Vasodilative effect of isosorbide dinitrate ointment in complex regional pain syndrome type 1.
BACKGROUND
In complex regional pain syndrome type 1 (CRPS1) vascular changes occur from the initial, inflammatory event onto the trophic signs during chronicity of the disease, resulting in blood flow disturbances and marked temperature changes. Pharmacotherapeutic treatment is generally inadequate.


OBJECTIVE
To determine whether local application of the nitric oxide donor isosorbide dinitrate (ISDN) could cause vasodilation and thereby improve tissue blood distribution in the affected extremity.


METHODS
In a pilot study, 5 female patients with CRPS1 in one hand were treated with ISDN ointment 4 times daily during 10 weeks. As a primary objective videothermography was used to monitor changes in blood distribution in both the involved and contralateral extremities.


RESULTS
Patients treated with ISDN showed an increase of 4 degrees C to 6 degrees C in mean skin temperature of the cold CRPS1 hands, reaching values similar to that of the contralateral extremities within 2 to 4 weeks time, suggesting normalization of blood distribution. This was confirmed by an improvement in skin color. In 3 patients the Visual Analog Scale pain declined, whereas in the other 2 patients the Visual Analog Scale pain was unchanged over time.


CONCLUSIONS
In this pilot study, topical application of ISDN seems to be beneficial to improve symptoms for patients with cold type CRPS1, but further study is needed.
Groeneweg
George
G
Department of Anesthesiology, Subdivision Pain Treatment Centre, Erasmus MC, Rotterdam, The Netherlands. j.groeneweg@erasmusmc.nl
Niehof
Sjoerd
S
Wesseldijk
Feikje
F
Huygen
Frank J P M
FJ
Zijlstra
Freek J
FJ
D000287:Administration, Topical; D019332:Endothelin-1 / Q000378:metabolism; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D007548:Isosorbide Dinitrate / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000627:therapeutic use*; D008833:Microcirculation / Q000187:drug effects / Q000502:physiology; D008875:Middle Aged; D009119:Muscle Contraction / Q000502:physiology; D018482:Muscle, Skeletal / Q000502:physiology; D009569:Nitric Oxide / Q000378:metabolism; D009824:Ointments; D010147:Pain Measurement; D010865:Pilot Projects; D012019:Reflex Sympathetic Dystrophy / Q000188:drug therapy* / Q000503:physiopathology; D012881:Skin Temperature; D013817:Thermography; D014665:Vasodilator Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000627:therapeutic use*
D019332:Endothelin-1; D009824:Ointments; D014665:Vasodilator Agents; D009569:Nitric Oxide; D007548:Isosorbide Dinitrate