Impaired Oxygen Utilization in Skeletal Muscle of CRPS I Patients

Tan, Edward; Laak, H.J. ter; Hopman, Maria T. E.; Goor, Harry van; Goris, R.J.A.

doi:10.1016/j.jss.2010.08.043

Cited by 14 publications

(20 citation statements)

References 46 publications

(58 reference statements)

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“…It has also been observed that venous oxygen saturation is significantly increased in patients with chronic end-stage CRPS I, in correspondence with impaired oxygen diffusion related to mitochondrial dysfunction. 44 Prospective studies are needed to test our hypothesis comprehensively that oxidative stress contributes to CRPS development in humans. The key questions raised are whether mitochondrial dysfunction plays a primary role or is a consequence of the pathogenesis of CRPS.…”

Section: Interventional Therapiesmentioning

confidence: 99%

Update on the pathogenesis of complex regional pain syndrome: Role of oxidative stress

Taha

Blaise

2012

Can J Anesth/J Can Anesth

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Purpose Complex regional pain syndrome (CRPS) is a chronic inflammatory pain syndrome that affects one or more extremities of the body. It is characterized by burning pain and abnormalities in the sensory, motor, and autonomic nervous systems. This review illustrates how oxidative stress and nuclear factor erythroid 2-related factor (Nrf2) activation might contribute to understanding the etiopathogenesis of CRPS.Principal findings The precise cause of CRPS remains unclear, and current treatments are not effective in many patients. The mechanism underlying CRPS may differ across patients and even within a single patient over time. Inflammatory and neuronal mechanisms have been suggested as key contributors to CRPS. Recent evidence demonstrates that oxidative stress is associated with clinical symptoms in patients with CRPS-I. Oxidative stress plays a key role in CRPS pathogenesis. The Nrf2 factor is a master regulator of the transcription of multiple antioxidants, which protects against oxidative stress and inflammation by inducing antioxidant and detoxifying genes through binding with an antioxidant response element. It has antinociceptive effects against inflammatory pain in an animal model. Conclusion This review summarises the effect of oxidative stress and mitochondrial dysfunction in the pathogenesis of CRPS. It also addresses the question of whether there is a potential role for Nrf2 (activated by pharmacological or nutritional activators) in alleviating the clinical features of CRPS or preventing its progression. RésuméObjectif Le syndrome douloureux re´gional complexe (SDRC) est un syndrome de douleur inflammatoire chronique affectant un ou plusieurs membres; il est caracte´rise´par des douleurs de type bruˆlures et par des anomalies des syste`mes nerveux sensitif, moteur et autonome. La cause pre´cise du SDRC est encore inconnue et les traitements actuels sont inefficaces chez de nombreux patients. Le me´canisme sous-jacent du SDRC peut varier selon les patients et meˆme chez un meˆme patient au fil du temps. Des me´canismes inflammatoires et neuronaux ont e´te´propose´s comme jouant un rôle cle´dans la gene`se du SDRC. Les constatations tire´es des e´tudes re´centes montrent que le stress oxydatif est associe´aux symptômes cliniques du SDRC-1. L'objectif de cet article de synthe`se est d'illustrer comment le stress oxydatif et l'activation d'un facteur apparente´au facteur nucle´aire e´rythroı¨de-2 (Nrf2) pourraient contribuer a`la compre´hension de l'e´tiopathogene`se du SDRC. Constatations principales Le stress oxydatif joue un rôle essentiel dans la pathogene`se du SDRC. Le facteur apparente´au facteur nucle´aire e´rythroı¨de-2 est le maıˆtre re´gulateur de la transcription de multiples antioxydants prote´geant contre le stress oxydatif et l'inflammation par Author contributions Rame Taha and Gilbert Blaise have made substantial contributions to design and drafting the reviewand both of them have approved the final version to be published.

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Section: Interventional Therapiesmentioning

confidence: 99%

Update on the pathogenesis of complex regional pain syndrome: Role of oxidative stress

Taha

Blaise

2012

Can J Anesth/J Can Anesth

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“…We hypothesize that the increased blood flow and reduced oxygen extraction in both skin and muscle in 'warm' CRPS reflect failure to suppress TBF in the presence of malignant CTH, that is, 'luxury perfusion'. We further speculate that that the high oxygen extraction fraction [43] found in chronic 'cold' CRPS represents suppression of resting blood flow and blood flow responses by endothelial dysfunction [40] to maintain tissue oxygenation. Vasospasms, rather than being the source of ischemia CRPS and CRPS models [6,7], are thus predicted to compensate for downstream capillary dysfunction by attenuating the 'oxygen loss' that occur as blood is shunted through the capillaries at high flow rates.…”

Section: Capillary Dysfunction Hypothesis Of Crpsmentioning

confidence: 81%

“…Second, limb hyperperfusion has been demonstrated in mixed populations of 'warm' and 'cold' CRPS patients [34,41,43], although skin oxygenation is low in both groups [27]. Third, oxygen extraction fraction is dramatically reduced in CRPS [34,43], not elevated as one would expect in limb ischemia. Taken together, these observations suggest that impaired tissue oxygenation, rather than ischemia, is central to the etiopathogenesis of CRPS.…”

Section: Is Tissue Oxygenation Impaired In Crps?mentioning

confidence: 97%

“…First, capillary changes and edema pressure have not been shown to impair tissue blood flow [41], and skin hypoxia cannot be explained by edema alone [27]. Second, limb hyperperfusion has been demonstrated in mixed populations of 'warm' and 'cold' CRPS patients [34,41,43], although skin oxygenation is low in both groups [27]. Third, oxygen extraction fraction is dramatically reduced in CRPS [34,43], not elevated as one would expect in limb ischemia.…”

Section: Is Tissue Oxygenation Impaired In Crps?mentioning

confidence: 99%

“…In patients with 'warm' CRPS, Matsumura et al found reduced pH and high venous oxygen saturation (low oxygen extraction fraction) in the affected limb, and radiographic signs consistent with fast blood transits and AV shunting [34]. In chronic CRPS patients, Tan et al reported reduced venous oxygen saturation (high oxygen extraction fraction), profound thickening of capillary endothelium and basement membranes in muscle, and evidence of severe hypoxia [43]. In a mixed population of individuals with 'warm' and 'cold' CRPS, of whom >90% showed severe tissue edema, Schurmann et al found elevated blood flow in the affected arm, but no correlation between skin temperature and limb blood flow [41].…”

Section: Blood Flow Regulation and Oxygen Extraction Fraction In Crpsmentioning

confidence: 99%

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Impaired Oxygen Utilization in Skeletal Muscle of CRPS I Patients

Cited by 14 publications

References 46 publications

Update on the pathogenesis of complex regional pain syndrome: Role of oxidative stress

Update on the pathogenesis of complex regional pain syndrome: Role of oxidative stress

Capillary dysfunction and impaired tissue oxygenation in complex regional pain syndrome: A hypothesis

Remote ischaemic conditioning decreases blood flow and improves oxygen extraction in patients with early complex regional pain syndrome

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