Complex regional pain syndrome: A systemic disease of the autonomic nervous system?

2011 ◽  
Vol 163 (1-2) ◽  
pp. 132-133
Author(s):  
K.R. Chémali ◽  
L. Zhou ◽  
S. Ianacci ◽  
T.C. Chelimsky
Keyword(s):  
Nervous System ◽  
Autonomic Nervous System ◽  
Complex Regional Pain Syndrome ◽  
Systemic Disease ◽  
Pain Syndrome ◽  
Autonomic Nervous

Prevalence of autonomic nervous system dysfunction in complex regional pain syndrome

2021 ◽  
pp. rapm-2020-101644
Author(s):  
Ho-Jin Lee ◽  
Kang Hee Lee ◽  
Jee Youn Moon ◽  
Yong-Chul Kim
Keyword(s):  
Nervous System ◽  
Autonomic Nervous System ◽  
Complex Regional Pain Syndrome ◽  
Pain Syndrome ◽  
Sympathetic Skin Response ◽  
Binary Logistic Regression Analysis ◽  
Nerve Blocks ◽  
Autonomic Nervous System Dysfunction ◽  
Clinical Criteria ◽  
Autonomic Nervous

BackgroundWe aimed to investigate the prevalence of dysautonomia in complex regional pain syndrome (CRPS) via the combined autonomic nervous system (ANS) function tests, including the deep breathing test (DBT), orthostatic test (OST) and sympathetic skin response (SSR).MethodWe retrospectively examined 263 patients who underwent the combined ANS tests to evaluate CRPS between August 2013 and December 2016. Based on the Budapest clinical criteria, patients were stratified into confirmed-CRPS or suspected-CRPS groups. We performed binary logistic regression analysis using the inverse probability of treatment weighting to investigate the association between the tests and CRPS. Sensitivity and specificity were calculated to assess the diagnostic performance of the ANS tests for CRPS. We compared the results of these tests between the outcomes of sympathetic nerve blocks (SNBs).ResultsAmong 247 patients, finally included in this study, 199 patients (80.6%) were diagnosed with CRPS. Abnormal results of overall or each ANS function test showed significant associations with CRPS, excluding OST (overall abnormality: OR 2.44, 95% CI 1.51 to 3.95; p<0.001; DBT: OR 2.57, 95% CI 1.23 to 5.38, p=0.013; OST: OR 1.88, 95% CI 0.92 to 3.84, p=0.085; SSR: OR 2.71, 95% CI 1.38 to 5.32, p=0.004). However, their prevalence in CRPS and their sensitivities for CRPS were low (overall abnormality: 26.1%; each test: <15%). No significant association existed between dysautonomia and SNB outcomes.ConclusionDysautonomia, as evaluated using the combined ANS tests, were observed in a small portion of patients with CRPS. The diagnostic performances of these tests for CRPS were inadequate for clinical purposes.

Complex regional pain syndrome: a focus on the autonomic nervous system

2019 ◽  
Vol 29 (4) ◽  
pp. 457-467 ◽  
Author(s):  
Lone F. Knudsen ◽  
Astrid J. Terkelsen ◽  
Peter D. Drummond ◽  
Frank Birklein
Keyword(s):  
Nervous System ◽  
Autonomic Nervous System ◽  
Complex Regional Pain Syndrome ◽  
Pain Syndrome ◽  
Autonomic Nervous

CRPS: what’s in a name? Taxonomy, epidemiology, neurologic, immune and autoimmune considerations

2019 ◽  
Vol 44 (3) ◽  
pp. 376-387 ◽  
Author(s):  
Michael d‘A Stanton-Hicks
Keyword(s):  
Nervous System ◽  
Autonomic Nervous System ◽  
Complex Regional Pain Syndrome ◽  
Severity Score ◽  
Clinical Management ◽  
Pain Syndrome ◽  
Clinical Syndromes ◽  
Shed Light ◽  
Historical Origins

