Why do people with complex regional pain syndrome take longer to recognize their affected hand?
Why do people with complex regional pain syndrome take longer to recognize their affected hand?
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DOI：
10.1212/01.wnl.0000130156.05828.43
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发表时间：
2004-06-22
期刊：
影响因子：
9.9
通讯作者：
Moseley, GL
中科院分区：
文献类型：
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作者：
Moseley, GL
背景资料：患有复杂区域疼痛综合征（CRPS）的人需要更长的时间才能识别出照片中的手与他们受影响的手一致时的偏侧性。作者从两个方面探讨了这一现象：症状的持续时间是否与延迟的程度有关，以及是否涉及保护型机制。方法：18例CRPS 1型腕关节患者和18名匹配的对照受试者进行了手侧化识别任务。分析麦吉尔疼痛问卷、神经病理性疼痛量表和识别手偏侧性的反应时间（RT）。回归分析：1）患者的平均RT与症状持续时间和疼痛强度相关; 2）每张图片的平均RT与患者判断的执行该运动时的预测疼痛以及所需运动的笨拙程度相关。结果：对于患者，症状持续时间与平均RT相关（斯皮尔曼rho = 0.44; p = 0.02）。预测的疼痛等级解释了每名患者每张照片RT的45%的方差（p < 0.01）。结论：结果表明，在复杂的区域疼痛综合征1型患者中，手偏侧性的延迟识别与症状的持续时间和执行运动引起的疼痛有关。前者与慢性疼痛和废用相一致，可能涉及身体图式相关的皮质重组。后者与可能发生在运动皮层上游的运动规划水平的守卫型反应一致。
Background: People with complex regional pain syndrome ( CRPS) take longer to recognize the laterality of a pictured hand when it coincides with their affected hand. The author explored two aspects of this phenomenon: whether the duration of symptoms relates to the extent of the delay and whether guarding-type mechanisms are involved. Methods: Eighteen patients with CRPS type 1 of the wrist and 18 matched control subjects performed a hand laterality recognition task. McGill pain questionnaire, Neuropathic Pain Scale, and response time (RT) to recognize hand laterality were analyzed. Regressions related 1) mean RT for patients to the duration of symptoms and to pain intensity; and 2) mean RT for each picture to the predicted pain on executing that movement as judged by the patient, and to the awkwardness of the movement that would be required. Results: For patients, the duration of symptoms correlated with mean RT ( Spearman rho = 0.44; p = 0.02). Predicted pain rating explained 45% of the variance in RT for each picture for each patient ( p < 0.01). Conclusions: The results suggest that in patients with complex regional pain syndrome type 1, delayed recognition of hand laterality is related to the duration of symptoms and to the pain that would be evoked by executing the movement. The former is consistent with chronic pain and disuse and may involve reorganization of the cortical correlate of body schema. The latter is consistent with a guarding-type response that probably occurs upstream of the motor cortex at a motor planning level.