Increased Venous Alpha-Adrenoceptor Responsiveness in Patients with Reflex Sympathetic Dystrophy

Arnold, Jennifer M.; Teasell, Robert; Macleod, A. P.; Brown, J. E.; Carruthers, S. George

doi:10.7326/0003-4819-118-8-199304150-00008

Cited by 149 publications

(68 citation statements)

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“…16 These cardiovascular abnormalities are attributed to autonomic instability caused by the combination of changes occurring within the spinal cord after SCI, including loss of descending autonomic control, plastic changes within spinal circuits and peripheral receptor hypersensitivity. 3,[17][18][19] It is important to acknowledge that severity of cardiovascular dysfunctions after SCI varies between individuals. For example, AD, even in quadriplegics, is not always severe: it may be characterized by only sweating or piloerection, or may even be asymptomatic.…”

Section: Discussionmentioning

confidence: 99%

Malignant autonomic dysreflexia in spinal cord injured men

Elliott

Krassioukov

2005

Spinal Cord

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Study design: Case reports.Objectives: To present a series of cases of protracted and severe autonomic dysreflexia (AD) in men with spinal cord injury (SCI), who sustained damage to their descending autonomic pathways. Settings: GF Strong Rehabilitation Centre, Sexual Health Rehabilitation Service, Vancouver Sperm Retrieval Clinic, Vancouver Coastal Health Authority, Vancouver, BC, Canada. Case report: AD is a serious complication of SCI triggered by a variety of noxious or nonnoxious stimuli below the level of injury. However, we are presenting three cases of protracted, severe AD we have termed 'malignant', owing to the tendency of progressive worsening not usually seen with AD once the alleviating factor is removed. In all three individuals, AD was initially triggered by ejaculation and continued for a period of more than 1 week. Systolic blood pressure in these individuals increased above 220 mmHg and required either acute hospitalization or hospital assessment. Two of the individuals with malignant AD had American Spinal Injury Association (ASIA) B and C high cervical injury, respectively, with the third having a high thoracic ASIA A injury. In addition to detailed history and neurological examination, electrophysiological assessment of sympathetic skin responses (SSR) demonstrated a significant disruption of the descending autonomic pathways in these individuals. Conclusions: Our findings suggest that in addition to the severe injury of the motor and sensory pathways (assessed by ASIA score), these individuals sustained severe injury to the supraspinal autonomic control. A combination of strong triggers such as ejaculation and bladder or colono-rectal irritation with total loss of descending autonomic control to the spinal sympathetic circuits could therefore contribute to the unusual manifestation of AD.

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Section: Discussionmentioning

confidence: 99%

Malignant autonomic dysreflexia in spinal cord injured men

Elliott

Krassioukov

2005

Spinal Cord

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“…Indeed, NE-induced pain in CRPS patients occurs at doses which produce vasoconstriction (Ali et al, 2000), and CRPS-I patients show a hyper-responsiveness of vascular responses to NE (Arnold et al, 1993;Birklein et al, 1997;Teasell & Arnold, 2004). Furthermore, it has been shown that there is enhanced vasoconstriction to exogenous NE following chronic constriction injury (CCI) of the sciatic nerve (an animal model of CRPS-II) (Kurvers et al, 1997;Kurvers et al, 1998).…”

Section: Introductionmentioning

confidence: 99%

Norepinephrine-induced nociception and vasoconstrictor hypersensitivity in rats with chronic post-ischemia pain

Xanthos

Bennett

Coderre

2008

Pain

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Painful hypersensitivity to norepinephrine (NE) has been reported in various chronic pain conditions that exhibit sympathetically-maintained pain (SMP), particularly CRPS-I and II. We investigated the parallels between the nociceptive and vascular sensitivity to NE in rats with chronic post-ischemia pain (CPIP), an animal model of CRPS-I induced by hind paw ischemiareperfusion injury. Intradermal injections of NE to the affected hind paw induced dose-dependent nociceptive behaviours in CPIP rats, but not sham animals. These behaviours were blocked by α 1 -and α 2 -adrenergic receptor antagonists, or a nitric oxide (NO) donor. Using laser Doppler flowmetry, we detected vasoconstrictor hypersensitivity in the ipsilateral CPIP hind paw, as compared to responses in sham animals or the contralateral hind paw. The vasoconstrictor hypersensitivity was also attenuated by adrenergic antagonists. Intradermal injection of [Arg 8 ] vasopressin (AVP) or the endothelial NO synthase (eNOS) inhibitor, L-NIO, to the affected paw also induced nociceptive behaviours in CPIP rats, but not sham rats. These results suggest CPIP rats display abnormal nociceptive responses to adrenergic and non-adrenergic vasoconstrictive agents. Furthermore, the nociceptive responses to NE in CPIP rats are paralleled by enhanced vasoconstrictive responses to NE, and are relieved by α-adrenergic antagonists or a vasodilator. We conclude that persistent tissue ischemia and hypersensitivity to sympathetic vasoconstriction are important mechanisms for pain in CPIP rats, and that either reducing vasoconstriction or enhancing vasodilatation may be effective methods of relieving the pain of CRPS-I.

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“…In fact, alpha-adrenoceptor density has been reported to be increased in skin biopsies of patients with CRPS. 74,75 Accordingly, the few microneurographic studies of small sympathetic nerve fascicles that have been performed so far in patients with chronic CRPS with cold aected limbs showed that the average skin sympathetic activity was not dierent between the aected and contralateral side. 76,77 Further important signs of sympathetic dysfunction in CRPS are unilateral sweating abnormalities.…”

Section: 65mentioning

confidence: 99%

Complex regional pain syndrome – diagnostic, mechanisms, CNS involvement and therapy

et al. 2003

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Complex regional pain syndromes (CRPS, formerly re¯ex sympathetic dystrophy and causalgia) are neuropathic pain conditions of one extremity developing inadequately after a trauma. The initiating trauma aects primarily the extremity, but can also be a central lesion (e.g., spinal cord injury, stroke). CRPS is clinically characterized by sensory, autonomic and motor disturbances. Pathophysiologically there is evidence for functional changes within the central nervous system and for involvement of peripheral in¯ammatory processes. The sympathetic nervous system plays a key role in maintaining pain and autonomic dysfunction in the aected extremity. After a primary central lesion, secondary peripheral changes in the paretic extremity are suggested to be important in initiating a CRPS. Though there is no diagnostic gold standard, careful clinical evaluation and additional test procedures should lead to an adequate diagnosis. An early diagnosis and an interdisciplinary approach are important for optimal and successful treatment.

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Increased Venous Alpha-Adrenoceptor Responsiveness in Patients with Reflex Sympathetic Dystrophy

Cited by 149 publications

References 0 publications

Malignant autonomic dysreflexia in spinal cord injured men

Malignant autonomic dysreflexia in spinal cord injured men

Norepinephrine-induced nociception and vasoconstrictor hypersensitivity in rats with chronic post-ischemia pain

Complex regional pain syndrome – diagnostic, mechanisms, CNS involvement and therapy

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