Increased endothelin-1 and diminished nitric oxide levels in blister fluids of patients with intermediate cold type complex regional pain syndrome type 1.
BACKGROUND
In complex regional pain syndrome type 1 (CRPS1) pro-inflammatory mediators and vascular changes play an important role in the sustained development and outcome of the disease. The aim of this study was to determine the involvement of vasoactive substances endothelin-1 (ET-1) and nitric oxide (NO) during early chronic CRPS1.


METHODS
Included were 29 patients with CRPS 1 who were diagnosed during the acute stage of their disease and observed during follow-up visits. Disease activity and impairment were determined and artificial suction blisters were made on the CRPS1 and the contralateral extremities for measurements of IL-6, TNF-alpha, ET-1 and nitrate/nitrite (NOx).


RESULTS
The levels of IL-6, TNF-alpha and ET-1 in blister fluid in the CRPS1 extremity versus the contralateral extremity were significantly increased and correlated with each other, whereas NOx levels were decreased.


CONCLUSIONS
The NOx/ET-1 ratio appears to be disturbed in the intermediate stage of CRPS, resulting in vasoconstriction and consequently in a diminished tissue blood distribution.
Groeneweg
J George
JG
Department of Anesthesiology, subdivision Pain Treatment Center, Erasmus MC Rotterdam, The Netherlands. j.groeneweg@erasmusmc.nl
Huygen
Frank J P M
FJ
Heijmans-Antonissen
Claudia
C
Niehof
Sjoerd
S
Zijlstra
Freek J
FJ
D000328:Adult; D015415:Biomarkers / Q000378:metabolism; D001768:Blister / Q000209:etiology / Q000378:metabolism* / Q000503:physiopathology; D003872:Dermatitis / Q000209:etiology / Q000378:metabolism* / Q000503:physiopathology; D015536:Down-Regulation / Q000502:physiology; D019332:Endothelin-1 / Q000032:analysis / Q000378:metabolism*; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000032:analysis / Q000378:metabolism; D015850:Interleukin-6 / Q000378:metabolism; D008297:Male; D008833:Microcirculation / Q000294:innervation / Q000503:physiopathology; D008875:Middle Aged; D009569:Nitric Oxide / Q000032:analysis / Q000378:metabolism*; D011237:Predictive Value of Tests; D012019:Reflex Sympathetic Dystrophy / Q000175:diagnosis* / Q000378:metabolism* / Q000503:physiopathology; D012039:Regional Blood Flow / Q000502:physiology; D012867:Skin / Q000098:blood supply / Q000294:innervation / Q000503:physiopathology; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism; D015854:Up-Regulation / Q000502:physiology
D015415:Biomarkers; D019332:Endothelin-1; D018836:Inflammation Mediators; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D009569:Nitric Oxide