title: Brain alterations and neurocognitive dysfunction in patients with complex regional pain syndrome.
abstract: Few studies have examined the involvement of specific subregions of the prefrontal cortex in complex regional pain syndrome (CRPS). We analyzed cortical thickness to identify morphologic differences in local brain structures between patients with CRPS and healthy control subjects (HCs). Furthermore, we evaluated the correlation between cortical thickness and neurocognitive function. Cortical thickness was measured in 25 patients with CRPS and 25 HCs using the FreeSurfer method. Pain severity and psychiatric symptoms were assessed using the Short Form McGill Pain Questionnaire and the Beck Depression and Anxiety Inventories, respectively. Neurocognitive function was assessed via the Wisconsin Card Sorting Test and the stop-signal task. The right dorsolateral prefrontal cortex and left ventromedial prefrontal cortex were significantly thinner in CRPS patients than in HCs. CRPS patients made more perseveration errors on the Wisconsin Card Sorting Test and had longer stop-signal task reaction times than HCs. Although the Beck Depression Inventory and the Beck Anxiety Inventory differ significantly between the groups, they were not correlated with cortical thickness. Our study suggests that the pathophysiology of CRPS may be related to reduced cortical thickness in the dorsolateral prefrontal cortex and the ventromedial prefrontal cortex. The structural alterations in dorsolateral prefrontal cortex may explain executive dysfunction and disinhibited pain perception in CRPS.
  
  
  CONCLUSIONS
  The present study reports decreased cortical thickness in the prefrontal cortex and neurocognitive dysfunctions in patients with CRPS. These findings may contribute to the understanding of pain-related impairments in cognitive function and could help explain the symptoms or progression of CRPS.
authors.affiliation: Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Do-Hyeong
authors.initials: DH
authors.lastname: Lee
authors.affiliation: Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Kyung-Jun
authors.initials: KJ
authors.lastname: Lee
authors.affiliation: Department of Brain and Cognitive Sciences, College of Natural Sciences, Seoul National University, Seoul, Republic of Korea.
authors.forename: Kang Ik K
authors.initials: KI
authors.lastname: Cho
authors.affiliation: Department of Brain and Cognitive Sciences, College of Natural Sciences, Seoul National University, Seoul, Republic of Korea.
authors.forename: Eun Chung
authors.initials: EC
authors.lastname: Noh
authors.affiliation: Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Joon Hwan
authors.initials: JH
authors.lastname: Jang
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Yong Chul
authors.initials: YC
authors.lastname: Kim
authors.affiliation: Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea; Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea. Electronic address: basuare@hanmail.net.
authors.forename: Do-Hyung
authors.initials: DH
authors.lastname: Kang
mesh_terms: D000328:Adult; D002540:Cerebral Cortex / Q000473:pathology*; D003072:Cognition Disorders / Q000209:etiology* / Q000473:pathology*; D020918:Complex Regional Pain Syndromes / Q000150:complications*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010147:Pain Measurement; D011569:Psychiatric Status Rating Scales; D013223:Statistics as Topic
keywords: Complex regional pain syndrome; cortical thickness; neurocognitive function; prefrontal cortex