Treatment of Reflex Sympathetic Dystrophy with Regional Intravenous Reserpine

Benzon, Honorio T.; Chomka, Christina M.; Brunner, Edward A.

doi:10.1213/00000539-198007000-00008

Cited by 28 publications

(8 citation statements)

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“…Chemical sympathetic denervation enhances the synthesis of IL-1ß and IL-6 in rats, suggesting a tonic inhibitory control of the sympathetic nerves on these inflammatory cytokines [13]. Several other studies also support that sympathetic nerves have anti-inflammatory effects [14][15][16].…”

Section: Introductionmentioning

confidence: 89%

IL-1α and TNF-α Expression in Rat Periapical Lesions and Dental Pulp after Unilateral Sympathectomy

Bletsa

Heyeraas²,

Haug³

et al. 2004

Neuroimmunomodulation

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Objectives: Apical periodontitis is an inflammatory disease characterized by bone resorption, and sympathetic nerves are known to modulate bone resorption and bone remodeling. Higher numbers of osteoclasts and larger periapical lesions have been observed after sympathectomy in rats, but the mechanisms underlying the inhibitory effect of sympathetic nerves on osteoclasts are unknown. This study aimed to test the hypothesis that sympathetic nerves inhibit the production of the bone-resorbing pro-inflammatory cytokines IL-1α and TNF-α in rat periapical lesions. Methods: Rats were unilaterally sympathectomized and apical lesions were induced by exposing the dental pulp of molar teeth to the oral microflora. We quantified the cytokines IL-1α and TNF-α by enzyme-linked immunosorbent assay, and immunohistochemical analysis was done for qualitative localization. Pulp from intact incisor teeth was tested as a control. Results: We showed that IL-1α was increased, but not TNF-α, in the periapical lesions on the sympathectomized side. Both IL-1α and TNF-α were expressed in unexposed pulp. TNF-α was significantly decreased in the denervated incisor pulp, whereas the level of IL-1α remained unchanged. Conclusions: This study suggests that sympathetic nerves have an inhibitory effect on IL-1α in periapical lesions and a stimulatory effect on TNF-α in the intact rat pulp.

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Section: Introductionmentioning

confidence: 89%

IL-1α and TNF-α Expression in Rat Periapical Lesions and Dental Pulp after Unilateral Sympathectomy

Bletsa

Heyeraas²,

Haug³

et al. 2004

Neuroimmunomodulation

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“…Es sei an die akute Zosterneuralgie erinnert, bei der diese Therapie zumeist wirksam ist, obgleich keine sympathische Dysfunktion besteht [6,90]. Weiterhin gibt es eine Vielzahl von Hinweisen, daß der sympathikolytische Effekt, also die Vasodilatation oder die Hemmung der Sudomotorik, ohnehin nicht mit der Dauer oder dem Ausmaß der Analgesie nach einer Sympathikusblockade oder nach der IVRS in Verbindung steht [12,18,66,67,100,120]. Die Analgesie kann persistieren, auch wenn sympathische Reflexe bereits wieder auslösbar sind [35].…”

Section: Störungen Der Sensibilitätunclassified

Diagnostik und Therapie des sympathisch unterhaltenen Schmerzes

Maier

Gleim

1998

Der Schmerz

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The term "sympathetically maintained pain" (SMP) describes a symptom that might accompany a variety of diseases (CRPS, (post-) herpetic and post-injury neuralgia), which might transform into sympathetically independent pain (SIP) after some time. Patients with SMP present a bunch of disorders of the autonomic and sensory system, but the only reliable way to diagnose a pain as SMP is a positive response to an intervention at the sympathetic nervous system. Three ways of influencing the sympathetic system are commonly used: (a) local anesthetic sympathetic blockade (SB), (b) intravenous regional sympathectomy (IVRS) and (c) ganglionic local opioid application (GLOA). A review of current literature shows that SB has certain advantages in diagnostic sensitivity, whereas GLOA might be slightly superior in therapy of some diseases with longstanding pain history. Obviously, the therapeutic benefit of all interventions is complete independent of the accompanying autonomic disorder and of a blockade of efferent fibers. A new heuristic model of the SMP mechanism is presented, including both experimental and clinical data. For reducing the risks of false positive or negative diagnosis of SMP and SIP, a diagnostic algorithm is proposed. This includes optimizing the technique, changes of interventional measures, and adequate monitoring both of analgesia and as well of the extend of efferent sympathetic blockade (e.g. measurement of sympathetic reflexes). The treatment recommendations in patients with SMP vary in dependence of the kind of disease. In SMP, invasive measures play an important, but only limited role within the comprehensive treatment concept. As an example a three-stage, symptom-adapted treatment algorithm is demonstrated for CRPS, including also drug therapy, psychologic and physiotherapeutic approaches.

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“…Treatment methods gaining popularity include the IV regional block technique (Bier block) employing reserpine, guanethidine, and bretylium as well as nifedipine, a calcium channel blocker, as a vasodilator [81][82][83][84][85][86][87].…”

Section: Nerve Blocksmentioning

confidence: 99%

“…Intravenous or intra-arterial infusion of ganglionic blocking agents into the affected extremity have recently gained prominence in the treatment of type I CRPS [81,83,85]. There are two reasons why IV administration of ganglionic blockers is superior to intra-arterial injection for treatment in this syndrome.…”

Section: Intravenous Regional Blockmentioning

confidence: 99%

Complex regional pain syndromes—reflex sympathetic dystrophy and causalgia

Raj

1998

Current Review of Pain

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Treatment of Reflex Sympathetic Dystrophy with Regional Intravenous Reserpine

Cited by 28 publications

References 0 publications

IL-1α and TNF-α Expression in Rat Periapical Lesions and Dental Pulp after Unilateral Sympathectomy

IL-1α and TNF-α Expression in Rat Periapical Lesions and Dental Pulp after Unilateral Sympathectomy

Diagnostik und Therapie des sympathisch unterhaltenen Schmerzes

Complex regional pain syndromes—reflex sympathetic dystrophy and causalgia

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