Fine-Grained Mapping of Cortical Somatotopies in Chronic Complex Regional Pain Syndrome
Fine-Grained Mapping of Cortical Somatotopies in Chronic Complex Regional Pain Syndrome
复制标题
DOI：
10.1523/jneurosci.2005-18.2019
复制
发表时间：
2019-11-13
影响因子：
5.3
通讯作者：
Rae, Caroline D.
中科院分区：
文献类型：
--
作者：
Mancini, Flavia;Wang, Audrey P.;Rae, Caroline D.
长期以来，人们一直认为，严重的慢性疼痛状况，如复杂区域疼痛综合征（CRPS），不仅与受累肢体初级体感皮层的体位表征重组有关，甚至还由其维持（S1）。这一概念推动了旨在恢复CRPS患者S1表征的治疗，如感觉辨别训练和镜像治疗。然而，这一概念是基于低空间分辨率成像方法获得的间接和不完整的证据。在这里，我们使用功能磁共振成像来表征单侧CRPS患者（无论男女）受影响和未受影响手的S1表征。CRPS手的皮质面积、位置和S1表征的几何形状与未受影响的手和健康对照在很大程度上相似。我们发现受影响与未受影响的手图测量和临床测量（疼痛严重程度、上肢残疾、疾病持续时间）之间没有差异关系。因此，如果发生任何图谱重组，它似乎与疼痛和疾病严重程度没有直接关系。这些发现迫使我们重新考虑CRPS背后的皮层机制，以及旨在“恢复”躯体表征以治疗疼痛的干预措施的基本原理。
It has long been thought that severe chronic pain conditions, such as complex regional pain syndrome (CRPS), are not only associated with, but even maintained by a reorganization of the somatotopic representation of the affected limb in primary somatosensory cortex (S1). This notion has driven treatments that aim to restore S1 representations in CRPS patients, such as sensory discrimination training and mirror therapy. However, this notion is based on both indirect and incomplete evidence obtained with imaging methods with low spatial resolution. Here, we used fMRI to characterize the S1 representation of the affected and unaffected hand in humans (of either sex) with unilateral CRPS. The cortical area, location, and geometry of the S1 representation of the CRPS hand were largely comparable with those of both the unaffected hand and healthy controls. We found no differential relation between affected versus unaffected hand map measures and clinical measures (pain severity, upper limb disability, disease duration). Thus, if any map reorganization occurs, it does not appear to be directly related to pain and disease severity. These findings compel us to reconsider the cortical mechanisms underlying CRPS and the rationale for interventions that aim to "restore" somatotopic representations to treat pain.