This account of the condition now termed complex regional pain syndrome (CRPS) spans approximately 462 years since a description embodying similar clinical features was described by Ambroise Paré in 1557. While reviewing its historical origins, the text describes why it became necessary to change the taxonomies of two clinical syndromes with similar pathophysiologies to one which acknowledges this aspect but does not introduce any mechanistic overtones. Discussed at length is the role of the sympathetic component of the autonomic nervous system (ANS) and why its dysfunction has both directly and indirectly influenced our understanding of the inflammatory aspects of CRPS. As the following article will show, our knowledge has expanded in an exponential fashion to include musculoskeletal, immune, autoimmune, central and peripheral nervous system and ANS dysfunction, all of which increase the complexity of its clinical management. A burgeoning literature is beginning to shed light on the mechanistic aspects of these syndromes and the increasing evidence of a genetic influence on such factors as autoimmunity, and its importance is also discussed at length. An important aspect that has been missing from the diagnostic criteria is a measure of disease severity. The recent validation of a CRPS Severity Score is also included.

scholarly journals Small Fiber Polyneuropathy May Be a Nexus Between Autonomic Nervous System Dysregulation and Pain in Interstitial Cystitis/Bladder Pain Syndrome

2022 ◽  
Vol 2 ◽  
Author(s):  
Dylan T. Wolff ◽  
Stephen J. Walker
Keyword(s):  
Nervous System ◽  
Autonomic Nervous System ◽  
Interstitial Cystitis ◽  
Sympathetic Innervation ◽  
Pain Syndrome ◽  
The United States ◽  
Bladder Pain Syndrome ◽  
Bladder Pain ◽  
Autonomic Nervous ◽  
Small Fiber

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a highly heterogeneous chronic and debilitating condition which effects millions of women and men in the United States. While primarily defined by urinary symptoms and pain perceived to be emanating from the bladder, IC/BPS patients frequently have co-occurring conditions and symptoms, many of which affect diverse body systems related to autonomic nervous system function. The impact on the autonomic system appears to stem from increased sympathetic innervation of the urinary tract, along with increased systemic sympathetic tone and decreased parasympathetic tone. Concurrent with these findings is evidence for destruction of peripheral sympathetic innervation to the sweat glands which may relate to small fiber polyneuropathy. It is unknown to what degree the wider alterations in autonomic function are also related to destruction/alterations in the small fibers carrying autonomic innervation. This potential nexus is an important point of investigation to better understand the unclarified pathophysiology of interstitial cystitis/bladder pain syndrome, the numerous co-occurring symptoms and syndromes, and for the identification of novel targeted therapeutic strategies.

Cardiovascular Reflexes and Autonomic Neuropathy

1978 ◽  
Vol 55 (4) ◽  
pp. 321-327 ◽  
Author(s):  
D. J. Ewing
Keyword(s):  
Nervous System ◽  
Autonomic Nervous System ◽  
Autonomic Neuropathy ◽  
Autonomic Dysfunction ◽  
Postural Hypotension ◽  
Systemic Disease ◽  
Cardiovascular Reflexes ◽  
Diabetic Patients ◽  
Pharmacological Agents ◽  
Autonomic Nervous

Clinical features of autonomic neuropathy include postural hypotension, sweating abnormalities, disturbance of body temperature regulation, gastric fullness and nausea, intermittent nocturnal diarrhoea, constipation, bladder problems and impotence. In diabetic patients, gustatory sweating and hypoglycaemic unawareness also sometimes occur (Johnson & Spalding, 1974). The onset of symptoms is usually insidious and permanent, but may occasionally be acute and reversible (Young, Asbury, Corbett & Adams, 1975). Autonomic dysfunction can arise from three main causes: first, those where the damage to the autonomic nervous system is isolated, as in primary postural hypotension (Bannister, Sever & Gross, 1977) and familial dysautonomia (Brunt & McKusick, 1970); secondly, those caused by toxic or pharmacological agents which interfere with autonomic reflexes; thirdly, those associated with systemic disease, of which diabetes mellitus is the most common. Other diseases which may cause autonomic dysfunction include amyloidosis, porphyria, tetanus, polyneuritis, tabes dorsalis, parkinsonism, chronic renal failure and alcoholism, and occasionally autonomic neuropathy has been associated with carcinoma of the bronchus or the pancreas (Johnson & Spalding, 1974). Although it is possible to localize lesions within the autonomic nervous system to afferent or efferent sympathetic or parasympathetic pathways (Johnson & Spalding, 1974; Moskowitz, 1977), many of the available tests are complex and invasive and often lack adequate control measurements (Young et al., 1975). Because of the patchy nature of autonomic neuropathy, current interest has centred around the search for bedside tests that are ‘global’, reproducible and non-invasive. This review summarizes the present state of knowledge of simple tests of cardiovascular reflex function in the clinical evaluation of autonomic neuropathy, particularly in diabetic subjects.

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