Issue:
Work-related injuries to nerves in the arm and hand are common and can lead to major disability. Surgeons can repair the nerves so that the arm can function and the hand can feel normally. Some patients have a poor result after surgery and are left without the ability to feel, weak movement and severe nerve pain (neurogenic) in the arm and hand.
Objectives:
The goal of this research is to determine whether there are pre-existing patient factors that are associated with sensorimotor recovery following surgical repair of an injured peripheral nerve. The study will assess the structure-function-behavioural relationships between the sensorimotor system, chronic neuropathic pain and brain plasticity following surgical repair of a peripheral nerve injury (PNIr). The first objective is to determine whether pre-surgical measures of personality and pain-related cognitions (neuroticism, pain catastrophizing) contribute to poor sensorimotor recovery and the development of chronic pain following PNIr. The second objective is to determine whether there are pre-existing structural or functional brain abnormalities in patients who have poor recovery of sensorimotor function and develop chronic pain following PNIr.
Anticipated Results:
Based on the results of our previous studies we expect pre-surgical repair characteristics (presumably reflecting pre-existing patient factors) to provide predictive markers of maladaptive functional and structural brain plasticity associated with poor sensorimotor recovery and the development of chronic neuropathic pain. These characteristics are expected to include high pain catastrophizing and neuroticism and brain abnormalities such as 1) functional and white matter structural connectivity patterns to/from brain areas implicated in pain perception, pain modulation, awareness and emotion, 2) gray and white matter reductions in and feeding cortical/subcortical pain modulatory areas, and 3) gray and white matter increases in and feeding cortical areas involved in pain perception and salience/awareness.
Investigators:
Karen D. Davis (Toronto Western Research Institute, TWH/UHN), Dimitri J. Anastakis, (Toronto Western Hospital/UHN), Joel D. Katz (York University)
