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Published on: January 21, 2020
Primary motor cortex function in complex regional pain syndrome: a systematic review and meta-analysis
Flavia Di Pietro1, James H McAuley, Luke Parkitny
1Neuroscience Research Australia, Sydney, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia.
The Journal of Pain
|September 17, 2013
Summary
Evidence for primary motor cortex (M1) dysfunction in complex regional pain syndrome (CRPS) is limited. A systematic review found only weak support for bilateral M1 disinhibition in upper limb CRPS, with high risk of bias in existing studies.
Area of Science:
- Neuroscience
- Pain Research
- Motor Control
Background:
- Complex regional pain syndrome (CRPS) is associated with central nervous system dysfunction and movement disorders.
- The primary motor cortex (M1) is frequently implicated, with proposed alterations in its representation of affected body parts.
- These assumptions have driven the development of new CRPS treatments.
Purpose of the Study:
- To systematically investigate the evidence for altered primary motor cortex (M1) function in complex regional pain syndrome (CRPS).
- To critically appraise the existing literature on M1 changes in CRPS using rigorous review methods.
Main Methods:
- Systematic literature search, risk-of-bias appraisal, and data extraction were performed.
- Eighteen studies (14 unique data sets) utilizing various neuroimaging techniques were included.
- Outcomes were grouped into M1 cortical excitability, spatial representation, reactivity, and glucose metabolism; meta-analyses were conducted where feasible.
Main Results:
- High risk of bias was noted across studies, primarily due to missing data and unblinded outcome assessments.
- No definitive conclusions could be drawn regarding M1 spatial representation, reactivity, or glucose metabolism in CRPS.
- Limited evidence suggests bilateral M1 disinhibition in cases of upper limb CRPS.
Conclusions:
- Widely held assumptions of primary motor cortex dysfunction in CRPS are not strongly supported by current evidence.
- The existing literature is characterized by a high risk of bias, limiting definitive conclusions.
- Further high-quality research is needed to clarify the role of M1 in CRPS pathophysiology.
Keywords:
Complex regional pain syndromeM1cortical reorganizationdisinhibitionneuroimagingprimary motor cortexMore Related Videos
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