Complex regional pain syndrome: intradermal injection of phenylephrine evokes pain and hyperalgesia in a subgroup of patients with upregulated α1-adrenoceptors on dermal nerves

The aim of this study was to determine whether upregulated cutaneous expression of α1-adrenoceptors (α1-AR) is a source of pain in patients with complex regional pain syndrome (CRPS). Immunohistochemistry was used to identify α1-AR on nerve fibres and other targets in the affected and contralateral skin of 90 patients, and in skin samples from 38 pain-free controls. The distribution of α1-AR was compared between patients and controls, and among subgroups of patients defined by CRPS duration, limb temperature asymmetry, and diagnostic subtype (CRPS I vs CRPS II). In addition, α1-AR expression was investigated in relation to pain and pinprick hyperalgesia evoked by intradermal injection of the α1-AR agonist phenylephrine. Expression of α1-AR on nerve bundles in the CRPS-affected limb was greater in patients who reported prolonged pain and pinprick hyperalgesia around the phenylephrine injection site than in patients with transient pain after the injection. In addition, α1-AR expression in nerve bundles was greater in patients with CRPS II than CRPS I, and was greater in acute than more long-standing CRPS. Although less clearly associated with the nociceptive effects of phenylephrine, α1-AR expression was greater on dermal nerve fibres in the painful than contralateral limb. Together, these findings are consistent with nociceptive involvement of cutaneous α1-AR in CRPS. This involvement may be greater in acute than chro...
Source: Pain - Category: Anesthesiology Tags: Research Paper Source Type: research

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Discussion: In this cohort, pediatric CRPS was most common in girls around the age of 12, usually in the lower extremity, and most experienced a favorable outcome. Further research is needed to better understand the prognosis and relapse rate of pediatric CRPS.
Source: The Clinical Journal of Pain - Category: Anesthesiology Tags: Original Articles Source Type: research
ConclusionThis study showed that calcitonin could be helpful analgesic agent in different painful situations. Calcitonin can be considered an eligible treatment for acute pains related to vertebral fractures and a feasible alternative for the treatment of the acute and chronic neuropathic pains where other medications might fail.ResumoJustificativa e objetivosA calcitonina é um hormônio polipeptídico que regula o metabolismo do cálcio no organismo. Por muitos anos a calcitonina tem sido usada para manter e melhorar a densidade mineral óssea e reduzir a incidência de fraturas. Muitos ...
Source: Brazilian Journal of Anesthesiology - Category: Anesthesiology Source Type: research
Complex regional pain syndrome (CRPS) is related to microcirculation impairment caused by tissue hypoxia and peripheral cytokine overproduction in the affected human limb and chronic post-ischemic pain (CPIP) ...
Source: Journal of Biomedical Science - Category: Biomedical Science Authors: Tags: Research Source Type: research
This study aimed to identify relationships between sensory function and pain in 3 common pain conditions (arthritis, Complex Regional Pain Syndrome [CRPS] and fibromyalgia syndrome [FMS]) and pain-free participants. Sensory abnormalities are known to be concomitant with some types of chronic pain but comparison across pain conditions using existing research is difficult due to methodological differences. Pragmatic Quantitative Sensory Testing (QST) methods were used. Materials and Methods: Hot and cold sensitivity, light touch threshold (LTT), two-point discrimination and pain threshold were assessed in 143 participants...
Source: The Clinical Journal of Pain - Category: Anesthesiology Tags: Original Articles Source Type: research
by Drew Rosielle (@drosielle)A Series of Observations on Opioids By a Palliative Doc Who Prescribes A Lot of Opioids But Also Has Questions.This is the 5th post in a series about opioids, with a focus on how my thinking about opioids has changed over the years. See also:Part 1 – Introduction, General Disclaimers, Hand-Wringing, and a Hand-Crafted Graph.Part 2 – We Were Wrong 20 years Ago, Our Current Response to the Opioid Crisis is Wrong, But We Should Still Be Helping Most of our Long-Term Patients Reduce Their Opioid DosesPart 3 – Opioids Have Ceiling Effects, High-Doses are Rarely Therapeutic, and Ano...
Source: Pallimed: A Hospice and Palliative Medicine Blog - Category: Palliative Care Tags: opioid pain rosielle The profession Source Type: blogs
Publication date: Available online 19 September 2019Source: Arthroscopy TechniquesAuthor(s): Adnan Kasapovic, Yorck Rommelspacher, Martin Gathen, Davide Cucchi, Rahel Bornemann, Robert Pflugmacher, Sebastian G. WalterAbstractSpinal cord stimulation (SCS) is an evidence-based, reversible but invasive procedure for the treatment of chronic pain syndromes: for example, in patients with failed-back-surgery syndrome or complex regional pain syndrome. A more recent, similar technique uses high-frequency stimulation for SCS and follows a different mechanism of action that does not result in paresthesia. This Technical Note and vi...
Source: Arthroscopy Techniques - Category: Surgery Source Type: research
AbstractPurpose of ReviewComplex regional pain syndrome (CRPS) is a painful and debilitating disorder involving dysfunction in multiple body systems. This review seeks to evaluate recent data and present treatment options for the practical management of this condition.Recent FindingsThe mechanism by which CRPS develops is multifactorial, affecting both the peripheral and central nervous systems, and nerve changes can be seen at a histologic level. Treatment should be initiated as early as possible, as the chronic disease is less responsive to intervention.SummaryCRPS is a clinical diagnosis; treatment is symptomatic and ai...
Source: Current Emergency and Hospital Medicine Reports - Category: Emergency Medicine Source Type: research
Discussion: Our findings indicate that the diagnostic validity of the current Budapest clinical criteria for PS-CRPS is low. Thus, the current Budapest criteria might not be appropriate for PS-CRPS diagnosis.
Source: The Clinical Journal of Pain - Category: Anesthesiology Tags: Original Articles Source Type: research
Complex regional pain syndrome (CRPS) type I and CRPS type II diminish quality of life and can lead to significant disability.15 Both conditions have varied and complex clinical features, with chronic debilitating pain being the primary symptom, usually involving the lower or upper extremities.16,24 The conditions are differentiated by the absence (CRPS-I) or presence (CRPS-II) of demonstrable nerve damage as an underlying etiology.
Source: The Journal of Pain - Category: Materials Science Authors: Source Type: research
ConclusionCertain conditions are prevalent in the same populations that are vaccinated with the HPV vaccine (peri-pubertal males and females). This association, however, is an insufficient proof of causality.
Source: Clinical Autonomic Research - Category: Research Source Type: research
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