Chronic Regional Pain Syndrome, Type 1: Part I

Abstract

Chronic regional pain syndrome refers to a class of disorders thought to involve common neuropathic and clinical features. These disorders usually are caused by injury, and they manifest in pain and sensory changes that are disproportionate in intensity, distribution, and duration to the underlying pathology. The result of these injuries is significant impairment of motor function over time. This article is divided into two parts. Part I discusses background information such as pain, pathophysiology, diagnosis, clinical stages, and the most common treatment modality, sympathetic nerve blocks. Part II, discusses alternate treatment modalities, such as sympathectomy, physical therapy, stimulators, trigger point injections, acupuncture, tourniquet effects, placebo effects, and amputation. AORN J 72 (Sept 2000) 421–449.

Noradrenaline stimulates ATP release from DRG neurons by targeting β3 adrenoceptors as a factor of neuropathic pain

“…Evidence has pointed to the participation of noradrenergic transmission in nociception (Mclachlan et al, 1993; Dunn, 2000a,b; Kim et al, 2001; Chung and Chung, 2002; Maruo et al, 2006). This prompted us to assess the effect of NA on ATP release from DRG neurons.…”

“…NA, released in association with sympathetic nerve sprouting into the DRG after peripheral nerve injury, may contribute to development of neuropathic pain (Mclachlan et al, 1993; Dunn, 2000a,b; Kim et al, 2001; Chung and Chung, 2002; Maruo et al, 2006). In the present study, NA significantly increased the frequency of NeSCCs that was blocked by the broad inhibitor of β adrenoceptors, propranolol, and the selective inhibitor of β 3 adrenoceptors, SR59230A.…”

“…This may account for amplification of pain through noradrenergic transmission. Blockade of sympathetic nerves or α 1 adrenoceptors is shown to relieve neuropathic pain (Dunn, 2000a,b). NA, thus, appears to serve as a regulator or modulator for neuropathic pain.…”