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Hemisensory disturbances in patients with complex regional pain syndrome

Drummond, Peter D.a,*; Finch, Philip M.a; Birklein, Franka,b; Stanton-Hicks, Michaelc; Knudsen, Lone F.d,e,f

doi: 10.1097/j.pain.0000000000001280
Research Paper
Editor's Choice

Sensory disturbances often spread beyond the site of injury in complex regional pain syndrome (CRPS) but whether this applies equally to CRPS I and II, or changes across the course of the disease, is unknown. Establishing this is important, because different symptom profiles in CRPS I and II, or in acute vs chronic CRPS, might infer different pathophysiology and treatment approaches. To explore these questions, sensory disturbances were assessed in the limbs and forehead of 71 patients with CRPS I and 33 patients with CRPS II. Pain had persisted up to 12 months in 32 patients, for 13 to 36 months in 29 patients, and for longer than this in 43 patients. Patients with CRPS I were more likely to be female, and pain was more likely to be present in an additional limb, than patients with CRPS II. Conversely, pain was more likely to be associated with sensory deficits and allodynia in patients with CRPS II than CRPS I. Nevertheless, heightened sensitivity, allodynia, and/or hyperalgesia to mechanical and thermal stimuli were detected in a hemisensory distribution ipsilateral to the affected limb in both forms of CRPS. Some of these hemisensory disturbances strengthened with chronicity of pain. These findings suggest that heightened excitability of nociceptive pathways in CRPS spreads to hemisensory convergence points in the brainstem or higher brain centres, possibly in association with compromised pain controls. The similarity of symptom profiles in chronic CRPS I and II implies shared mechanisms despite different triggers.

Hemisensory disturbances strengthen with time in complex regional pain syndrome, suggesting that heightened excitability in spinal pain pathways spreads ipsilaterally to higher brain centres.

aSchool of Psychology and Exercise Science, Murdoch University, Perth, Australia

bDepartment of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany

cDepartment of Pain Management, Cleveland Clinic, Cleveland, OH, United States

dDanish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark,

eSpinal Cord Injury Centre of Western Denmark, Viborg Regional Hospital, Viborg, Denmark,

fDanish National Rehabilitation Center for Neuromuscular Diseases, Aarhus, Denmark

Corresponding author. Address: School of Psychology and Exercise Science, Murdoch University, Perth 6150, Australia. Tel.: +61 893602415. E-mail address: P.Drummond@murdoch.edu.au (P.D. Drummond).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.painjournalonline.com).

Received November 02, 2017

Received in revised form January 19, 2018

Accepted March 12, 2018

© 2018 International Association for the Study of Pain
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