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Published on: January 21, 2020
Transient and persistent pain induced connectivity alterations in pediatric complex regional pain syndrome
Clas Linnman1, Lino Becerra, Alyssa Lebel
1Pain and Analgesia Imaging Neuroscience P.A.I.N. Group, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, United States of America. Clas.Linnman@childrens.harvard.edu
Insights
Pediatric complex regional pain syndrome (CRPS) shows persistent brain connectivity changes even after recovery. Functional MRI reveals lasting alterations in amygdala and basal ganglia systems, highlighting the need for early intervention.
Area of Science:
- Neuroscience
- Pediatric Medicine
- Pain Research
Background:
- Pediatric complex regional pain syndrome (CRPS) is a debilitating condition.
- Understanding the neurological underpinnings of CRPS is crucial for effective treatment.
Purpose of the Study:
- To evaluate pain-induced changes in functional brain connectivity in pediatric CRPS patients.
- To differentiate between transient and persistent alterations in functional connectivity.
Main Methods:
- High-field functional magnetic resonance imaging (fMRI) was employed.
- Connectivity was assessed in both symptomatic (painful) and asymptomatic (recovered) states.
- Cold-induced functional connectivity in affected versus unaffected limbs was analyzed.
Main Results:
- Transient increases in functional connectivity were observed in the CRPS state, normalizing upon recovery.
- Persistent increases in functional connectivity were identified in the affected limb, even after symptomatic recovery.
- Specific brain regions, including the amygdala and basal ganglia, showed persistent alterations.
Conclusions:
- Brain system alterations persist in pediatric CRPS patients even after symptomatic recovery.
- Functional connectivity analysis may serve as a biomarker for therapeutic intervention efficacy.
- Early recognition and management are vital for improving pediatric CRPS outcomes.
Abstract:
Evaluation of pain-induced changes in functional connectivity was performed in pediatric complex regional pain syndrome (CRPS) patients. High field functional magnetic resonance imaging was done in the symptomatic painful state and at follow up in the asymptomatic pain free/recovered state. Two types of connectivity alterations were defined: (1) Transient increases in functional connectivity that identified regions with increased cold-induced functional connectivity in the affected limb vs. unaffected limb in the CRPS state, but with normalized connectivity patterns in the recovered state; and (2) Persistent increases in functional connectivity that identified regions with increased cold-induced functional connectivity in the affected limb as compared to the unaffected limb that persisted also in the recovered state (recovered affected limb versus recovered unaffected limb). The data support the notion that even after symptomatic recovery, alterations in brain systems persist, particularly in amygdala and basal ganglia systems. Connectivity analysis may provide a measure of temporal normalization of different circuits/regions when evaluating therapeutic interventions for this condition. The results add emphasis to the importance of early recognition and management in improving outcome of pediatric CRPS.
