Evidence of motor system reorganization in complex regional pain syndrome type 1: A case report

BACKGROUND: Central nervous system reorganization, particularly in networks devoted to somatosensation, is thought to be a significant feature of complex regional pain syndrome (CRPS). AIMS: In the present case report, we evaluated the corticomotor system of a woman suffering from CRPS, as she started and completed her rehabilitation, in order to explore whether CRPS could also be linked to changes in motor networks. METHODS: The patient, a 58-year-old woman, was diagnosed with right-hand CRPS. Transcranial magnetic stimulation measures, reflecting the strength of the corticospinal projections, were evaluated before, during, and after an 8-week graded motor imagery (GMI) program. RESULTS: Before treatment, the patient reported significant pain and disability, and the strength of the corticospinal projections of the first dorsal interosseous of the affected hand was reduced compared to the healthy, unaffected hand. Pain and disability decreased as the patient completed the GMI program. These changes were paralleled by an increase in the strength of the corticospinal projections. CONCLUSIONS: These observations suggest that corticomotor changes can be observed in individuals suffering from CRPS and that some of the clinical manifestations observed in these patients (e.g., pain, disability) could possibly be linked to these neurophysiological changes.