and autonomic functions; and computer-based psychophysical tests of neuropsychological functions. Data are collected in four research visits: four weeks and one day before treatment, and one day and four weeks after the end of treatment. Additional follow-up through postal questionnaires is conducted three and six months post-treatment.DiscussionIt is hypothesised that participants undergoing PA treatment, compared to those receiving sham treatment, will show greater reduction in pain and CRPS severity score, and improvements on other clinical and neuropsychological measures. Also, more pronounced neuropsychological symptoms are predicted to correlate with more severe clinical CRPS symptoms. This study will provide the first randomized double-blind evaluation of the therapeutic effects of PA that could be implemented as a rehabilitation method for CRPS, and will contribute to the understanding of how neuropsychological changes in body representation and attention pertain to the manifestation and treatment of CRPS.

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