Journal
EXPERIMENTAL NEUROLOGY
Volume 247, Issue -, Pages 456-465Publisher
ACADEMIC PRESS INC ELSEVIER SCIENCE
DOI: 10.1016/j.expneurol.2013.01.017
Keywords
Complex regional pain syndrome; Microdialysis; Noradrenaline; Skin; Whole-body cooling
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Funding
- Danish Council for Independent Research: Medical Sciences, Copenhagen, Denmark [271-07-0396]
- Grosserer L.F. Foghts Foundation, Copenhagen, Denmark
- King Christian the 10th Foundation, Copenhagen, Denmark
- Helga and Peter Kornings Foundation, Aarhus, Denmark
- Director Jacob Madsen and his wife Olga Madsen's foundation, Copenhagen, Denmark
- Foundation of Research Apparatus, Aarhus University Hospital, Denmark
- National Health and Medical Research Council of Australia (NHMRC)
- EFIC-Grunenthal-Grant (EGG)
- State Ministry for Science and Education of Schleswig-Holstein
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Complex regional pain syndrome (CRPS) is characterised by autonomic, sensory, and motor disturbances. The underlying mechanisms of the autonomic changes in CPRS are unknown. However, it has been postulated that sympathetic inhibition in the acute phase with locally reduced levels of noradrenaline is followed by an up-regulation of alpha-adrenoceptors in chronic CRPS leading to denervation supersensitivity to catecholamines. This exploratory study examined the effect of cutaneous sympathetic activation and inhibition on cutaneous noradrenaline release, vascular reactivity, and pain in CRPS patients and in healthy volunteers. Seven patients and nine controls completed whole-body cooling (sympathetic activation) and heating (sympathetic inhibition) induced by a whole-body thermal suit with simultaneous measurement of the skin temperature, skin blood flow, and release of dermal noradrenaline. CRPS pain and the perceived skin temperature were measured every 5 min during thermal exposure, while noradrenaline was determined from cutaneous microdialysate collected every 20 mm throughout the study period. Cooling induced peripheral sympathetic activation in patients and controls with significant increases in dermal noradrenaline, vasoconstriction, and reduction in skin temperature. The main findings were that the noradrenaline response did not differ between patients and controls or between the CRPS hand and the contralateral unaffected hand, suggesting that the evoked noradrenaline release from the cutaneous sympathetic postganglionic fibres is preserved in chronic CRPS patients. (C) 2013 Elsevier Inc. All rights reserved.
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