Changes in visual attentional behavior in complex regional pain syndrome: A preliminary study

Purpose The purpose of the present study was to investigate the visual attentional behavior towards a pain-affected area and face/body images using eye tracking in complex regional pain syndrome (CRPS) patients. Moreover, we investigated the relationship between visual attentional behavior and clinical symptoms. Patients and methods Eight female patients with CRPS type 1 in their upper limbs and 8 healthy adult women participated in this study. First, the participants were asked to watch videoclips in a relaxed manner (Videoclip 1 featured young adults who introduced themselves; Videoclip 2 featured young adults touching the hand of the other person sitting across from them with their hand.) Eye movement data were tracked with eye-tracking glasses. Results In video clip 1, the fixation duration (FD) and fixation count (FC) on faces tended to be lower in CRPS patients than in healthy controls. This tendency was found in patients with low body cognitive distortions. In video clip 2, CRPS patients displayed significantly lower FD and FC on the unaffected hand while watching a video of the unaffected hand being touched compared with healthy controls. Moreover, patients with low body cognitive distortion displayed significantly longer FD on the affected hand. Conclusion Some CRPS patients differed in visual attentional behavior toward the face and body compared with healthy controls. In addition, our findings suggest that patients with lower body cognitive distortion may have a high visual attention for the affected hand, while patients with higher distortion may be neglecting the affected hand.

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Complex regional pain syndrome type 1 in young adults

GULHANE MEDICAL JOURNAL ◽

10.26657/gulhane.00026 ◽

2018 ◽

Vol 60 (3) ◽

pp. 78

Author(s):

Yasin Demir ◽

Ümüt Güzelküçük ◽

Serdar Kesikburun ◽

Berke Aras ◽

Mehmet Ali Taşkaynatan ◽

...

Keyword(s):

Young Adults ◽

Complex Regional Pain Syndrome ◽

Pain Syndrome ◽

Syndrome Type

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Prednisolone in Complex Regional Pain Syndrome

January 2018 - Pain Physician ◽

10.36076/ppj.2014/17/179 ◽

2014 ◽

Vol 2;17 (2;3) ◽

pp. 179-185 ◽

Cited By ~ 3

Author(s):

Nilgun Simsir Atalay

Keyword(s):

Quality Of Life ◽

Range Of Motion ◽

Grip Strength ◽

Complex Regional Pain Syndrome ◽

Upper Extremity ◽

Functional Ability ◽

Clinical Symptoms ◽

Pain Syndrome ◽

Sf 36

Background: Although there are several studies of systemic corticosteroid therapies in various doses and various durations in complex regional pain syndrome (CRPS), the outcome measurement parameters are limited to the range of motion measurements, edema, and symptoms of CRPS. Objective: To investigate the effects of prednisolone on clinical symptoms, pain, hand grip strength, range of motion, as well as on functional ability and quality of life in patients who developed CRPS after traumatic upper extremity injury. Study Design: Retrospective evaluation. Methods: Forty-five patients who used prednisolone for CRPS of the upper extremity were retrospectively studied. Prednisolone was started with a dose of 30 mg and tapered by 5 mg every 3 days until discontinuation after 3 weeks. Clinical symptoms (morning stiffness, cold intolerance, shoulder pain, numbness of fingers, hyperesthesia, abnormal sweating, and cyanosis that is exacerbated by exposure to cold temperature), pain (Visual Analogue Scale-Rest [VAS-R] and VASActivity [VAS-A]) were reviewed. The muscle strength with grip strength (GS) (kg), lateral pinch (LP) (pound), tip-to-tip pinch (TP) (pound), and chuck pinch (CP) (pound) measurements; the joint range of motion with using third finger tip-distal crease distance (FT-DC) (cm); functional ability with Quick-Disabilities of the Arm, Shoulder and Hand (Q-DASH) score; and quality of life with Short Form-36 (SF-36) score were evaluated. Results: Mean age was 43.53 ± 11.43 years. After 3 weeks of therapy, patients showed significant improvements in clinical symptoms compared to the basal assessments (P < 0.05). The comparison of pre- and post-treatment results revealed that VAS-R, VAS-A, GS, LP, TP, CP, FT-DC, Q-DASH scores, and all SF-36 subscores were significantly improved (P < 0.05). Limitations: The retrospective design and data collection procedure was limited to the medical records of patients. Conclusion: A short-term oral prednisolone therapy significantly reduced the symptoms and signs of CRPS, and improved the functional abilities and quality of life. Key words: Complex regional pain syndrome, prednisolone, function, quality of life

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USE OF DEEP OSCILLATION - THERAPY IN REHABILITATION PROGRAM FOR PATIENT AFTER DISTAL RADIUS FRACTURE WITH A COMPLEX REGIONAL PAIN SYNDROME: A CASE REPORT

Trakia Journal of Sciences ◽

10.15547/tjs.2020.s.01.034 ◽

2020 ◽

Vol 18 (Suppl.1) ◽

pp. 187-193

Author(s):

