Sympathetic skin responses in reflex sympathetic dystrophy

Abstract

This study was performed to determine the utility of sympathetic skin response (SSR) in evaluating the sympathetic function and to follow up the effects of sympathetic blockade in reflex sympathetic dystrophy (RSD). Thirty patients having RSD with upper extremity involvement were randomly divided into two groups. Besides medical therapy and exercise, physical therapy agents were applied to both the groups. In addition to this treatment protocol, stellar ganglion blockade was done by diadynamic current in Group II. The normal sides of the patients were used for the control group. SSRs were measured in all the patients before and after the therapy. The amplitude was found to be increased and the latency was found to be decreased in the affected side in both the groups before the therapy. After the therapy, the amplitude was decreased and latency was increased in both the groups. But, the differences in amplitude (P = 0.001) and latency (P = 0.002) before and after the therapy were significantly higher in Group II. (Before the treatment, SSRs were significantly different between the normal and the affected sides in both the groups. The observed change in SSRs after the treatment was higher in Group II.) It was concluded that, SSR can be a useful and noninvasive method in diagnosing the sympathetic dysfunction in RSD and can be used for evaluating the response to sympathetic blockade and other treatment modalities.

Evaluation of Sympathetic Skin Response and F Wave in Fibromyalgia Syndrome Patients

“…Many studies have shown increased amplitude and decreased latency in hemiplegic patients and in reflex sympathetic dystrophy patients as a sign of sympathetic overactivity. [23,24] There are contradictory results regarding SSR latencies. Some studies have reported the intra-individual variations for amplitudes (2-48%) and latencies (2-22%).…”

Efficacy of Noninvasive Stellate Ganglion Blockade Performed Using Physical Agent Modalities in Patients with Sympathetic Hyperactivity-Associated Disorders: A Systematic Review and Meta-Analysis

“…The final sample consisted of nine randomized placebo- or active-controlled [40, 43–50] and four quasi-randomized [51–54] trials published between 1994 and 2014 with a total sample size of 440 patients.…”

“…Compared with the conventional nerve blockade technique, noninvasive SGB is free from potential complications such as infection, bleeding, potential nerve damage, and other adverse events that may be caused by an injective or a puncture injury following repeated applications [19–29]. Moreover, noninvasive SGB can be conveniently performed in clinical practice even in the absence of an anesthesiologist and is well tolerated by patients without any thermal injury or with few adverse effects [31, 39, 40, 43–56], regardless of the application modality.…”

“…Noninvasive SGB can provide clinically effective pain relief, improve peripheral vasomotor and sudomotor dysfunction and abnormal heart rate variability (HRV), and maintain homeostasis in patients with neuropathic pain syndromes such as CRPS [40, 41, 43, 44, 46, 53, 57], fibromyalgia [33], glossodynia [52], burning mouth syndrome [31, 36, 58], postherpetic neuralgia [49, 59, 60], trigeminal neuralgia [61], and thalamic pain [55] as well as in those with other disorders such as Bell’s palsy [50, 51, 60], musculoskeletal pain [38], postoperative sensory disturbance [62], Raynaud’s phenomenon [63], glaucoma [64], and sudden deafness [65]. In addition, noninvasive SGB can alleviate conditions associated with hypersympathetic tone [35, 45, 47, 64–68] and physiological changes associated with suppressed sympathetic activities in healthy adults [34, 37, 42, 56, 69–75].…”

Recurrent Postoperative CRPS I in Patients With Abnormal Preoperative Sympathetic Function

“…Quantitative sensory testing, the quantitative sudomotor axon reflex test, and the cold pressor test combined with thermographic imaging have been used for the assessment of sympathetic nervous system function. 29 Electroneurodiagnostic sudomotor testing, 30 the sympathetic skin response test, 31 and thermography alone have been used to assess sympathetic nervous system activity. 32 Clinical findings remain the gold standard for the diagnosis of CRPS I, 33 and the tests described above may serve as additional tools to establish the diagnosis in doubtful cases.…”