Liesto S, Aho T, Jääskeläinen S K, Hietanen M, Kalso E
Dept. of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Outpatient Clinic for Persistent Symptom Rehabilitation, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Eur J Pain. 2025 Jul;29(6):e70070. doi: 10.1002/ejp.70070.
Complex Regional Pain Syndrome (CRPS) is characterised by pain, sensory, vasomotor, sudomotor, motor, and trophic symptoms, with cognitive symptoms also reported. This study aimed to examine the neuropsychological profile of patients with meticulously diagnosed CRPS 1 and 2.
A neuropsychological examination was conducted in 54 CRPS patients. The test battery included Block Design and Similarities from Wechsler Adult Intelligence-IV, word list learning and delayed recall, and Digit Span from Wechsler Memory Scale-III, Trail Making Test (TMT), verbal and drawing fluency, Brixton, Manikin and Bourdon-Wiersma tests. Patients performing below -0.67 SD of the performance of a healthy Finnish population in ≥ 3 tests were classified as having cognitive decline. Questionnaires included Insomnia Severity Index, Beck Depression Inventory-II, CRPS Severity Scale, Disabilities of the Arm, Shoulder and Hand, Pain Catastrophizing Scale, Resilience Scale-14, Brief Pain Inventory, Insomnia Severity Index and State Trait Anxiety Inventory. Patients were asked about subjective cognitive difficulties.
A subgroup comprising 30% of the CRPS patients showed cognitive decline. Higher pain catastrophising was associated with poorer test performance in TMT Part A. There were no differences between left and right sides on the visual attention test. Subjective cognitive difficulties were not associated with objective cognitive test performance. Cognitive functioning did not differ between CRPS 1 and 2 patients.
This study elucidates how CRPS affects cognitive functioning, important information when tailoring multidisciplinary rehabilitation to CRPS patients. Psychological factors may have a stronger impact on subjective cognitive difficulties than on objective test performances.
CRPS is an enigmatic syndrome with multifactorial origins, leading to chronic, disabling pain due to progressing neuroplastic alterations in the central nervous system. This study adds comprehensive novel information about cognitive function in CRPS, as, except for lateralised cognitions and body perception, cognitive domains have not previously been extensively studied in CRPS patients. Cognitive decline in 30% of patients indicates that neuropsychological assessment should be included in the diagnostics, and results considered in the rehabilitation of CRPS patients.
ClinicalTrials.gov identifier: NCT04439669.
复杂性区域疼痛综合征（CRPS）的特征为疼痛、感觉、血管运动、汗腺分泌、运动和营养症状，也有认知症状的报告。本研究旨在检查经精确诊断的CRPS 1型和2型患者的神经心理学概况。
对54例CRPS患者进行了神经心理学检查。测试组合包括韦氏成人智力量表-IV中的积木设计和相似性、单词表学习及延迟回忆、韦氏记忆量表-III中的数字广度、连线测验（TMT）、言语和画图流畅性、布里克斯顿测验、人体模型测验和布尔东-维尔斯马测验。在≥3项测试中，表现低于健康芬兰人群表现标准差-0.67的患者被归类为有认知衰退。问卷包括失眠严重程度指数、贝克抑郁量表-II、CRPS严重程度量表、手臂、肩部和手部功能障碍量表、疼痛灾难化量表、复原力量表-14、简明疼痛问卷、失眠严重程度指数和状态特质焦虑量表。询问患者主观认知困难情况。
30%的CRPS患者亚组表现出认知衰退。疼痛灾难化程度越高，与TMT A部分的测试表现越差相关。视觉注意力测试中左右两侧无差异。主观认知困难与客观认知测试表现无关。CRPS 1型和2型患者的认知功能无差异。
本研究阐明了CRPS如何影响认知功能，这是为CRPS患者量身定制多学科康复方案时的重要信息。心理因素对主观认知困难的影响可能比对客观测试表现的影响更大。
CRPS是一种起源多因素的神秘综合征，由于中枢神经系统中不断进展的神经可塑性改变，导致慢性致残性疼痛。本研究增加了关于CRPS认知功能的全面新信息，因为除了偏侧认知和身体感知外，认知领域此前在CRPS患者中尚未得到广泛研究。30%的患者出现认知衰退表明，神经心理学评估应纳入诊断，并在CRPS患者的康复中考虑评估结果。
ClinicalTrials.gov标识符：NCT04439669。
