Non-invasive brain stimulation therapy for the management of complex regional pain syndrome (CRPS) (pp. 277-284)
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Authors: (Ricardo A. Cruciani, Santiago Esteban, Una Sibirceva and Helena Knotkova)
Abstract: Neuropathic pain is an abnormal response to painful stimuli
that can be caused by a variety of insults that may or may
not involve direct nerve injury, and ranges from very
common conditions like lumbar radiculopathy, to unusual
causes like HTLV-1 myelopathy. Neuropathic pain
syndromes that in addition to pain present with allodynia,
hyperalgesia, changes in coloration of the skin and edema,
are classified under the umbrella known as Complex
Regional pain Syndrome (CRPS). Although full blown
CRPS is easily recognizable, when the associated
symptoms are subtle, then it can become a diagnostic
challenge. The underlying mechanism responsible for
CRPS is not well understood but due to the variability in its
presentation and to the different nature of the symptoms, it
is believed to be multifactorial. Sensitization of nociceptors,
increase release of neurotransmitters and changes in the
phenotype of certain receptors in the posterior horn of the
spinal cord, and modifications in the excitability and
topographical cortical representation of the sensorimotor
and motor cortices that receive projections from the
affected body part, have been identified and recognized as
important contributors. Indeed, recent findings suggest that
pain in CRPS is positively associated with a functional
reorganization of the somatosensory and motor cortex.
Cortical reorganization is the result of changes in
somatotopic organization, and changes in excitability of the
somatosensory and motor cortices. Preliminary data
suggests that both rTMS and tDCS under certain conditions
can alleviate pain in patients with CRPS and that may be
related to reversal of excitability and topographical
changes.
