Journal
PAIN MEDICINE
Volume 19, Issue 10, Pages 2021-2030Publisher
OXFORD UNIV PRESS
DOI: 10.1093/pm/pnx240
Keywords
Complex Regional Pain Syndrome; Small Fiber Neuropathy; Thermal Thresholds; Thermal Stimulation; Nerve Fiber Density
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Funding
- Danish Diabetes Academy
- Novo Nordisk foundation [1030379]
- National Health and Medical Research Council
- Reflex Sympathetic Dystrophy Syndrome Association of America
- Lundbeckfonden and Lippmann Fonden
- Novo Nordisk Fonden [NNF14OC0011633] Funding Source: researchfish
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Objective. Findings regarding small nerve fiber damage in complex regional pain syndrome type I (CRPS-I) are not uniform, and studies have not included a matched healthy control group. The aim was to assess intraepidermal nerve fiber density (IENFD) in relation to thermal sensitivity of the same skin areas in CRPS-I patients and a gender- and age-matched healthy control group. Methods. IENFD was investigated in skin biopsies from the CRPS-affected and contralateral limbs of eight CRPS-I patients and from an equivalent site in eight gender-and age-matched healthy controls (HCs). Thermal thresholds (cold/warm detection, cold-and heat-pain detection) were assessed on the affected limb, the matching contralateral limb, and on the equivalent limbs of HCs, and participants rated the intensity of cold/heat and pain to static thermal stimuli (5 degrees C and 40 degrees C). Results. IENFD was significantly lower in both the affected and contralateral limbs of CRPS-I patients than HCs, but IENFD did not differ between the affected and contralateral limbs of patients. The heat pain threshold was lower in the affected CRPS-I limb than in HCs, but all other thermal thresholds were similar in both groups. CRPS-I patients rated the cold stimulus as colder and more painful in the affected limb, and the warm stimulus as hotter, bilaterally, than the HCs. Conclusions. CRPS-I may be associated with bilateral small fiber damage, and perhaps small fiber neuropathy and bilateral disturbances in thermosensory perception. These disturbances could stem from a systemic response to injury or might increase the risk of developing CRPS-I after physical trauma.
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