The brain in chronic CRPS pain: abnormal gray-white matter interactions in emotional and autonomic regions.
Chronic complex regional pain syndrome (CRPS) is a debilitating pain condition accompanied by autonomic abnormalities. We investigated gray matter morphometry and white matter anisotropy in CRPS patients and matched controls. Patients exhibited a disrupted relationship between white matter anisotropy and whole-brain gray matter volume; gray matter atrophy in a single cluster encompassing right insula, right ventromedial prefrontal cortex (VMPFC), and right nucleus accumbens; and a decrease in fractional anisotropy in the left cingulum-callosal bundle. Reorganization of white matter connectivity in these regions was characterized by branching pattern alterations, as well as increased (VMPFC to insula) and decreased (VMPFC to basal ganglion) connectivity. While regional atrophy differentially related to pain intensity and duration, the strength of connectivity between specific atrophied regions related to anxiety. These abnormalities encompass emotional, autonomic, and pain perception regions, implying that they likely play a critical role in the global clinical picture of CRPS.
Geha
Paul Y
PY
Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA.
Baliki
Marwan N
MN
Harden
R Norman
RN
Bauer
William R
WR
Parrish
Todd B
TB
Apkarian
A Vania
AV
D000328:Adult; D001008:Anxiety Disorders / Q000473:pathology / Q000503:physiopathology; D001284:Atrophy / Q000209:etiology / Q000473:pathology / Q000503:physiopathology*; D017776:Autonomic Pathways / Q000473:pathology / Q000503:physiopathology*; D001921:Brain / Q000473:pathology / Q000503:physiopathology*; D001931:Brain Mapping; D002540:Cerebral Cortex / Q000473:pathology / Q000503:physiopathology; D002908:Chronic Disease; D020918:Complex Regional Pain Syndromes / Q000473:pathology / Q000503:physiopathology*; D003337:Corpus Callosum / Q000473:pathology / Q000503:physiopathology; D004644:Emotions / Q000502:physiology; D005260:Female; D006801:Humans; D008032:Limbic System / Q000473:pathology / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D009413:Nerve Fibers, Myelinated / Q000502:physiology*; D009434:Neural Pathways / Q000473:pathology / Q000503:physiopathology; D009714:Nucleus Accumbens / Q000473:pathology / Q000503:physiopathology; D010147:Pain Measurement; D017397:Prefrontal Cortex / Q000473:pathology / Q000503:physiopathology