Journal of Neurology

, Volume 253, Issue 6, pp 772–779 | Cite as

Mislocalization of tactile stimulation in patients with complex regional pain syndrome

  • Ch. Maihöfner
  • B. Neundörfer
  • F. Birklein
  • H. O. Handwerker
ORIGINAL COMMUNICATION

Abstract

Complex–Regional–Pain–Syndromes (CRPS) are characterized by sensory,motor and autonomic dysfunctions. Patterns of sensory symptoms suggest changes within the central nervous system (CNS). Recently, we could show substantial reorganization of somatotopic maps within the central nervous system of patients with CRPS using functional imaging techniques (Maihofner et al. Neurology, 2003). These changes were predicted by CRPS pain and mechanical hyperalgesia. In the present study we looked for potential psychophysical correlates of cortical reorganization in CRPS. Sequential pneumatic non–noxious tactile stimulation was performed at digits 1 and 5 in 24 patients with CRPS of the upper extremities. Both the unaffected and affected side were examined. Patients were interviewed for tactile induced sensations. The occurrence of mislocalizations was correlated with a detailed psychophysical examination in which sensory, motor and autonomic symptoms were assessed. Eight patients (30 %) reported tactile mislocalizations, which were felt in the affected hand. In four cases the referred sensations spread into other nerve territories (ulnar/median nerve). Presence of mechanical hyperalgesia significantly predicted the occurrence of mislocalizations. In contrast, in a healthy control group, no mislocalizations were found. Thus, our results further support the concept of pain–induced reorganization in the somatosensory system of CRPS patients.

