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PubMed1997

Chronic neuropathic pain and its control by drugs.

The medical treatment and some currently known aspects of the aetiology of five neurogenic pain states are discussed. Neurogenic pain can be described as pain resulting from noninflammatory dysfunction of the peripheral or central nervous system without nociceptor stimulation or trauma. The enormity of the field has limited this review to post-herpetic neuralgia, complex regional pain syndromes, phantom pain, trigeminal neuralgia and diabetic neuralgia. Evidence suggests that many neurogenic pain states are not effectively controlled. This may be due in part to a lack of understanding of the aetiology of these conditions and to the lack of high quality studies evaluating existing treatments. A compact review of the literature is presented with some treatment options and possible future directions. Where appropriate surgical management and physical therapy have been discussed; however, a thorough appraisal of nondrug treatments was not the main priority of this review.

Adult↗
PubMed2001

[Reliability of TcPO(2) measurement in the upper limb].

INTRODUCTION: Several reports suggest the usefulness of transcutaneous oxygen tension (TcPO(2)) in assessing the shoulder hand syndrome in stroke patients. But the literature presents a number of conflicting views on the variation of TcPO(2) values in this case. We found no report demonstrating the reliability of TcPO(2) measurements in the upper limb. The aim of this study was to evaluate the reliability of TcPO(2) measurements and investigate whether TcPO(2) can be used to evaluate the shoulder hand syndrome after stroke. MATERIAL AND METHODS: The TcPO(2) values were obtained on two separate occasions at one-day interval on 18 normal volunteers. Basal TcPO(2), local vasomotor reflex and reaction to ischemia were assessed. RESULTS: Thirty-six upper limbs were tested. The reliability was bad. We found that measurements of TcPO(2) varied by an average of 7.89 +/- 7.6 mmHg for a coefficient of variation of 96%. CONCLUSION: The reliability of TcPO(2) measurement was not sufficient to recommend this method in this indication.

Blood Gas Monitoring, Transcutaneous↗
PubMed1986

[Doppler study in algodystrophy. Apropos of 10 cases].

Algodystrophy is usually attributed to disorders of microcirculation, and one may reasonably expect to demonstrate these by the Doppler method applied to arteries. Ten patients with algodystrophy stage I were explored and compared with 10 healthy controls and 10 patients with diseases likely to encourage the development of algodystrophy. Systolic, diastolic and mean blood flow velocities were recorded at different levels in the limbs involved and compared with velocities recorded at the same levels in the limbs of healthy subjects and in the clinically healthy limb of control patients. Algodystrophic patients actually had local circulatory abnormalities consisting of an increase in mean velocity with a diastolic component. A diastolic velocity superior to 3 cm/sec on the main arterial axis of the affected limb, or a difference of more than 5 cm/sec in mean velocity between the right and left sides provided an early diagnosis of algodystrophy with an 80 p. 100 sensitivity in this small series. Moreover, in 3 out of 10 cases Doppler velocimetry demonstrated abnormalities at varying levels of the contralateral limb.

Adult↗
PubMed1997

Psychological distress associated with algodystrophy.

We have carried out a prospective study of the level of psychological distress in patients with Colles' fractures. Those who developed algodystrophy did not show increased distress before the onset of the condition.

Aged↗
PubMed1997

Algodystrophy is an early complication of Colles' fracture. What are the implications?

One hundred patients who had sustained a Colles' fracture were observed for features of algodystrophy at 1, 5, 9 and 12 weeks following injury. The diagnosis of algodystrophy was possible as soon as 1 week after fracture. Early diagnosis has important clinical implications: the aetiological factors may become apparent and different treatment modalities be identified; furthermore, early treatment can be started, limiting the morbidity of the condition. It is proposed that patients with features of algodystrophy require physiotherapy after a Colles' fracture. Those without features may not.

Aged↗
PubMed2001

Despite clinical similarities there are significant differences between acute limb trauma and complex regional pain syndrome I (CRPS I).

In order to analyze the pathophysiology behind the clinical similarity acutely after limb trauma and in acute stages of complex regional pain syndrome (CRPS), 20 patients with external fixation after distal radius fracture (3.5 days after surgery) without signs of CRPS and 24 patients suffering from acute CRPS I (without nerve lesion; duration, 5 weeks) were investigated. Hyperalgesia to heat was tested by a feedback-controlled thermode, and to mechanical stimuli by an impact stimulator. The sympathetic nervous system was examined by measuring skin temperature (infra-red thermography), testing different sympathetic vasoconstrictor reflexes (laser-Doppler flowmetry) and quantitative sudometry after thermal load (thermoregulatory sweat test). We found hyperalgesia to heat after trauma (P<0.001), but not in CRPS, whereas mechanical hyperalgesia was present in both patient groups (trauma: P<0.001; CRPS: P<0.005). Skin temperature was significantly increased on the affected side in both patient groups (acute trauma: P<0.001; CRPS: P<0.005). However, sympathetic failure, as indicated by impairment of sympathetic vasoconstrictor reflexes (P<0.02) and hyperhidrosis (P<0.01), was found exclusively in CRPS patients. Our results indicate that pain and vasomotor disturbances may be generated by different mechanisms acutely after trauma and in acute CRPS. Despite the clinical similarity, additional changes in the peripheral or central nervous system are required for CRPS. In the light of our observations, it seems unlikely that CRPS is a simple exaggeration of post-traumatic inflammation.

Acute Disease↗
PubMed2002

Skin temperature side differences--a diagnostic tool for CRPS?

Complex regional pain syndrome type I (CRPS I) is a chronic painful disease of one extremity that may develop as a disproportionate consequence of a trauma affecting the limbs without overt nerve injury. It is clinically characterized by sensory, motor and autonomic symptoms including vascular abnormalities. Previously, we have reported that pathophysiological alterations of the ongoing sympathetic activity play a crucial role in vasomotor disturbances (Brain 124 (2001) 587). As a companion article, the aim of this study was to evaluate the diagnostic value of skin temperature side differences in consideration of the spontaneous sympathetic vasoconstrictor activity. Twenty-five patients with CRPS I were studied. Fifteen patients with painful limbs of other origin and 20 healthy individuals served as controls. Controlled thermoregulation was performed to change cutaneous sympathetic vasoconstrictor activity by the use of a thermal suit: skin sympathetic vasoconstrictor neurones were activated by whole-body cooling and nerve activity was abolished by whole-body warming. Skin temperature at the affected and unaffected limbs (infra-red thermometry) was measured under resting conditions and continuously monitored during controlled modulation of sympathetic activity. The results showed only minor skin temperature asymmetries between both limbs under resting conditions in most CRPS patients. However, during controlled thermoregulation temperature differences between both sides increased dynamically and were most prominent at a high to medium level of vasoconstrictor activity. In both control groups, there were only minor side differences in temperature both in rest and during thermoregulatory changes of sympathetic activity. When comparing the diagnostic value of skin temperature asymmetries in CRPS I, sensitivity was only 32% under resting conditions, but increased up to 76% during controlled alteration of sympathetic activity. Specificity was 100% at rest and 93% at controlled thermoregulation. We concluded that the degree of unilateral vascular disturbances in CRPS I depends critically on spontaneous sympathetic activity. Taking this into consideration, skin temperature differences in the distal limbs are capable of reliably distinguishing CRPS I from other extremity pain syndromes with high sensitivity and specificity.

Adult↗

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