Abstract
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.
Highlights
Complex Regional Pain Syndrome (CRPS) is a chronic pain condition of poorly understood origin that predominately affects distal parts of one extremity, in some cases it can spread to other limbs over time [1]
We have suggested a possible explanation for the inconsistent biases shown by people with CRPS on temporal order judgement (TOJ) and visual straight ahead tasks based on known cortical dissociations between the representation of near and far space identified through research on brain-lesioned patients
The role of cortical mechanisms in CRPS is evident in the neuropsychological symptoms, modulation of low-level sensory and autonomic symptoms by higher cognitive functions, and functional cortical reorganization
Summary
Complex Regional Pain Syndrome (CRPS) is a chronic pain condition of poorly understood origin that predominately affects distal parts of one extremity, in some cases it can spread to other limbs over time [1]. Going beyond the analogy to hemispatial neglect and integrating the current knowledge about the full breadth of cognitive changes found in CRPS is important for elucidating the cortical and cognitive mechanisms that could be involved in the development, maintenance, and treatment of its clinical symptoms. This might have implications for other chronic pain conditions that share similar neuropsychological components. We relate these symptoms to evidence of similar cognitive deficits in people who suffered brain lesions or other chronic pain conditions (iii) Discuss the specificity of neuropsychological symptoms to CRPS and their clinical relevance with regard to the development, maintenance, and treatment of CRPS. We conclude that the currently used “neglect-like” framework is insufficient for characterising the variety of neuropsychological changes shown by people with CRPS and advocate the role of parietal cortical networks in the emergence of these symptoms
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