• Pain Med · Aug 2023

    Central sensitization in CRPS patients with widespread pain: A cross-sectional study.

    • Iara De Schoenmacker, Anna Mollo, Paulina Simonne Scheuren, Laura Sirucek, Florian Brunner, Petra Schweinhardt, Armin Curt, Jan Rosner, and Michèle Hubli.
    • Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland.
    • Pain Med. 2023 Aug 1; 24 (8): 974984974-984.

    ObjectiveWidespread pain hypersensitivity and enhanced temporal summation of pain (TSP) are commonly reported in patients with complex regional pain syndrome (CRPS) and discussed as proxies for central sensitization. This study aimed to directly relate such signs of neuronal hyperexcitability to the pain phenotype of CRPS patients.MethodsTwenty-one CRPS patients and 20 healthy controls (HC) were recruited. The pain phenotype including spatial pain extent (assessed in % body surface) and intensity were assessed and related to widespread pain hypersensitivity, TSP, and psychological factors. Quantitative sensory testing (QST) was performed in the affected, the contralateral and a remote (control) area.ResultsCRPS patients showed decreased pressure pain thresholds in all tested areas (affected: t(34)  = 4.98, P < .001, contralateral: t(35) = 3.19, P = .005, control: t(31) = 2.65, P = .012). Additionally, patients showed increased TSP in the affected area (F(3,111) = 4.57, P = .009) compared to HC. TSP was even more enhanced in patients with a high compared to a low spatial pain extent (F(3,51) = 5.67, P = .008), suggesting pronounced spinal sensitization in patients with extended pain patterns. Furthermore, the spatial pain extent positively correlated with the Bath Body Perception Disturbance Scale (ρ = 0.491; P = .048).ConclusionsOverall, we provide evidence that the pain phenotype in CRPS, that is, spatial pain extent, might be related to sensitization mechanism within the central nociceptive system. This study points towards central neuronal excitability as a potential therapeutic target in patients with more widespread CRPS.© The Author(s) 2023. Published by Oxford University Press on behalf of the American Academy of Pain Medicine.

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