Abstract
Evaluation of pain-induced changes in functional connectivity was performed in pediatric complex regional pain syndrome (CRPS) patients. High field functional magnetic resonance imaging was done in the symptomatic painful state and at follow up in the asymptomatic pain free/recovered state. Two types of connectivity alterations were defined: (1) Transient increases in functional connectivity that identified regions with increased cold-induced functional connectivity in the affected limb vs. unaffected limb in the CRPS state, but with normalized connectivity patterns in the recovered state; and (2) Persistent increases in functional connectivity that identified regions with increased cold-induced functional connectivity in the affected limb as compared to the unaffected limb that persisted also in the recovered state (recovered affected limb versus recovered unaffected limb). The data support the notion that even after symptomatic recovery, alterations in brain systems persist, particularly in amygdala and basal ganglia systems. Connectivity analysis may provide a measure of temporal normalization of different circuits/regions when evaluating therapeutic interventions for this condition. The results add emphasis to the importance of early recognition and management in improving outcome of pediatric CRPS.
Highlights
Clinical features of post-traumatic complex regional pain syndrome (CRPS) include severe pain, hypersensitivity to noxious somatosensory stimuli, pain to non-noxious stimuli, autonomic signs such as coldness, poor circulation, abnormal sweating, swelling and skin discoloration, motor abnormalities, including tremors and focal dystonias, and sometimes trophic signs such as abnormal hair and nail growth, muscle atrophy and joint contractures
In this follow up analysis on the same dataset, we address how pain changes the functional connectivity in the CRPS brain during the symptomatic state and whether such alterations persist after symptom resolution
Functional connectivity analyses are based on temporal correlation in functional Magnetic Resonance Imaging Blood-Oxygen-Level-Dependent (BOLD) signal, allowing the testing of functional interactions between brain regions and how such interactions may be affected by experimental stimuli or diagnostic state
Summary
Clinical features of post-traumatic complex regional pain syndrome (CRPS) include severe pain, hypersensitivity to noxious somatosensory stimuli (hyperalgesia), pain to non-noxious stimuli (allodynia), autonomic signs such as coldness, poor circulation, abnormal sweating, swelling and skin discoloration, motor abnormalities, including tremors and focal dystonias, and sometimes trophic signs such as abnormal hair and nail growth, muscle atrophy and joint contractures. We have previously studied how functional activation in pediatric CPRS changes over the course of recovery [3]. In this follow up analysis on the same dataset, we address how pain changes the functional connectivity in the CRPS brain during the symptomatic state and whether such alterations persist after symptom resolution. Functional connectivity analyses are based on temporal correlation in functional Magnetic Resonance Imaging (fMRI) Blood-Oxygen-Level-Dependent (BOLD) signal, allowing the testing of functional interactions between brain regions and how such interactions may be affected by experimental stimuli or diagnostic state
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