Cutaneous norepinephrine application in complex regional pain syndrome. |
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| Authors: | F. Birklein,B. Riedl,D. Claus,B. Neund rfer,H.O. Handwerker |
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| Affiliation: | 1. Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan;2. Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan;3. Non-invasive Neuromodulation Consortium for Mental Disorders, Society of Psychophysiology, Taipei, Taiwan;4. Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan;5. Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan;6. Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan;7. Department of Psychiatry, General Cheng Hsin Hospital, Taipei, Taiwan;8. Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan;9. Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan;10. Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, Taipei, Taiwan;11. Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan;1. Key Laboratory of Environment and Health, Ministry of Education, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan 430030, People''s Republic of China;2. Department of Child Health Care, Hunan Children''s Hospital, Changsha 410007, People''s Republic of China |
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| Abstract: | Patients with complex regional pain syndrome (CRPS) (n=20) were examined in order to evaluate cutaneous reactions to norepinephrine (NE) on both the affected and the unaffected limb in comparison to healthy controls. Sixteen female and four male patients suffering from very acute and therefore untreated CRPS with a mean duration of 5.5 weeks were included in this study. Two groups of healthy volunteers served as control groups: the first group (n=18) according to the same study protocol as CRPS patients, and the second group (n=10) after warming up one limb. Norepinephrine was iontophoresized (0.2 mA, 120 s) and vasoconstriction was recorded by laser-doppler flowmetry. Pain sensations were simultaneously rated on a visual analogue scale (VAS). Five patients underwent a second trial with higher intracutaneous NE concentrations in order to study possible dose-dependent effects of NE on pain sensation. After acclimatization, skin temperature was recorded by infra-red thermography. The NE-induced reduction of skin blood flow was significantly higher in the affected limb in the patient group (33.0 vs 11.2%, p<0.005). None of the patients reported pain or hyperalgesia. The skin temperature of CRPS patients was significantly higher in the affected limb (34.7 vs 32.5 degrees C, p<0.001). The first control group did not show any difference between left and right sides concerning NE-induced vasoconstriction or skin temperature. The second control group had an increased unilateral skin temperature after warming up (35.0 vs 34.3 degrees C, p<0.006) and demonstrated a significantly increased vasoconstriction on the warmer side (52.0 vs 20.2%, p<0.03) corresponding to findings in patients with acute CRPS. The present study proves that there are signs of decreased sympathetic activity in the affected limb in very acute CRPS. However, no indication was found for increased sensitivity of vascular alpha-receptors in the very acute stages of CRPS, and there was also no indication for a significant direct contribution of the sympathetic nervous system to pain in very acute CRPS. |
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