The Brain in Pain Cortical contributions to Complex Regional Pain Syndrome Dr Janet Bultitude.
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Transcript of The Brain in Pain Cortical contributions to Complex Regional Pain Syndrome Dr Janet Bultitude.
![Page 1: The Brain in Pain Cortical contributions to Complex Regional Pain Syndrome Dr Janet Bultitude.](https://reader036.fdocuments.us/reader036/viewer/2022062422/56649f145503460f94c29b04/html5/thumbnails/1.jpg)
The Brain in Pain
Cortical contributions to Complex Regional Pain Syndrome
Dr Janet Bultitude
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Overview
1. Cognitive and cortical changes in CRPS
2. Possible role in clinical symptoms
3. Implications for treatment
4. Proposed mechanisms
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Complex Regional Pain Syndrome
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Complex Regional Pain Syndrome
“As the pain increases, the general sympathy becomes more marked. The temper changes and grows irritable, the face becomes anxious, and has a look of weariness and suffering. The sleep is restless, and the constitutional condition, reacting on the wounded limb, exasperates the hyperaesthetic state, so that the rattling of a newspaper, a breath of air…the vibrations caused by a military band, or the shock of the feet in walking, gives rise to increase of pain.” Silas Weir Mitchel, 1864
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Distorted body representation
Lewis et al., 2010, Pain
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Distorted body representation
• “I feel disgust, I know it sounds a very strong word to use but I’m disgusted that my arm is this way.”
• “It was just like this foreign body you were carrying around with you cause it didn’t feel like it was part of you.”
Lewis et al., 2007, Pain
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Distorted body representation
• Difficulty locating / moving the limb unless directly looking at it
• Difficulty identifying fingers from touch• Referred pain, or pain when viewing an
object approaching the limb• Movement-induced pain greater when
viewing hand through magnifying lens, less when viewing hand through minimising lens.
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Cortical reorganisation
Maihöfner et al., 2004, Neurology
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Cortical reorganisation
Gieteling et al., 2008, Pain
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Mechanisms of CRPS
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1999, The Lancet
“When our senses present us with discordant information, such as when our eyes give our brain information that does not agree with our senses of body position, balance, and equilibrium, we feel nausea. Less familiar is the notion that discordance between awareness of motor intention, muscle and joint proprioception, and vision may result in our feeling pain.”
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Poke your eye
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Predictive signal
True sensory outcome
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Predictive signal
True sensory outcome
? ? ?
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Implications for treatment
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Predictive signal
True sensory outcome
? ? ? Healthy handrepresentation
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Predictive signal
True sensory outcome
Healthy handrepresentation
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Predictive signal
True sensory outcome
? ? ?
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Prism adaptation
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Prism adaptation
Sumitani et al., 2007, Neurology
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Prism adaptation
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Transcranial Direct Current Stimulation
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Transcranial Direct Current Stimulation
Antal et al., 2010; The Clinical Journal of Pain
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Proposed mechanisms
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Immobilization-driven reorganisation?
Immobilized IF Healthy IF
Lissek et al., 2004, Current Biology
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Direct immune mechanisms?
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Overview
1. Cognitive and cortical changes in CRPS
2. Possible role in clinical symptoms
3. Implications for treatment
4. Proposed mechanisms
![Page 28: The Brain in Pain Cortical contributions to Complex Regional Pain Syndrome Dr Janet Bultitude.](https://reader036.fdocuments.us/reader036/viewer/2022062422/56649f145503460f94c29b04/html5/thumbnails/28.jpg)
Take-home messages
Cortical origins to pain
≠It’s all just in your head
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Take-home messages
• Importance of:– Early recognition– Aggressive intervention– Multiple simultaneous approaches– Cognitively- and cortically-targeted treatments
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Now recruiting
We are looking for volunteers with CRPS for a study investigating two potential treatments that target cognitive and cortical changes.
Interested patients can contact me at [email protected]
or