1: Clin J Pain 3):256-67
Central nervous system abnormalities in complex regional
pain syndrome (CRPS):
clinical and quantitative evidence of medullary dysfunction.
Thimineur M, Sood P, Kravitz E, Gudin J, Kitaj M
Comprehensive Pain and Headache Treatment Center, L.L.C.,
Department of
Anesthesiology, Griffin Hospital, Derby, Connecticut
06418, USA.
OBJECTIVE: Sensory and motor abnormalities are common
among patients with complex regional pain syndrome (CRPS). The purpose
of the present study was to define and characterize these abnormalities
and to develop a hypothesis regarding the area of the central nervous system
from which they derive.
DESIGN:
Data were acquired from study subjects using clinical
examination and
quantitative assessment of neurological function. Subjects
were divided into
four groups. CRPS patients were differentiated into two
groups based on the
presence or absence of sensory deficit on the face to
clinical examination.
The other two groups were composed of patients with other
chronic pain syndromes and normal individuals without chronic pain or disability.
Clinical and quantitative data were compared between groups. PATIENTS:
One hundred forty-five CRPS patients, 69 patients with other pain conditions,
and 26 normal individuals were studied. RESULTS: A high incidence of trigeminal
hypoesthesia was observed in CRPS patients. CRPS patients with trigeminal
hypoesthesia manifested bilateral deficits of sensory function, with a
predominant hemilateral pattern. These patients also manifested bilateral
motor weakness with a more prominent hemiparetic pattern. Both sensory
and motor deficits were greatest ipsilateral to the painful side of the
body. These features differed significantly from those of CRPS patients
lacking clinical trigeminal deficit, other pain patients, and normals.
A lower cranial nerve abnormality (sternocleidomastoid weakness) and a
myelopathic feature (Hoffman's reflex) were more common in CRPS patients
with trigeminal hypoesthesia. CONCLUSIONS: Nearly half of CRPS patients
had abnormalities of spinothalamic, trigeminothalamic, and corticospinal
function that may represent dysfunction of the medulla. One-third of the
remaining CRPS patients had neuroimaging evidence of spinal cord or brain
pathology. The majority of CRPS patients in this study have measurable
abnormalities of the sensory and motor systems or neuroimaging evidence
of spinal cord or brain dysfunction.
Publication Types:
Clinical trial
Comments:
Comment in: Clin J Pain 1999 Jun;15(2):155
PMID: 9758076, UI: 98429043
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