Alterations of skin and muscle sensibility in chronic obliterating arteriopathy of the lower limbs and their importance in determining intermittent claudication

Twenty patients with peripheral arterial disease and 10 normal controls were submitted to i.v. injection of aprotinin, polypeptide (mol.wt. 6512) extracted from bovine lung, in order to examine its effects on: (a) lower limbs pain, (b) lower limbs sensibility, (c) calf blood flow. Aprotinin (100,000 Ku i.v. diluted in NaCl 0.9%) was given in a single dose or twice a day for a week; for control the same subject received, before or after aprotinin, an equivalent volume of diluent (0.9% NaCl). The results demonstrate that aprotinin is able to increase the initial pain limit walking tolerance and to decrease the intensity of pain at rest and of myalgic or "trigger" areas. No variation was observed on skin sensibility and on calf blood flow, both basal resting and hyperemic. The favorable effect of examined polypeptide on ischemic pain can be attributed neither to increase of calf blood flow nor to influence on perception of painful stimuli. It seems therefore to suggest that aprotinin acts on biochemical mechanisms that cause the ischemic pain. Presumably it inhibits kininogenases and tissue protein-hydrolyzine enzymes activated in the course of ischemia.

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Effect of a proteinase inhibitor on intermittent claudication or on pain at rest in patients with peripheral arterial disease

Digiesi

Bartoli

1975

Pain

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Fibrositic myofascial pain in intermittent claudication. Effect of anesthetic block of trigger points on exercise tolerance

Bartoli

Grisillo

et al. 1979

Pain

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The blocking of trigger points in the calf by the local injection of an anesthetic agent was performed in 15 patients with intermittent claudication. Reactive and exercise hyperemia, work load and duration of exercise were recorded before and after infiltration of the trigger points. Reactive hyperemia does not change, but the exercise tolerance of the leg significantly improves after local blocking of the trigger areas and the exercise hyperemia increases because of the higher work load. The pain pattern of intermittent claudication can be activated by the summation of abnormal input from muscles, due to contraction in the presence of anoxia, with activity from trigger points. Local infiltration of trigger areas blocks theirir activity. The vicious cycle of pain is interrupted and the exercise tolerance of the leg is increased, without improving blood circulation.

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Fibrositic Myofascial Pain in Intermittent Claudication: Significance of Trigger Areas in the Calf

Bartoli

Grisillo

et al. 1980

Angiology

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To test the hypothesis of a myofascial component in intermittent claudication, 56 male patients were studied. Calf blood flow, at rest and during postischemic and postexercise hyperemia, presence of trigger areas, and exercise tolerance were evaluated and compared. The results can be summarized as follows: The exercise tolerance is reduced when trigger areas are present in the calf muscles, and the more severe the trigger areas, the lower is the exercise tolerance. Trigger areas are more severe when the hyperemic flow is more reduced. The peak flow of reactive hyperemia is also correlated to work load. Pain in intermittent claudication is a complex phenomenon. According to the aforesaid results, the severity of limb ischemia and the presence of trigger areas in the calf appear to be the major factors. Besides the two reasons already known, a third is suggested to explain calf claudication: the elective location of trigger points in the gastrocnemius muscle.

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Alterations of skin and muscle sensibility in chronic obliterating arteriopathy of the lower limbs and their importance in determining intermittent claudication

Cited by 3 publications

References 43 publications

Effect of a proteinase inhibitor on intermittent claudication or on pain at rest in patients with peripheral arterial disease

Effect of a proteinase inhibitor on intermittent claudication or on pain at rest in patients with peripheral arterial disease

Fibrositic myofascial pain in intermittent claudication. Effect of anesthetic block of trigger points on exercise tolerance

Fibrositic Myofascial Pain in Intermittent Claudication: Significance of Trigger Areas in the Calf

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