G. Мratskova

Keyword(s):

Complex Regional Pain Syndrome ◽

Distal Radius ◽

Sagittal Plane ◽

Clinical Symptoms ◽

Pain Syndrome ◽

Rehabilitation Program ◽

Manual Muscle Testing ◽

Muscle Testing ◽

Number Of Patients ◽

Therapeutic Exercises

THE PURPOSE is to present a clinical case of a patient with a fracture of the distal radius and complex regional pain syndrome I, in which complex rehabilitation was applied, including Deep Oscillation, cryotherapy and therapeutic exercises. MATERIALS AND METHODS: The rehabilitation program was conducted to a 62-year-old woman, four months after the injury. The intervention includes Deep Oscillation in biphasic mode (up to 7μA) and therapeutic exercises 10 procedures. The clinical symptoms were assessed before and after therapy and after 1-st and 3-rd months after therapy. RESULTS: Reduction in pain (VAS) after therapy from “very strong” (75mm) before therapy, to “mild” at 3 months (12mm) was observed. Reduction of wrist swelling and muscle weakness as assessed by manual muscle testing was observed. The range of movement in the sagittal plane from 25º-0-35º to 70º-0º-85º and the frontal plane from 5º-0-15º to 20º-0º-35º was increase. Improved performance of activities of daily living was observed. No adverse events with Deep Oscillation therapy were observed. CONCLUSION: Deep Oscillation and therapeutic exercises effectively reduce the clinical symptoms of regional pain syndrome. To establish the therapeutic efficacy of Deep Oscillation treatment after a fracture of the distal radius with complex regional pain syndrome, randomized studies involving a larger number of patients are required.

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Outcome in young adults who were diagnosed with complex regional pain syndrome in childhood and adolescence

PAIN Reports ◽

10.1097/pr9.0000000000000860 ◽

2020 ◽

Vol 5 (6) ◽

pp. e860

Author(s):

Becky J. Wong ◽

Isabel A. Yoon ◽

Elliot J. Krane

Keyword(s):

Young Adults ◽

Complex Regional Pain Syndrome ◽

Pain Syndrome ◽

Childhood And Adolescence

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Elevated Plasma Levels of sIL-2R in Complex Regional Pain Syndrome: A Pathogenic Role for T-Lymphocytes?

Mediators of Inflammation ◽

10.1155/2017/2764261 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6 ◽

Cited By ~ 15

Author(s):

Krishna D. Bharwani ◽

Maaike Dirckx ◽

Dirk L. Stronks ◽

Willem A. Dik ◽

Marco W. J. Schreurs ◽

...

Keyword(s):

Immune System ◽

T Cell ◽

Complex Regional Pain Syndrome ◽

Interleukin 2 ◽

Cell Activity ◽

Pain Syndrome ◽

High Sensitivity ◽

Healthy Controls ◽

Good Discriminator ◽

Soluble Interleukin 2 Receptor

The immune system has long been thought to be involved in the pathophysiology of complex regional pain syndrome (CRPS). However, not much is known about the role of the immune system and specifically T-cells in the onset and maintenance of this disease. In this study, we aimed to evaluate T-cell activity in CRPS by comparing blood soluble interleukin-2 receptor (sIL-2R) levels between CRPS patients and healthy controls. CRPS patients had statistically significant elevated levels of sIL-2R as compared to healthy controls (median sIL-2R levels: 4151 pg/ml (Q3 − Q1 = 5731 pg/ml − 3546 pg/ml) versus 1907 pg/ml (Q3 − Q1: 2206 pg/ml − 1374 pg/ml), p<0.001, resp.). Furthermore, sIL-2R level seems to be a good discriminator between CRPS patients and healthy controls with a high sensitivity (90%) and specificity (89.5%). Our finding indicates increased T-cell activity in patients with CRPS. This finding is of considerable relevance as it could point towards a T-cell-mediated inflammatory process in this disease. This could pave the way for new anti-inflammatory therapies in the treatment of CRPS. Furthermore, sIL-2R could be a promising new marker for determining inflammatory disease activity in CRPS.

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Heartbeat-enhanced immersive virtual reality to treat complex regional pain syndrome

Neurology ◽

10.1212/wnl.0000000000005905 ◽

2018 ◽

Vol 91 (5) ◽

pp. e479-e489 ◽

Cited By ~ 16

Author(s):

Marco Solcà ◽

Roberta Ronchi ◽

Javier Bello-Ruiz ◽

Thomas Schmidlin ◽

Bruno Herbelin ◽

...

