Article Figures & Data
Figures
- Figure 1.
A, A psychometric function of two-point discrimination threshold for a single subject’s index finger. The percentage of two-point perception was plotted against the different point-to-point distances tested in the two-point discrimination task. The gray curve with gray squares indicates the subject’s percentage of correct responses for each distance, and the black curve with circles is the fitted binary logistic regression. The two-point discrimination threshold is the distance at which correct two-point perception was at 50% (black arrow). B, MRS voxel placement on the sensorimotor cortex. Voxel placement over the left sensorimotor cortex of a single subject indicated by the white square outline. The voxel was guided by the “hand hook” in the sagittal plane and the "hand knob" in the axial plane. C, A typical MEGA-PRESS spectrum obtained from the sensorimotor cortex. NAA, N-acetyl aspartate. D, Plots demonstrating the age distribution of the two groups. The left plot shows subjects used for GABA, the middle plot for Glx, and the right plot for TPD. While there were significant differences between groups if all control and CRPS subjects were used for the analyses, restriction of the control group numbers allowed for group comparisons in which there was no overall significant difference in age (Mann–Whitney U test, p > 0.05), sex (χ2 test, p > 0.05), or handedness (Mann–Whitney U test, p > 0.05).
- Figure 2.
Plots of GABA/Cr ratios (×10−1) of a 30 × 30 × 30 mm voxel placed over the hand representation of the sensorimotor cortex. A, Values for individual subjects with upper limb CRPS for the right and left, dominant and nondominant hemispheres and also for the affected (hemisphere representing the side of ongoing pain) and unaffected hemispheres. Plots show pairwise connections for each individual subject. B, Values for individual control subjects. C, Values comparing individual CRPS and control subjects. Horizontal lines indicate the mean ± SEM for each group. Note there are no significant differences between any hemisphere in the CRPS or control subjects alone or between CRPS and control groups.
- Figure 3.
Plots of Glx/Cr ratios (×10−1) of a 30 × 30 × 30mm voxel placed over the hand representation of the sensorimotor cortex. A, Values for individual subjects with upper limb CRPS for the right and left hands, dominant and nondominant hemispheres, and also for the affected (hemisphere representing the side of ongoing pain) and unaffected hemispheres. Plots show pairwise connections for each individual subject. B, Values for individual control subjects. C, Values comparing individual CRPS subject and control subject groups. Horizontal lines indicate the mean ± SEM for each group. Note that there are no significant differences between any hemisphere in the CRPS or control subjects alone or between CRPS and control groups.
- Figure 4.
Plots of TPD in millimeters. A, Values for individual subjects with upper limb CRPS for the right and left hands, dominant and nondominant hands, and also for the affected (hand with ongoing pain) and unaffected hands. Plots show pairwise connections for each individual subject. B, Values for individual control subjects. C, Values comparing individual CRPS subject and control subject groups. Horizontal lines indicate the mean ± SEM for each group. Note that CRPS subjects displayed reduced tactile acuity (increased TPD) in the affected hand compared with the unaffected hand and the dominant and nondominant hands in control subjects (*p < 0.05).
