Sensorimotor Problems in CRPS: Utilizing Novel Treatment Approaches

JOURNAL OF NEUROIMMUNE PHARMACOLOGY
2012, DOI: 10.1007/s11481-012-9405-9

Imaging and Clinical Evidence of Sensorimotor Problems in CRPS: Utilizing Novel Treatment Approaches

Jacqueline Bailey, Sara Nelson, Jenny Lewis and Candida S. McCabe


Abstract
Inflammation and altered autonomic function are diagnostic signs and symptoms of Complex Regional Pain Syndrome. In the acute stages these are commonly at their most florid accompanied by severe pain and reduced function. Understandably this has directed research towards potential peripheral drivers for the causal mechanisms of this condition. In particular this is now focused on the inflammatory process and the potential role of autoantibodies. More subtle changes also occur in terms of altered tactile processing within the affected limb, disturbances in body perception and motor planning problems that become more evident as the condition progresses. Through careful clinical observation and neuro-imaging techniques, these changes are now thought to be associated with altered cortical processing that includes reorganisation of both the motor and sensory maps. Furthermore, there appears to be a close relationship between the intensity of pain experienced and the extent of cortical re-organisation. This increased knowledge around the peripheral and central mechanisms that may be operating in CRPS has been used to inform novel therapeutic approaches. We discuss here the presenting signs and symptoms of CRPS, with particular focus on sensory and motor changes and consider which mechanisms may drive these changes. Finally, we consider the emerging therapeutic options designed to correct these aberrant mechanisms.




An earlier article, some of the same authors, similar topic:

Hand Therapy Vol. 16 No. 2 June 2011

‘Now you see it, now you do not’:sensory–motor re-education in complex regional pain syndrome
Jennifer S Lewis,* Karen Coales,* Jane Hall* and Candida S McCabe*
†
*The Royal National Hospital for Rheumatic Diseases, Bath, UK;
†
The Faculty of Health and Life Sciences, Universityof the West of England, Bristol, UK
Correspondence: Professor Candy McCabe, Bath Centre for Pain Services, The Royal National Hospital for Rheumatic Diseases, Upper Borough Walls, BathBA1 1RL, UK. Email: candy.mccabe@uwe.ac.uk

Abstract
The patient with complex regional pain syndrome (CRPS) commonly describes a lack of ownership of theirpainful limb, poor definition of that body part and difficulty with localization of the limb when performingdaily activities. These descriptions suggest that sensory input from the limb may be reduced leading toneglect of the limb and poor motor control. However, the cardinal symptom of CRPS is pain, commonlysevere, which demands a high level of attention. Patients are highly protective of the painful region andhypervigilant to any potential threats to their affected limb. These seemingly conflicting behaviouralresponses and sensory descriptions are confusing for the patient and health-care professional. In recent yearsour understanding has greatly advanced on how altered sensory perception of a CRPS affected limb relatesto changes in the central representation of that body part, and how this may interact with motor planningand autonomic function. Excitingly, this increased knowledge has directly informed clinical practice via anew evaluation of sensory–motor re-education techniques and the development of novel interventions toenhance sensory discrimination. We review the common sensory problems seen in CRPS, the mechanismsthat may be behind these clinical symptoms, and how sensory, motor and autonomic systems interact.Therapies designed to enhance sensory discrimination and motor planning are discussed, supported by theresults of a small case series undergoing sensory re-education for CRPS. The clinical protocol and two case studiesare available as additional online material to illustrate how all of this is applied in practice.

Keywords:
Complex regional pain syndrome, cortical reorganization, pain, sensory re-education, sensory discrimination

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