scholarly journals Atypical influence of biomechanical knowledge in Complex Regional Pain Syndrome-Towards a different perspective on body representation

2021 ◽  
Author(s):  
Lieve Filbrich ◽  
Charlotte Verfaille ◽  
Gilles Vannuscorps ◽  
Anne Berquin ◽  
Olivier Barbier ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Reaction Time ◽  
Complex Regional Pain Syndrome ◽  
Motor Imagery ◽  
Body Movement ◽  
Pain Syndrome ◽  
Body Representation ◽  
Hand Laterality ◽  
Behavioral Studies ◽  
The One

Part of the multifaceted pathophysiology of Complex Regional Pain syndrome (CRPS) has been ascribed to a lateralized maladaptive neuroplasticity in sensorimotor cortices, a finding that has been corroborated by behavioral studies indicating that CRPS patients indeed present difficulties in mentally representing their painful limb. Hand laterality judgment tasks (HLT) are widely used to measure such difficulties, with the laterality of hand stimuli corresponding to the affected hand judged more slowly than the one of hand stimuli corresponding to the unaffected hand. Importantly, the HLT is also regularly used in the rehabilitation of CRPS and other chronic pain disorders, with the aim to activate motor imagery and, consequently, restoring the cortical representation of the limb. The potential of these tasks to elicit motor imagery is thus critical to their use in therapy. Yet, the influence of the biomechanical constraints (BMC) on HLT reaction time, supposed to reflect the activation of motor imagery, is rarely verified. In the present study we investigated the influence of the BMC on the perception of hand postures and movements. The results of a first experiment, in which a HLT was used, showed that CRPS patients were significantly slower than controls in judging hand stimuli, whether or not the depicted hand corresponded to their affected hand, but that their performance did not differ from controls when they judged non-body stimuli. Results regarding reaction time patterns reflecting the BMC were inconclusive in CRPS and controls, questioning the validity of the task in activating motor imagery processes. In a second experiment we therefore directly investigated the influence of implicit knowledge of upper-limb BMC on perceptual judgments of hand movements with the apparent body movement perception task. Participants judge the perceived path of movement between two depicted hand positions, with only one of the two proposed paths that is biomechanically plausible. While the controls chose the biomechanically plausible path most of the time, CRPS patients did not, indicating that the perception and/or use of the BMC seems to be disturbed in CRPS. These findings show a non-lateralized body representation impairment in CRPS, which might be related to difficulties in using correct knowledge of the body's biomechanics. Most importantly however, our results, in agreement with previous studies, indicate that it seems highly challenging to measure motor imagery and the indexes of BMC with the classical HLT task, which has important implications for the rehabilitation of chronic pain with these tasks.

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.

Ketamine Infusions for Complex Regional Pain Syndrome

2016 ◽  
Author(s):  
Roy K. Esaki
Keyword(s):  
Chronic Pain ◽  
Complex Regional Pain Syndrome ◽  
Hepatic Dysfunction ◽  
Case Reports ◽  
Pain Syndrome ◽  
Nmda Receptor Antagonist ◽  
Treatment Resistant ◽  
Urinary Tract Symptoms ◽  
Chronic Pain Conditions ◽  
Lower Urinary

Ketamine is an N-methyl-d-aspartate (NMDA) receptor antagonist that has been increasingly used in the management of treatment-resistant chronic pain conditions, particularly representing neuropathic involvement or central sensitization. Complex regional pain syndrome (CRPS) is a prototypical condition often treated with ketamine infusions. Although the analgesic benefits of ketamine as an opioid-sparing adjunct in the preoperative period have been well studied, the use of ketamine to mitigate chronic pain conditions remains largely anecdotal, composed largely of case reports and uncontrolled small studies. The limited evidence and published reports support the use of ketamine infusions as one aspect of a comprehensive, multimodal approach for CRPS. Although ketamine infusions are relatively safe when titrated appropriately, with minimal respiratory depression, side effects include sympathetic activation, unpleasant psychomimetic effects, lower urinary tract symptoms, and hepatic dysfunction. 

