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To the Editor:
Maihöfner et al.1 describe fMRI data of allodynia in complex regional pain syndrome (CRPS). The authors are to be congratulated for a very carefully designed study. Of the 12 patients, 11 had pain and sensory abnormalities in the right hand. This homogeneity in the anatomic distribution of the pain complaints may explain why the authors obtained allodynia-induced activation of S1 whereas other brain imaging studies failed.2
The study of Maihöfner et al. is also important because their pain-related activations are predominantly contralateral to the stimulated body area, conforming with findings in acute, experimental pain studies. This contrasts with reports of bilateral responses in the pain matrix, often with a preponderance of responses in the hemisphere ipsilateral to stimulation.2,3 Whereas these latter studies investigated neuropathic pain patients with minor2 or major3 lesions to the nervous system, Maihöfner et al. used CRPS-type I patients, a neuropathic pain condition characterized by an absence of lesion to the peripheral nervous system. …
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