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Central sensitization in CRPS patients with widespread pain: a cross-sectional study
Iara De Schoenmacker1, Anna Mollo1, Paulina Simonne Scheuren1
1Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland.
Pain Medicine (Malden, Mass.)
|March 22, 2023
Summary
Complex regional pain syndrome (CRPS) patients exhibit widespread pain hypersensitivity and enhanced temporal summation of pain (TSP), indicating central sensitization. These neuronal hyperexcitability signs correlate with the pain phenotype in CRPS.
Area of Science:
- Neuroscience
- Pain Research
- Clinical Medicine
Background:
- Complex regional pain syndrome (CRPS) is characterized by widespread pain hypersensitivity and enhanced temporal summation of pain (TSP).
- These symptoms are often considered indicators of central sensitization, a key mechanism in chronic pain conditions.
- However, direct links between neuronal hyperexcitability and the clinical pain phenotype in CRPS remain to be fully elucidated.
Purpose of the Study:
- To investigate the relationship between signs of neuronal hyperexcitability, specifically widespread pain hypersensitivity and TSP, and the pain phenotype in patients with CRPS.
- To determine if central sensitization mechanisms contribute to the spatial extent and intensity of pain experienced by CRPS patients.
Main Methods:
- Quantitative sensory testing (QST) was employed to assess pressure pain thresholds and TSP in CRPS patients (n=21) and healthy controls (HC, n=20).
- Testing was conducted in affected, contralateral, and remote body areas to evaluate widespread effects.
- The spatial pain extent and intensity were correlated with QST findings and psychological factors, including body perception disturbance.
Main Results:
- CRPS patients demonstrated significantly decreased pressure pain thresholds across all tested areas compared to HC.
- Enhanced TSP was observed in the affected areas of CRPS patients, particularly in those with a larger spatial pain extent.
- A positive correlation was found between the spatial pain extent and the Bath Body Perception Disturbance Scale.
Conclusions:
- The findings provide evidence linking the pain phenotype in CRPS, specifically the spatial pain extent, to central sensitization mechanisms within the central nervous system.
- Neuronal hyperexcitability, as indicated by TSP and widespread hypersensitivity, appears to be a significant factor in the CRPS pain experience.
- Targeting central neuronal excitability presents a potential therapeutic strategy for managing CRPS, especially in patients with more extensive pain patterns.