Chronic pain syndromes

2018 ◽  
pp. 623-642
Author(s):  
Gavin Clunie ◽  
Nick Wilkinson ◽  
Elena Nikiphorou ◽  
Deepak R. Jadon
Keyword(s):  
Chronic Pain ◽  
General Practitioner ◽  
Children And Adolescents ◽  
Complex Regional Pain Syndrome ◽  
Musculoskeletal Pain ◽  
Pain Syndrome ◽  
Pain Syndromes ◽  
Pain Medications ◽  
Cross Reference ◽  
Chronic Pain Syndromes

The Oxford Handbook of Rheumatology 4th edition, has been extensively updated to thoroughly review aspects of musculoskeletal pain. Pain pathophysiology is reviewed. Chronic pain and fibromyalgia in adults and in children and adolescents is dealt with in detail. The reader is advised to cross reference from this chapter to Chapters 1–3 in the Handbook, where regional musculoskeletal pain conditions are listed and reviewed. In localized pain syndromes, the chapter has an overview of complex regional pain syndrome (CRPS), which is not infrequently encountered in rheumatology and musculoskeletal clinics. Included in detail for this edition, is the assessment and management of pain in children, which is a highly specialized clinical area of medicine and will be of use to the adult rheumatologist and general practitioner as well as paediatric specialists. Readers should cross reference to Chapter 23 on medications, for ‘pain medications’ in the Handbook

Update on the effects of graded motor imagery and mirror therapy on complex regional pain syndrome type 1: A systematic review

2017 ◽  
Vol 30 (3) ◽  
pp. 441-449 ◽  
Author(s):  
Guillermo Méndez-Rebolledo ◽  
Valeska Gatica-Rojas ◽  
Rafael Torres-Cueco ◽  
María Albornoz-Verdugo ◽  
Eduardo Guzmán-Muñoz
Keyword(s):  
Systematic Review ◽  
Complex Regional Pain Syndrome ◽  
Motor Imagery ◽  
Pain Syndrome ◽  
Syndrome Type ◽  
Mirror Therapy ◽  
Graded Motor Imagery

scholarly journals Motor imagery and its effect on complex regional pain syndrome: an integrative review

2015 ◽  
Vol 7 (3) ◽  
Author(s):  
Nélio Silva De Souza ◽  
Ana Carolina Gomes Martins ◽  
Victor Hugo Do Vale Bastos ◽  
Marco Orsini ◽  
Marco Antônio A. Leite ◽  
...  
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Motor Imagery ◽  
Pain Perception ◽  
Pain Syndrome ◽  
Practice Research ◽  
Level 3 ◽  
The Difference ◽  
Brain Reorganization ◽  
Stress Influences

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.

scholarly journals Ketamine for Non-Neuropathic Pain

2021 ◽  
Author(s):  
Subbulakshmi Sundaram ◽  
Ashok Swaminathan Govindarajan
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Complex Regional Pain Syndrome ◽  
Antinociceptive Effect ◽  
Pain Syndrome ◽  
Well Being ◽  
Pain Mechanisms ◽  
Cardiovascular Side Effects ◽  
Chronic Pain Conditions ◽  
Rescue Agent

Chronic pain is one of the leading causes of years lost to disability, as most of the time it is refractory to conventional treatment. Recent advances in understanding the pain mechanisms have favored the use of ketamine as a rescue agent in refractory chronic pain conditions, as it has potential modulating effect on both sensory-discriminative and affective motivational components of pain. Preclinical studies also suggested the antinociceptive effect of sub anesthetic dose of ketamine against central and peripheral neuropathic pain conditions and non-neuropathic pain conditions such as inflammatory and nociceptive pain states. Subanesthetic infusion of ketamine along with adjuvants such as midazolam and clonidine is found to reduce the psychomimetic and cardiovascular side effects of ketamine. Even though the consensus guidelines for intravenous use of ketamine for chronic pain advocate the use of ketamine only for complex regional pain syndrome, various other clinical studies suggested its role in other refractory painful conditions. Hence the present topic focuses specifically on the effect of ketamine on non-neuropathic pain conditions such as complex regional pain syndrome, fibromyalgia, headache, ischemic limb pain, etc. Many studies had shown that ketamine not only reduces the pain scores but also the analgesic medications, which further improves the well-being and quality of life.

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