Inflammatory mediators are altered in the acute phase of posttraumatic complex regional pain syndrome.
OBJECTIVE
Complex regional pain syndrome type 1 (CRPS 1) is a disorder that can affect an extremity after minor trauma or surgery. The pathogenesis of this syndrome is unclear. It has clinical signs of severe local inflammation as a result of an exaggerated inflammatory response, but neurogenic dysregulation also may contribute to it.


METHODS
For further insights into the pathogenesis of CRPS 1, the authors investigated inflammatory and neurogenic mediators-C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-8 (IL-8), soluble tumor necrosis factor receptor I/II (sTNFR I/II), sE-selectin, sL-selectin, sP-selectin, substance P, neuropeptide Y, and calcitonin gene-related peptide-in venous blood from both the healthy arm and the arm with acute CRPS I from 25 patients and from 30 healthy volunteers.


RESULTS
Levels of IL-8 and sTNFR I/II were significantly elevated in patients, whereas all soluble forms of selectins were significantly suppressed. There was no significant difference in white blood cell count (WBC), CRP, and IL-6. Substance P was significantly elevated in patients. The other two neuropeptides were unchanged. None of the parameters studied showed any differences between the CRPS I-affected arm and the normal arm.


CONCLUSIONS
Elevated IL-8 and sTNFR I/II levels indicate an association between CRPS I and an inflammatory process. Normal WBC, CRP, and IL-6 give evidence for localized inflammation. The hypothesis of neurogenic-induced inflammation mediated by neuropeptides is supported by elevated substance P levels.
Schinkel
Christian
C
Department of Surgery, Ruhr University, Bochum, Germany. christian.schinkel@ruhr-uni-bochum.de
Gaertner
Andreas
A
Zaspel
Johannes
J
Zedler
Siegfried
S
Faist
Eugen
E
Schuermann
Matthias
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D016207:Cytokines / Q000097:blood*; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood*; D016209:Interleukin-8 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D018124:Receptors, Tumor Necrosis Factor / Q000097:blood*; D012019:Reflex Sympathetic Dystrophy / Q000097:blood* / Q000209:etiology; D013373:Substance P / Q000097:blood*; D014947:Wounds and Injuries / Q000097:blood* / Q000150:complications
D015415:Biomarkers; D016207:Cytokines; D018836:Inflammation Mediators; D016209:Interleukin-8; D018124:Receptors, Tumor Necrosis Factor; D013373:Substance P