Highlighting the Role of Biomarkers of Inflammation in the Diagnosis and Management of Complex Regional Pain Syndrome

Bharwani, Krishna D; Dik, Willem A.; Dirckx, Maaike; Huygen, Frank

doi:10.1007/s40291-019-00417-x

Cited by 32 publications

(49 citation statements)

References 83 publications

(147 reference statements)

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“…So far, objective diagnostic tests to diagnose CRPS are not available. This lack of objective tests hampers early diagnosis and timely initiation of appropriate therapies [ 17 ]. Based on the findings from our previous study in which sIL-2R levels were found to be significantly higher in CRPS patients than in healthy controls [ 8 ], we conducted this current study in which we investigated whether serum sIL-2R could be used to help establish the diagnosis CRPS in patients who were referred to a tertiary referral center with pain in a limb that was suspected to be caused by CRPS.…”

Section: Discussionmentioning

confidence: 99%

Serum Soluble Interleukin-2 Receptor Does Not Differentiate Complex Regional Pain Syndrome from Other Pain Conditions in a Tertiary Referral Setting

Bharwani

Dirckx

Stronks

et al. 2020

Mediators of Inflammation

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Previously, we showed that serum soluble interleukin-2 receptor (sIL-2R) levels, a marker for T-cell activation, were higher in complex regional pain syndrome (CRPS) patients than in healthy controls, suggesting pathogenic T-cell activation in CRPS. Additionally, sIL-2R levels discriminated well between CRPS and healthy controls with a high sensitivity (90%) and specificity (89.5%), suggesting a possible role for sIL-2R in the diagnosis of CRPS. In order to further validate this marker in the diagnostic workup of CRPS, we conducted this prospective cohort study in which we determined sIL-2R levels in patients that were referred to our tertiary referral center with a suspicion of CRPS in a limb, and subsequently compared sIL-2R levels between the patients that were diagnosed with CRPS (CRPS group) and those who were not (no CRPS group). A group of anonymous blood bank donors were used as a healthy control group. Furthermore, we explored the relationship between sIL-2R and CRPS disease severity using the CRPS severity score. Median sIL-2R levels of both the CRPS group (2809.0 pg/ml; Q3-Q1: 3913.0-1589.0) and no CRPS group (3654.0 pg/ml; Q3-Q1: 4429.0-2095.5) were significantly higher than that of the control group (1515.0 pg/ml; Q3-Q1: 1880.0-1150.0): CRPS vs. controls, p < .001 ; no CRPS vs. controls, p < 0.001 . Serum sIL-2R levels did not differ significantly between the CRPS and no CRPS group. A statistically significant negative correlation was observed between sIL-2R levels and the CRPS severity score ( r s = − 0.468 , p = 0.024 ). Our results confirm our previous findings of higher sIL-2R levels in CRPS patients than in healthy controls. We further showed that serum sIL-2R cannot differentiate between CRPS and other pain conditions of a limb in a tertiary referral setting. Interestingly, a negative correlation was found between sIL-2R and CRPS disease severity; this finding warrants further research into the relationship between sIL-2R and CRPS disease severity.

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Section: Discussionmentioning

confidence: 99%

Serum Soluble Interleukin-2 Receptor Does Not Differentiate Complex Regional Pain Syndrome from Other Pain Conditions in a Tertiary Referral Setting

Bharwani

Dirckx

Stronks

et al. 2020

Mediators of Inflammation

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“…CRPS remains a very difficult condition to treat despite medical advancement [ 11 , 12 ]. The diagnosis of CRPS is purely on clinical grounds as there are no specific diagnostic tests to confirm it [ 13 ]. Our patient demonstrated all the signs and symptoms in all categories of the Orlando diagnostic criteria for CRPS, the Budapest diagnostic criteria of IASP for CRPS and the Japanese CRPS 1 diagnostic criteria for clinical purposes [ 3 , 7 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

Truncal complex regional pain syndrome, myth or reality: Case report

Jokonya

Mungazi

Mduluza-Jokonya

et al. 2021

International Journal of Surgery Case Reports

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Introduction Complex regional pain syndrome (CRPS) is an under diagonised, chronic pain condition commonly described occurring in the extremities. Its occurrence in the trunk is rarely reported and is thought by some to be non existent. Case presentation We report an unusual case of trunkul CRPS post appendectomy which presented with debilitating pain and review relevant literature. Discussion and conclusion We recommend that subsequent descriptions and diagnostic criteria should include the trunk as a site of occurrence of CRPS and not just the extremities. This will help reduce under diagnosis of this important condition.

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“…Increased expression of adrenoreceptors on nociceptive fibers impacts the coupling of sympathetic activation and pain sensitivity in CRPS patients [6]. Validation of biomarkers involved in pathogenesis has the potential to improve diagnostic and remediation approaches by minimizing the subjectivity of current criteria [12].…”

Section: Discussionmentioning

confidence: 99%

Intramuscular Injection and Complex Regional Pain Syndrome Development After “Harmless” Procedures

Babineau

Alweis

2020

Cureus

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Complex regional pain syndrome (CRPS) is a puzzling pain condition, typically occurring after trauma. Incidents as innocent as IV injection and vaccine administration may serve as the impetus for an as yet poorly understood cascade of neuro-inflammation and somatosensory changes. A condition with variable degrees of psychological involvement, disability, and purely clinical diagnostic criteria, the diagnosis is often significantly delayed before effective treatment is begun, decreasing the likelihood of success. A 58-year-old female initially presented with painless peripheral edema of the left arm without erythema or loss of function, with later bilateral development of multiple domains of symptoms consistent with CRPS. Plausible initiation events in this instance were an IV insertion in the left cubital fossa and vaccination into the right deltoid. Delay in diagnosis is common but utilization of the Budapest Criteria for diagnosis and prompt treatment improves outcomes.

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Highlighting the Role of Biomarkers of Inflammation in the Diagnosis and Management of Complex Regional Pain Syndrome

Cited by 32 publications

References 83 publications

Serum Soluble Interleukin-2 Receptor Does Not Differentiate Complex Regional Pain Syndrome from Other Pain Conditions in a Tertiary Referral Setting

Serum Soluble Interleukin-2 Receptor Does Not Differentiate Complex Regional Pain Syndrome from Other Pain Conditions in a Tertiary Referral Setting

Truncal complex regional pain syndrome, myth or reality: Case report

Intramuscular Injection and Complex Regional Pain Syndrome Development After “Harmless” Procedures

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