• Mahsa Shokouhi, Collin Clarke, Patricia Morley-Forster, Dwight E Moulin, Karen D Davis, and Keith St Lawrence.
• Imaging Department, Lawson Health Research Institute, London, Ontario, Canada; Medical Biophysics, University of Western Ontario, London, Ontario, Canada. Electronic address: mshokouh@lawsonimaging.ca.
• J Pain. 2018 Feb 1; 19 (2): 146-157.

AbstractBrain plasticity is demonstrated in complex regional pain syndrome (CRPS), although it is unclear how it modulates at different stages of CRPS. The observation that symptoms can progress over time suggests that the pattern of brain changes might also evolve. We measured structural and functional changes as well as sensorimotor integration at the early stage (ES) and late stage (LS) of CRPS. Twelve ES patients, 16 LS patients, and 16 age- and sex-matched controls were recruited. Gray matter (GM) volume was estimated using voxel-based morphometry. Cerebral perfusion was measured using arterial spin labeling, because it provides a measure of resting neural activity. Connectivity to sensorimotor regions was evaluated using blood-oxygen level-dependent images. The ES group showed reduced GM volume and perfusion in areas associated with spatial body perception, somatosensory cortex, and the limbic system, whereas the LS group exhibited increased perfusion in the motor cortex but no changes in GM volume. However, in the LS group, GM volume in areas associated with pain processing was negatively correlated with average pain levels, likely reflecting a response to ongoing pain. Furthermore, connectivity to sensorimotor cortex showed disruptions in regions associated with motor control and planning, implying impairment of higher-order motor control.Copyright © 2017 The American Pain Society. Published by Elsevier Inc. All rights reserved.

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