Keyword(s):

Virtual Reality ◽

Complex Regional Pain Syndrome ◽

Pain Syndrome ◽

Double Blind Study ◽

Immersive Virtual Reality ◽

Healthy Controls ◽

Mirror Therapy ◽

Class Iii ◽

Double Blind ◽

Pain Ratings

ObjectivesTo develop and test a new immersive digital technology for complex regional pain syndrome (CRPS) that combines principles from mirror therapy and immersive virtual reality and the latest research from multisensory body processing.MethodsIn this crossover double-blind study, 24 patients with CRPS and 24 age- and sex-matched healthy controls were immersed in a virtual environment and shown a virtual depiction of their affected limb that was flashing in synchrony (or in asynchrony in the control condition) with their own online detected heartbeat (heartbeat-enhanced virtual reality [HEVR]). The primary outcome measures for pain reduction were subjective pain ratings, force strength, and heart rate variability (HRV).ResultsHEVR reduced pain ratings, improved motor limb function, and modulated a physiologic pain marker (HRV). These significant improvements were reliable and highly selective, absent in control HEVR conditions, not observed in healthy controls, and obtained without the application of tactile stimulation (or movement) of the painful limb, using a readily available biological signal (the heartbeat) that is most often not consciously perceived (thus preventing placebo effects).ConclusionsNext to these specific and well-controlled analgesic effects, immersive HEVR allows the application of prolonged and repeated doses of digital therapy, enables the automatized integration with existing pain treatments, and avoids application of painful bodily cues while minimizing the active involvement of the patient and therapist.Classification of evidenceThis study provides Class III evidence that HEVR reduces pain and increases force strength in patients with CRPS.

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Different Activation of Opercular and Posterior Cingulate Cortex (PCC) in Patients With Complex Regional Pain Syndrome (CRPS I) Compared With Healthy Controls During Perception of Electrically Induced Pain: A Functional MRI Study

Clinical Journal of Pain ◽

10.1097/ajp.0b013e3181cb4055 ◽

2010 ◽

Vol 26 (4) ◽

pp. 339-347 ◽

Cited By ~ 38

Author(s):

Wolfgang Freund ◽

Arthur P. Wunderlich ◽

Gregor Stuber ◽

Florian Mayer ◽

Peter Steffen ◽

...

Keyword(s):

Complex Regional Pain Syndrome ◽

Functional Mri ◽

Pain Syndrome ◽

Cingulate Cortex ◽

Posterior Cingulate Cortex ◽

Healthy Controls ◽

Posterior Cingulate ◽

Mri Study

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Virtual Reality-Induced Sensorimotor Conflict Evokes Limb-Specific Sensory Disturbances in Complex Regional Pain Syndrome

Frontiers in Virtual Reality ◽

10.3389/frvir.2021.694293 ◽

2021 ◽

Vol 2 ◽

Author(s):

Clémentine Brun ◽

Anne Marie Pinard ◽

Candida S. McCabe ◽

Catherine Mercier

Keyword(s):

Complex Regional Pain Syndrome ◽

Clinical Characteristics ◽

Sensorimotor Integration ◽

Pain Syndrome ◽

Healthy Controls ◽

Body Perception ◽

Item Questionnaire ◽

Sensory Disturbances ◽

Motor Disturbances ◽

Rule Out

The origin of sensory disturbances in complex regional pain syndrome (CRPS) remains unclear. It has been hypothesized that such disturbances are due to attentional effects and/or sensorimotor integration deficits. If sensory disturbances are explained by sensorimotor integration deficits, they would be expected to be specific in terms of the category of sensation evoked and in terms of localization. Objective 1: To test whether sensory disturbances evoked by a unilateral sensorimotor conflict are specific to the painful limb and differ according to the category of sensory disturbances in individuals with a unilateral CRPS compared to healthy controls (HC). Objective 2: To assess the association between clinical characteristics and conflict-induced sensory disturbances. Objective 3: To assess conflict-induced motor disturbances. Ten adults with upper limb (UL) CRPS and 23 HC were recruited. Sensorimotor conflict was elicited with a KINARM exoskeleton interfaced with a 2D virtual environment allowing the projection of a virtual UL that was moving in either a congruent or incongruent manner relative to the actual UL movement. Participants rated sensory disturbances from 0 (no change) to 3 (high change) on a 8-item questionnaire. Items were classified into two Categories (Category 1: pain, discomfort, the feeling of losing a limb, change in weight and temperature; Category 2: feelings of peculiarity, the impression of gaining a limb and losing control). Motor disturbances were quantified as mediolateral drift and changes in amplitude of UL movement. Clinical characteristics included the intensity and duration of pain, proprioception, and body perception. CRPS participants report higher Category 1 than Category 2 disturbances for the Affected limb (while the reverse was observed for HC and for the Unaffected limb). In addition, no difference was observed between the Unaffected limb in CRPS and the Dominant limb in HC for Category 2 disturbances, while higher conflict sensitivity was observed for Category 1 disturbances. Conflict sensitivity was only related to higher pain for Category 1 disturbances in the Affected limb. Finally, no effect on motor disturbances was observed. While they do not completely rule out the attentional hypothesis, these results support the hypothesis of sensorimotor integration deficits.

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