Abstract
IntroductionMany central pathophysiological aspects of complex regional pain syndrome (CRPS) are still unknown. Although brain‐imaging studies are increasingly supporting the contribution of the central nervous system to the generation and maintenance of the CRPS pain, the brain's white‐matter alterations are seldom investigated.MethodsIn this study, we used diffusion tensor imaging to explore white‐matter changes in twelve CRPS‐type‐1 female patients suffering from chronic right upper‐limb pain compared with twelve healthy control subjects.ResultsTract‐based spatial‐statistics analysis revealed significantly higher mean diffusivity, axial diffusivity, and radial diffusivity in the CRPS patients, suggesting that the structural connectivity is altered in CRPS. All these measures were altered in the genu, body, and splenium of corpus callosum, as well as in the left anterior and posterior and the right superior parts of the corona radiata. Axial diffusivity was significantly correlated with clinical motor symptoms at whole‐brain level, supporting the physiological significance of the observed white‐matter abnormalities.ConclusionsAltogether, our findings further corroborate the involvement of the central nervous system in CRPS.
Highlights
Many central pathophysiological aspects of complex regional pain syndrome (CRPS) are still unknown
& Apkarian, 2011; Barad, Ueno, Younger, Chatterjee, & Mackey, 2014; Geha et al, 2008; Pleger et al, 2014), and we have observed the enlargement of choroid plexus (Zhou, Hotta, Lehtinen, Forss, & Hari, 2015), in line with the suggestion that neuroinflammation might play a role in the pathophysiology of CRPS (Linnman, Becerra, & Borsook, 2013)
The CRPS patients exhibited abnormally high mean diffusivity (MD) values in large parts of white-matter tracts, coupled with more local increases in radial diffusivity (RD) and axial diffusivity (AD), and an overall decrease in fractional anisotropy (FA). These findings do not specify the underlying microstructural abnormalities, they further support the involvement of the central nervous system in the pathophysiology of CRPS, implying a large-scale pathology in the structural connectivity of the brains of chronic CRPS patients
Summary
The complete pathophysiology of complex regional pain syndrome (CRPS) is still poorly understood, previous brain-imaging studies have suggested the involvement of central nervous system in the maintenance and progression of the pain (Marinus et al, 2011). Diffusion tensor imaging (DTI) has revealed plastic changes in the brain’s white matter after motor training in healthy subjects (Bengtsson et al, 2005; Scholz, Klein, Behrens, & Johansen-Berg, 2009; Valkanova, Eguia Rodriguez, & Ebmeier, 2014) as well as in patients with traumatic brain injury (Drijkoningen et al, 2015). Considering the motor dysfunction, maladaptive neuroplasticity, and neuroinflammation in CRPS (Marinus et al, 2011), DTI has the potency to detect CRPS-related primary and secondary white-matter changes. We performed whole-brain tract-based spatial-statistics (TBSS) analysis of FA, mean diffusivity (MD), AD, and RD to further examine changes in white-matter integrity in CRPS type-1 patients.
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