Strauss Sebastian, Barby Silke, Härtner Jonas, Pfannmöller Jörg Peter, Neumann Nicola, Moseley G Lorimer, Lotze Martin
Functional Imaging Unit, Center for Diagnostic Radiology, University Medicine Greifswald, Greifswald, Germany.
Department of Neurology, University Medicine Greifswald, Greifswald, Germany.
Brain Commun. 2021 Sep 25;3(4):fcab216. doi: 10.1093/braincomms/fcab216. eCollection 2021.
Patients with complex regional pain syndrome suffer from chronic neuropathic pain and also show a decrease in sensorimotor performance associated with characteristic central and peripheral neural system parameters. In the brain imaging domain, these comprise altered functional sensorimotor representation for the affected hand side. With regard to neurophysiology, a decrease in intracortical inhibition for the sensorimotor cortex contralateral to the affected hand has been repetitively verified, which might be related to increased primary somatosensory cortex functional activation for the affected limb. Rare longitudinal intervention studies in randomized controlled trials have demonstrated that a decrease in primary somatosensory cortex functional MRI activation coincided with pain relief and recovery in sensorimotor performance. By applying a randomized wait-list control crossover study design, we tested possible associations of clinical, imaging and neurophysiology parameters in 21 patients with complex regional pain syndrome in the chronic stage (>6 months). In more detail, we applied graded motor imagery over 6 weeks to relieve movement pain of the affected upper limb. First, baseline parameters were tested between the affected and the non-affected upper limb side and age-matched healthy controls. Second, longitudinal changes in clinical and testing parameters were associated with neurophysiological and imaging parameters. During baseline short intracortical inhibition, as assessed with transcranial magnetic stimulation, was decreased only for hand muscles of the affected hand side. During movement of the affected limb, primary somatosensory cortex functional MRI activation was increased. Hand representation area size for somatosensory stimulation in functional MRI was smaller on the affected side with longer disease duration. Graded motor imagery intervention but not waiting, resulted in a decrease of movement pain. An increase of somatosensory hand representation size over graded motor imagery intervention was related to movement pain relief. Over graded motor imagery intervention, pathological parameters like the increased primary somatosensory cortex activation during fist movement or decreased short intracortical inhibition were modified in the same way as movement pain and hand performance improved. No such changes were observed during the waiting period. Overall, we demonstrated characteristic changes in clinical, behaviour and neuropathology parameters applying graded motor imagery in patients with upper limb complex regional pain syndrome, which casts light on the effects of graded motor imagery intervention on biomarkers for chronic neuropathic pain.
复杂性区域疼痛综合征患者遭受慢性神经性疼痛,并且还表现出与特征性中枢和周围神经系统参数相关的感觉运动功能下降。在脑成像领域,这些包括患侧手部功能感觉运动表征的改变。在神经生理学方面,患侧手部对侧感觉运动皮层的皮质内抑制作用降低已得到反复验证,这可能与患侧肢体初级体感皮层功能激活增加有关。随机对照试验中罕见的纵向干预研究表明,初级体感皮层功能磁共振成像激活的降低与疼痛缓解和感觉运动功能恢复相一致。通过采用随机等待列表对照交叉研究设计,我们测试了21例慢性期(>6个月)复杂性区域疼痛综合征患者的临床、影像学和神经生理学参数之间的可能关联。更具体地说,我们在6周内应用分级运动想象来缓解患侧上肢的运动疼痛。首先,在患侧和非患侧上肢以及年龄匹配的健康对照之间测试基线参数。其次,临床和测试参数的纵向变化与神经生理学和影像学参数相关。在基线时,经颅磁刺激评估的皮质内短抑制仅在患侧手部肌肉中降低。在患侧肢体运动期间,初级体感皮层功能磁共振成像激活增加。功能磁共振成像中体感刺激的手部表征区域大小在患侧较小,病程较长。分级运动想象干预而非等待,导致运动疼痛减轻。分级运动想象干预过程中体感手部表征大小的增加与运动疼痛缓解相关。在分级运动想象干预过程中,握拳运动时初级体感皮层激活增加或皮质内短抑制降低等病理参数与运动疼痛和手部功能改善的方式相同。在等待期间未观察到此类变化。总体而言,我们证明了在上肢复杂性区域疼痛综合征患者中应用分级运动想象时临床、行为和神经病理学参数的特征性变化,这揭示了分级运动想象干预对慢性神经性疼痛生物标志物的影响。