Journal
FRONTIERS IN NEUROLOGY
Volume 12, Issue -, Pages -Publisher
FRONTIERS MEDIA SA
DOI: 10.3389/fneur.2021.722334
Keywords
CRPS; chronic pain; neuropathic pain; gray matter volume; thalamus; ACC; insula
Categories
Funding
- Australian National Health and Medical Research Council (NHMRC) [1163149]
- Gerhard-Domagk fellowship
- Else Kroner Fresenius-Stiftung [2019A24]
- DFG [LO 795/37-1]
- National Health and Medical Research Council of Australia [1163149] Funding Source: NHMRC
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Research on CRPS patients revealed alterations in gray matter volume, with CRPS patients showing decreased GMV in the bilateral medial thalamus. Associations were found between GMV in ACC and insula with clinical and behavioral data, indicating a negative relationship between GMV in ACC and pain intensity/CRPS duration, and in the left posterior insula with sensorimotor performance.
Results on gray matter alterations in complex regional pain syndrome (CRPS) showed heterogeneous findings. Since CRPS is a rare disease, most studies included only small and heterogeneous samples resulting in a low reliability of findings between studies. We investigated 24 CRPS patients with right upper limb affection in the chronic stage of disease using structural MRI and clinical testing. We focused on gray matter volume (GMV) alterations of the brain in comparison to 33 age matched healthy controls, their association to clinical characteristics (duration of pain syndrome and pain intensity ratings) and sensorimotor performance (finger dexterity and spatiotactile resolution). When applying an explorative whole brain analysis CRPS patients showed lower GMV in the bilateral medial thalamus. No other areas showed a relevant GMV difference for the group comparisons. When applying a region of interest driven approach using anatomical masks of the thalamus, ACC/mPFC, putamen, and insula we found relevant associations of clinical and behavioral data in ACC and insula. Whereas, the GMV in ACC showed negative associations with pain intensity and CRPS duration, the GMV of the left posterior insula was negatively associated with sensorimotor performance of the affected hand side. Overall, our results are in accordance to results of others describing a thalamic reduction of GMV in patients with neuropathic pain and are also in accordance with associations of pain intensity and duration with reduced ACC in general in patients with chronic pain syndromes. Sensorimotor performance seems to be related to posterior insula GMV reduction, which has not been described yet for other patient groups.
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