Chronic pelvic pain as a form of complex regional pain syndrome. Role of autonomic nervous system in chronic pelvic pain

The possible effect or activity of the autonomic nervous system (ANS) in urogenital disorders is still controversial. Day by day, further studies that have proved the association between chronic urological situations like chronic pelvic pain, premature ejaculation, etc., and autonomic dysfunction have been published. Understanding the actual role of the autonomic nervous system on chronic pelvic disorders will be of interest soon.

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

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2018-100064 ◽

2019 ◽

Vol 44 (3) ◽

pp. 376-387 ◽

Cited By ~ 5

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.

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Prevalence of autonomic nervous system dysfunction in complex regional pain syndrome

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2020-101644 ◽

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.

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