Sympathetic vasoconstrictor reflex pattern in patients with complex regional pain syndrome

Abstract

Twenty patients suffering from complex regional pain syndrome (CRPS) and 21 healthy control subjects were examined to evaluate sympathetic reflex vasoconstriction. The mean age of the 12 female and eight male patients was 48.9 (21-72) years. At the time of investigation the median duration of the disease was 8.5 weeks (2-70). Twenty-one healthy subjects were investigated for control. Different maneuvers, such as the veno-arteriolar reflex (VAR), inspiratory gasp (IG), cold pressor test (CP) and mental arithmetic (MA), were employed to induce vasoconstriction while the cutaneous blood flow of the affected and the contralateral limb was recorded. In addition, the skin temperature of both limbs was measured by infrared thermography. In 14 of 20 patients and in 14 of 21 control subjects vasoconstriction due to the provocation tests could be measured, while the remaining six patients and seven controls showed vasodilatation in at least one test, and by that they were excluded from analysis of vasoconstrictor reflex pattern. After thermoregulatory adaptation skin temperature was not different between the affected and the unaffected limb. Sympathetic reflex vasoconstriction triggered by MA which represents cortical generated, moderate vasoconstrictor stimulus, was significantly reduced on the affected limb (102.9% of prestimulus period) when compared to the control limb (85.0%, P < 0.002) or to controls (84.8%, P < 0.001). VAR (pure postganglionic), IG and CP (both spinal and supraspinal), representing stronger vasoconstrictor stimuli, revealed no significant side to side difference of sympathetic vasoconstriction and no significant difference as compared to controls. In conclusion our findings prove impairment of sympathetic vasoconstrictor activity after central vasoconstrictor stimulation in CRPS, and possible mechanisms are discussed.

Norepinephrine-induced nociception and vasoconstrictor hypersensitivity in rats with chronic post-ischemia pain

“…CRPS patients also have increased vasoconstrictive responses to NE (Arnold et al, 1993;Birklein et al, 1997;Teasell & Arnold, 2004). Although early in the disease CRPS patients have reduced sympathetic function (Birklein et al, 1998;Wasner et al, 1999;Schurmann et al, 1999;, later in the disease CRPS patients have greater decreases in blood flow in response to sympathetic stimulation (Drummond et al, 2001;Wasner et al, 2001;Baron et al, 2002;Ackerman et al, 2005), and exhibit denervation supersensitivity of vasoconstrictive adrenoceptors (Kurvers et al, 1995).…”

Causalgia and reflex sympathetic dystrophy: Does the sympathetic nervous system contribute to the generation of pain?

“…Autonomic abnormalities include swelling and changes of sweating and skin blood flow. 7,9,12,28 At normal room temperature the skin temperature of the limbs shows a systematic interside difference in about 80% of patients; that is, the affected extremity is either warmer or colder. 7,9,16,175 In the acute stages of RSD the affected limb is more often warmer than the contralateral limb.…”

“…Autonomic functions of the affected region can be tested by a variety of new and emerging methods. For example, blood flow changes can be evaluated by laser Doppler flowmetry 9,12 and infrared thermography. Furthermore, the quantitative sudomotor axon reflex test has been used to demonstrate abnormal function of sudomotor reflex loops in RSD.…”

Natural Wool Fabrics in Physiotherapy

“…Pain is frequently associated with sympathetic system stimulation and almost always causes vasoconstriction and a resultant decrease in body temperature (Birklein et al, 1998). Longterm emotional stress may act as an additional factor activating the sympathetic nervous system; it often underlies psychosomatic syndromes including locomotor organ disorders.…”