4 years ago

Structural and Functional Brain Changes at Early and Late Stages of Complex Regional Pain Syndrome

Brain plasticity is demonstrated in complex regional pain syndrome (CRPS), although it is unclear how it modulates at different stages of CRPS. The observation that symptoms can progress over time suggests that the pattern of brain changes might also evolve. We measured structural and functional changes as well as sensorimotor integration at early and late stages (ES and LS) of CRPS. Twelve ES patients, sixteen LS patients, and sixteen age- and sex-matched controls were recruited. Gray matter (GM) volume was estimated using voxel-based morphometry. Cerebral perfusion was measured using arterial spin labeling, as it provides a measure of resting neural activity. Connectivity to sensorimotor regions was evaluated using blood-oxygen-level-dependent images. The ES group showed reduced GM volume and perfusion in areas associated with spatial body perception, somatosensory cortex and the limbic system, whereas the LS group exhibited increased perfusion in the motor cortex but no changes in GM volume. However in the LS group, GM volume in areas associated with pain processing was negatively correlated with average pain levels, likely reflecting a response to ongoing pain. Furthermore, connectivity to sensorimotor cortex showed disruptions in regions associated with motor control and planning, implying impairment of higher order of motor control. Perspective This article presents brain changes at early and late states of CRPS. We found different pattern of brain changes between these two stages. Understanding modulation of brain plasticity at different stages of CRPS could help understand the diversity in outcomes and treatment response and hopefully improve treatment planning.

Publisher URL: www.sciencedirect.com/science

DOI: S1526590017307344

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