Chronic Regional Pain Syndrome, Type 1: Part II

Abstract

Chronic regional pain syndrome, type 1 (CRPS1) is a complex neurologic disease characterized by chronic, severe, burning pain; hyperesthesia; soft tissue swelling; dystrophy; hyperhidrosis; vasomotor and sudomotor instability; joint stiffness; and patchy osteoporosis. Five to six million people in the United States alone suffer from CRPS1. To date, CRPS1 is poorly understood and often is not recognized clinically. This syndrome requires early detection, pain control, and treatment in tandem with physical therapy to the affected area. Part I (published in September) discussed background information on CRPS1 and sympathetic nerve blocks. Part II focuses on the remaining treatment modalities (e.g., sympathectomy, physical therapy, stimulators, trigger point injections, acupuncture, tourniquet effects, placebo effects, amputation).

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.…”

Sympathectomy attenuates excitability of dorsal root ganglion neurons and pain behaviour in a lumbar radiculopathy model

“…11,12 To treat such patients, in particular those suffering from chronic pain such as complex regional pain syndrome, sympathetic nerve blocks and surgical sympathectomy are used, which are often effective. 9,10 …”

Report of a focus group survey of current practice in the therapeutic treatment of Complex Regional Pain Syndrome in the United Kingdom

“…The literature points towards early diagnosis and treatment of the disease as being a key factor in successful outcome (Moroz et al 2001, Muir and Vernon 2000, Bushnell and Cobo-Castro 1999, Atkins 2003. Management of the disease reflects its complex nature and an interdisciplinary approach is advocated by most authors on the subject (Stanton-Hicks et al 2002, Dommerholt 2003, Rho et al 2002, Dunn 2000. Treatment may include a combination of pharmacologic management, regional anaesthetic techniques, spinal cord or peripheral nerve stimulation, psychological therapy and occupational and physical therapy (Siddiqui et al 2001).…”