Regulation of peripheral blood flow in Complex Regional Pain Syndrome: clinical implication for symptomatic relief and pain management

Groeneweg, George; Huygen, Frank; Coderre, Terence J.; Zijlstra, Freek J.

doi:10.1186/1471-2474-10-116

Cited by 39 publications

(34 citation statements)

References 137 publications

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“…[3][4][5] Impaired microcirculation during the chronic stage of CRPS is related to increased vasoconstriction, tissue hypoxia, and metabolic acidosis of the tissues of the affected limb. 6 Epidemiological studies indicate that there are at least 50,000 new cases of CRPS I annually in the United States. 7,8 Complex regional pain syndrome can affect both sexes and persons of all ages (including children), although it is thought to be more common between the ages of 40 and 60 yr and may be more frequent in women.…”

Section: Résumémentioning

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: Résumémentioning

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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“…The acute phase is often followed by an intermediate phase in which skin blood flow and temperature alternate between warm and cold [15,30]. Then, some patients develop a cold or chronic phase of CRPS [15,30], in which both nutritional and thermoregulatory skin flow is reduced. This hypoperfusion has been interpreted as catecholamine hypersensitivity [15], but this hypothesis is not supported by recent results [45].…”

Section: Blood Flow Regulation and Oxygen Extraction Fraction In Crpsmentioning

confidence: 99%

“…This has been ascribed to functional inhibition of the sympathetic vasoconstriction of the dermal arterioles involved in thermoregulation [50,51], to ongoing inflammation, and to increased blood flow in underlying muscle and soft tissue (see below) [41]. The acute phase is often followed by an intermediate phase in which skin blood flow and temperature alternate between warm and cold [15,30]. Then, some patients develop a cold or chronic phase of CRPS [15,30], in which both nutritional and thermoregulatory skin flow is reduced.…”

Section: Blood Flow Regulation and Oxygen Extraction Fraction In Crpsmentioning

confidence: 99%

“…Then, some patients develop a cold or chronic phase of CRPS [15,30], in which both nutritional and thermoregulatory skin flow is reduced. This hypoperfusion has been interpreted as catecholamine hypersensitivity [15], but this hypothesis is not supported by recent results [45]. Instead, increasing evidence suggests that endothelium-dependent vasodilation is suppressed, a condition called endothelial dysfunction [9,40].…”

Section: Blood Flow Regulation and Oxygen Extraction Fraction In Crpsmentioning

confidence: 99%

“…Skin blood flow in CRPS can be subdivided according to three distinct phases [15,30]. In the acute or 'warm' phase of CRPS, the affected limb is usually warmer than the contralateral limb.…”

Section: Blood Flow Regulation and Oxygen Extraction Fraction In Crpsmentioning

confidence: 99%

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

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

Hegelmaier

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Regulation of peripheral blood flow in Complex Regional Pain Syndrome: clinical implication for symptomatic relief and pain management

Cited by 39 publications

References 137 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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