Key words

complex regional pain syndrome CRPS pain neuropathic pain plasticity 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Birklein F, Riedl B, Sieweke N, Weber M, Neundorfer B (2000) Neurological findings in complex regional pain syndromes—analysis of 145 cases. Acta Neurol Scand 101:262–269PubMedCrossRefGoogle Scholar
  2. 2.
    Clarke S, Regli L, Janzer RC, Assal G, de Tribolet N (1996) Phantom face: conscious correlate of neural reorganization after removal of primary sensory neurones. Neuroreport 7:2853–2857PubMedGoogle Scholar
  3. 3.
    Coderre TJ, Katz J, Vaccarino AL, Melzack R (1993) Contribution of central neuroplasticity to pathological pain: review of clinical and experimental evidence. Pain 52:259–285PubMedCrossRefGoogle Scholar
  4. 4.
    Draganski B, Gaser C, Busch V, Schuierer G, Bogdahn U, May A (2004) Neuroplasticity: changes in grey matter induced by training. Nature 427:311–312PubMedCrossRefGoogle Scholar
  5. 5.
    Druschky K, Kaltenhauser M, Hummel C, Druschky A, Huk WJ, Stefan H, et al. (2000) Alteration of the somatosensory cortical map in peripheral mononeuropathy due to carpal tunnel syndrome. Neuroreport 11:3925–3930PubMedGoogle Scholar
  6. 6.
    Druschky K, Kaltenhauser M, Hummel C, Druschky A, Pauli E, Huk WJ, et al. (2002) Somatotopic organization of the ventral and dorsal finger surface representations in human primary sensory cortex evaluated by magnetoencephalography. Neuroimage 15:182–189PubMedCrossRefGoogle Scholar
  7. 7.
    Flor H (2003) Cortical reorganisation and chronic pain: implications for rehabilitation. J Rehabil Med:66–72CrossRefGoogle Scholar
  8. 8.
    Flor H, Braun C, Elbert T, Birbaumer N (1997) Extensive reorganization of primary somatosensory cortex in chronic back pain patients. Neurosci Lett 224:5–8PubMedCrossRefGoogle Scholar
  9. 9.
    Flor H, Elbert T, Knecht S, Wienbruch C, Pantev C, Birbaumer N, et al. (1995) Phantom–limb pain as a perceptual correlate of cortical reorganization following arm amputation. Nature 375:482–484PubMedCrossRefGoogle Scholar
  10. 10.
    Forderreuther S, Sailer U, Straube A (2004) Impaired self–perception of the hand in complex regional pain syndrome (CRPS). Pain 110:756–761PubMedCrossRefGoogle Scholar
  11. 11.
    Gelnar PA, Krauss BR, Sheehe PR, Szeverenyi NM, Apkarian AV (1999) A comparative fMRI study of cortical representations for thermal painful, vibrotactile, and motor performance tasks. Neuroimage 10:460–482PubMedCrossRefGoogle Scholar
  12. 12.
    Juottonen K, Gockel M, Silen T, Hurri H, Hari R, Forss N (2002) Altered central sensorimotor processing in patients with complex regional pain syndrome. Pain 98:315–323PubMedCrossRefGoogle Scholar
  13. 13.
    Kakigi R, Hoshiyama M, Shimojo M, Naka D, Yamasaki H, Watanabe S, et al. (2000) The somatosensory evoked magnetic fields. Prog Neurobiol 61:495–523PubMedCrossRefGoogle Scholar
  14. 14.
    Katz J, Melzack R (1987) Referred sensations in chronic pain patients. Pain 28:51–59PubMedCrossRefGoogle Scholar
  15. 15.
    Knecht S, Henningsen H, Hohling C, Elbert T, Flor H, Pantev C, et al. (1998) Plasticity of plasticity? Changes in the pattern of perceptual correlates of reorganization after amputation. Brain 121:717–724PubMedCrossRefGoogle Scholar
  16. 16.
    Knecht S, Soros P, Gurtler S, Imai T, Ringelstein EB, Henningsen H (1998) Phantom sensations following acute pain. Pain 77:209–213PubMedCrossRefGoogle Scholar
  17. 17.
    Maihofner C, Handwerker HO, Neundorfer B, Birklein F (2003) Patterns of cortical reorganization in Complex Regional Pain Syndrome. Neurology 61:1707–1715PubMedGoogle Scholar
  18. 18.
    Maihofner C, Forster C, Birklein F, Neundorfer B, Handwerker HO (2005) Brain processing during mechanical hyperalgesia in complex regional pain syndrome: a functional MRI study. Pain 114:93–103PubMedCrossRefGoogle Scholar
  19. 19.
    Maihofner C, Handwerker HO, Neundorfer B, Birklein F (2004) Cortical reorganization during recovery from complex regional pain syndrome. Neurology 63:693–701PubMedGoogle Scholar
  20. 20.
    Maihofner C, Kaltenhauser M, Neundorfer B, Lang E (2002) Temporospatial analysis of cortical activation by phasic innocuous and noxious cold stimuli – a magnetoencephalographic study. Pain 100:281–290PubMedCrossRefGoogle Scholar
  21. 21.
    McCabe CS, Haigh RC, Halligan PW, Blake DR (2003) Referred sensations in patients with complex regional pain syndrome type 1. Rheumatology (Oxford)Google Scholar
  22. 22.
    Moore CI, Stern CE, Dunbar C, Kostyk SK, Gehi A, Corkin S (2000) Referred phantom sensations and cortical reorganization after spinal cord injury in humans. Proc Natl Acad Sci USA 97:14703–14708PubMedCrossRefGoogle Scholar
  23. 23.
    Nakamura A, Yamada T, Goto A, Kato T, Ito K, Abe Y, et al. (1998) Somatosensory Homunculus as Drawn by MEG. Neuroimage 7:377–386PubMedCrossRefGoogle Scholar
  24. 24.
    Pleger B, Tegenthoff M, Ragert P, Forster AF, Dinse HR, Schwenkreis P, et al. (2005) Sensorimotor retuning (corrected) in complex regional pain syndrome parallels pain reduction. Ann Neurol 57:425–429PubMedCrossRefGoogle Scholar
  25. 25.
    Pleger B, Tegenthoff M, Schwenkreis P, Janssen F, Ragert P, Dinse HR, et al. (2004) Mean sustained pain levels are linked to hemispherical side–to–side differences of primary somatosensory cortex in the complex regional pain syndrome I. Exp Brain Res 155:115–119PubMedCrossRefGoogle Scholar
  26. 26.
    Ramachandran VS (1993) Behavioral and magnetoencephalographic correlates of plasticity in the adult human brain. Proc Natl Acad Sci USA 90:10413–10420PubMedCrossRefGoogle Scholar
  27. 27.
    Ramachandran VS, Hirstein W (1998) The perception of phantom limbs. The DO, Hebb lecture. Brain 121(Pt 9):1603–1630PubMedCrossRefGoogle Scholar
  28. 28.
    Rausell E, Cusick CG, Taub E, Jones EG (1992) Chronic deafferentation in monkeys differentially affects nociceptive and nonnociceptive pathways distinguished by specific calciumbinding proteins and down–regulates gamma–aminobutyric acid type A receptors at thalamic levels. Proc Natl Acad Sci USA 89:2571–2575PubMedCrossRefGoogle Scholar
  29. 29.
    Richter CP (1977) Mysterious form of referred sensation in man. Proc Natl Acad Sci USA 74:4702–4705PubMedCrossRefGoogle Scholar
  30. 30.
    Rommel O, Gehling M, Dertwinkel R, Witscher K, Zenz M, Malin JP, et al. (1999) Hemisensory impairment in patients with complex regional pain syndrome. Pain 80:95–101PubMedCrossRefGoogle Scholar
  31. 31.
    Rommel O, Malin JP, Zenz M, Janig W (2001) Quantitative sensory testing, neurophysiological and psychological examination in patients with complex regional pain syndrome and hemisensory deficits. Pain 93:279–293PubMedCrossRefGoogle Scholar
  32. 32.
    Stanton–Hicks M, Janig W, Hassenbusch S, Haddox JD, Boas R, Wilson P (1995) Reflex sympathetic dystrophy: changing concepts and taxonomy. Pain 63:127–133PubMedCrossRefGoogle Scholar
  33. 33.
    Stein C, Mendl G (1988) The German counterpart to McGill Pain Questionnaire. Pain 32:251–255PubMedCrossRefGoogle Scholar
  34. 34.
    Tecchio F, Padua L, Aprile I, Rossini PM (2002) Carpal tunnel syndrome modifies sensory hand cortical somatotopy: a MEG study. Hum Brain Mapp 17:28–36PubMedCrossRefGoogle Scholar
  35. 35.
    Turton AJ, Butler SR (2001) Referred sensations following stroke. Neurocase 7:397–405PubMedCrossRefGoogle Scholar
  36. 36.
    Veldman PH, Reynen HM, Arntz IE, Goris RJ (1993) Signs and symptoms of reflex sympathetic dystrophy: prospective study of 829 patients. Lancet 342:1012–1016PubMedCrossRefGoogle Scholar

Copyright information

© Steinkopff-Verlag 2006

Authors and Affiliations

  • Ch. Maihöfner
    • 1
    • 2
  • B. Neundörfer
    • 1
  • F. Birklein
    • 3
  • H. O. Handwerker
    • 1
  1. 1.Department of NeurologyUniversity of Erlangen-NurembergErlangenGermany
  2. 2.Institute for Physiology and Experimental PathophysiologyUniversity of Erlangen-NurembergErlangenGermany
  3. 3.Department of NeurologyUniversity of MainzMainzGermany

Personalised recommendations