Tables
Signs (symptoms) Subject Age Sex EHI score (handedness) Pain duration
(years)CRPS affected region Inciting event Medications Comorbidity Sensory Vaso-motor Sudomotor/edema Motor/trophic Pain intensity (diary VAS) Pain intensity (day VAS) 1 49 M 100.0 (R) 7.0 R UL,
R LL,
L LL, face, abdomenPain in R hand Turmeric tablets None + (+) + (+) + (+) + (+) 4.5 4.0 2 56 F 100.0 (R) 4.2 L UL,
R UL,
R LL,
R and L chestL humerus fracture Duloxetine, gabapentin, oxycodone, quetiapine, tapentadol L radial nerve palsy, Triangular fibrocartilage complex of R hand + (+) + (+) + (+) + (+) 8.1 7.8 3 56 F 60.0 (R) 0.9 R UL,
R neck,
R chestSpontaneous onset Ashwagandha, budesonide, cannabis, codeine, formoterol, oxycodone, paracetamol, salbutamol Back pain, COPD, fibromyalgia, osteoarthritis, peptic ulcer, radiculopathy, Raynaud’s disease, spinal disc herniation + (+) + (+) − (+) + (+) 8.3 7.9 4 62 F 100.0 (R) 6.2 L UL,
R UL 2R hand tendon release surgery Amitriptyline, cannabidiol drops, codeine , levothyroxine, magnesium, paracetamol, topiramate, tramadol, valerian Diverticulitis, gastroesophageal reflux disease, Graves’ disease (thyroidectomized) + (+) + (+) − (+) + (+) 5.8 4.3 5 58 F −20.0 (A) 8.7 R UL,
R LL,
R faceR arm surgery Codeine, duloxetine, linagliptin, meloxicam, metformin, paracetamol Diabetes + (+) + (+) + (+) + (+) 4.7 4.1 6 67 F 100.0 (R) 9.5 R UL,
L UL,
R LL,
L LLR radius fracture Amlodipine, gabapentin, ketamine in lipoderm cream, metformin, metoprolol, pantoprazole, salbutamol Asthma, diabetes, gastric reflux, hypertension, osteoarthritis, pubic symphysitis, supraventricular tachycardia + (+) − (+) − (+) + (+) 3.7 5.0 7 47 M 44.4 (R) 1.5 R UL Spontaneous onset Amlodipine, atorvastatin, ibuprofen, paracetamol, perindopril, pregabalin Hyperlipidemia, hypertension + (+) + (+) − (−) + (+) 6.8 7.1 8 34 F −23.1 (A) 5.3 R UL,
R LL,
R hipR wrist fracture Amitriptyline, buprenorphine patch Migraine, R hip bursitis + (+) + (+) + (+) + (+) 4.3 2.4 9 26 F −40.0 (A) 1.3 R UL,
L and R neck,
spine,
L LLR hand nerve damage None Endometriosis, polycystic ovarian syndrome + (+) + (+) + (+) + (+) 5.4 6.8 10 46 F 80.0 (R) 3.9 L UL L hand carpal tunnel release surgery Amitriptyline, betahistine, duloxetine, naproxen, pantoprazole, rizatriptan, tapentadol, valaciclovir Carpal tunnel of R hand, fibromyalgia, herpes, migraine, polycystic ovarian syndrome with insulin resistance, vertigo + (−) + (+) + (+) − (+) 0.6 5.6 11 24 F 70.0 (R) 2.6 R UL,
L ULOverload Amitriptyline, gabapentin, levothyroxine Hashimoto’s disease − (−) − (+) + (+) + (+) 4.5 4.4 12 52 F 40.0 (A) 2.9 R UL,
R torsoBroke tailbone Ashwagandha, fish oil, ibuprofen, magnesium, mega B, melatonin, paracetamol, tapentadol, vitamin C, vitamin D Endometriosis + (+) + (+) − (+) − (+) 3.8 3.5 13 38 F 17.6 (A) 12.7 R UL,
R neck,
L LLSpontaneous onset Duloxetine, gabapentin, naloxone, oxycodone, palmitoylethanolamide (PEA) Endometriosis, endosalpingiosis, Raynaud’s disease + (+) + (+) + (+) + (+) 0.0 5.9 14 52 M −88.9 (L) 1.9 R UL,
L and R neck, backR scaphoid fusion surgery Cholecalciferol, ibuprofen, magnesium, oxycodone, paracetamol, pregabalin, tramadol, venlafaxine, zopiclone L shoulder bursitis, Sleep apnea + (+) + (+) + (+) + (+) 7.0 7.6 R, Right; L, left; A, ambidextrous; UL, upper limb; LL, lower limb; +, present; −, absent. Bold type indicates the CRPS region with the most severe pain. Italic type indicates remission of the CRPS region. Underline indicates medication taken in the last 24 h of the day of testing. The presence (+) or absence (-) of CRPS signs and symptoms are presented as signs (symptoms).
In this issue
