Monday, December 7, 2009

More evidence for supraspinal mechanism in CRPS/RSD

From H. Uematsu, M. Sumitani, A. Yozu, Y. Otake, M. Shibata, T. Mashimo, and S. Miyauchi of the Department of Acute Critical Medicine (Anesthesiology) of Osaka University's Graduate School of Medicine comes this study [via PubMed]:

Complex Regional Pain Syndrome (CRPS) Impairs Visuospatial Perception, whereas Post-Herpetic Neuralgia (PHN) does not: Possible Implications for Supraspinal Mechanism of CRPS, published in the Annals of the Academy of Medicine, Singapore (2009 Nov;38(11):931-6).

Introduction -- Complex regional pain syndrome (CRPS) patients show impaired visuospatial perception in the dark, as compared to normal patients with acute nociceptive pain. The purpose of this study is 2-fold: (i) to ascertain whether this distorted visuospatial perception is related to the chronicity of pain, and (ii) to analyse visuospatial perception of CRPS in comparison with another neuropathic pain condition.
Materials and Methods -- We evaluated visual subjective body-midline (vSM) representation in 27 patients with post-herpetic neuralgia (PHN) and 22 with CRPS under light and dark conditions. A red laser dot was projected onto a screen and moved horizontally towards the sagittal plane of the objective body-midline (OM). Each participant was asked to direct the dot to a position where it crossed their vSM. The distance between the vSM and OM was analysed to determine how and in which direction the vSM deviated.
Results -- Under light condition, all vSM judgments approximately matched the OM. However, in the dark, CRPS patients, but not PHN patients, showed a shifted vSM towards the affected side.
Conclusion -- We demonstrated that chronic pain does not always impair visuospatial perception. The aetiology of PHN is limited to the peripheral nervous system, whereas the distorted visuospatial perception suggests a supraspinal aetiology of CRPS.

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