Transcranial magnetic stimulation studies in complex regional pain syndrome type I: A review

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Complex regional pain syndrome (CRPS) is a chronic progressive disease characterized by severe pain combined with sensory, autonomic, and motor disturbances.1 CRPS type I (CRPS‐I) occurs typically after a minor injury and is characterized by the absence of nerve lesions, and its clinical features are disproportionate compared with the initiating event.3 Motor dysfunction includes weakness, loss of voluntary motor control, and slowness; movement disorders such as tremor, jerks, and postural abnormalities of the affected limb (“fixed dystonia”) also occur in about 15%‐20% of CRPS‐I patients.5 The pathophysiology of motor dysfunction and movement disorders in CRPS‐I is still controversial and largely unknown. It has been hypothesized that the peripheral changes in CRPS are a manifestation of neuroplastic changes in sensorimotor circuits and processing in the brain.7 The abnormal peripheral input might induce a functional reorganization of the central nervous system.10 Overall, the underlying pathophysiology of neuropathic pain syndromes seems to occur at cortical and subcortical level.14
Transcranial magnetic stimulation (TMS) techniques may offer a reliable tool to characterize important neurophysiological and pathophysiological aspects of brain involvement in CRPS.16 We review here all studies that have applied TMS in patients with CRPS‐I in order to provide a comprehensive perspective of past and current research and to develop valuable suggestions for future studies.
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