title: Systemic inflammatory mediators in post-traumatic complex regional pain syndrome (CRPS I) - longitudinal investigations and differences to control groups.
abstract: OBJECTIVE
  The Complex Regional Pain Syndrome I (CRPS I) is a disease that might affect an extremity after trauma or operation. The pathogenesis remains yet unclear. It has clinical signs of severe local inflammation as a result of an exaggerated inflammatory response but neurogenic dysregulation also contributes to it. Some studies investigated the role inflammatory mediators and cytokines; however, few longitudinal studies exist and control groups except healthy controls were not investigated yet.
  
  
  METHODS
  To get further insights into the role of systemic inflammatory mediators in CRPS I, we investigated a variety of pro-, anti-, or neuro-inflammatory mediators such as C-Reactive Protein (CRP), White Blood Cell Count (WBC), Interleukins 4, 6, 8, 10, 11, 12 (p70), Interferon gamma, Tumor-Necrosis-Factor alpha (TNF-a) and its soluble Receptors I/II, soluble Selectins (E,L,P), Substance-P (SP), and Calcitonin Gene-Related Peptide (CGRP) at different time points in venous blood from patients with acute (AC) and chronic (CC) CRPS I, patients with forearm fractures (FR), with neuralgia (NE), and from healthy volunteers (C).
  
  
  RESULTS
  No significant changes for serum parameters investigated in CRPS compared to control groups were found except for CC/C (CGRP p = 0.007), FR/C (CGRP p = 0.048) and AC/CC (IL-12 p = 0.02; TNFRI/II p = 0.01; SP p = 0.049). High interindividual variations were observed. No intra- or interindividual correlation of parameters with clinical course (e.g. chronification) or outcome was detectable.
  
  
  CONCLUSIONS
  Although clinically appearing as inflammation in acute stages, local rather than systemic inflammatory responses seem to be relevant in CRPS. Variable results from different studies might be explained by unpredictable intermittent release of mediators from local inflammatory processes into the blood combined with high interindividual variabilities. A clinically relevant difference to various control groups was not notable in this pilot study. Determination of systemic inflammatory parameters is not yet helpful in diagnostic and follow-up of CRPS I.
authors.affiliation: Berufsgenossenschaftliche Kliniken Bergmannsheil, Department of Surgery, Ruhr University, Bochum, Germany. christian.schinkel@ruhr-uni-bochum.de
authors.forename: Christian
authors.initials: C
authors.lastname: Schinkel
authors.forename: A
authors.initials: A
authors.lastname: Scherens
authors.forename: M
authors.initials: M
authors.lastname: Köller
authors.forename: G
authors.initials: G
authors.lastname: Roellecke
authors.forename: G
authors.initials: G
authors.lastname: Muhr
authors.forename: C
authors.initials: C
authors.lastname: Maier
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D016207:Cytokines / Q000097:blood; D005260:Female; D005543:Forearm Injuries / Q000097:blood*; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000097:blood*; D009479:Neuropeptides / Q000097:blood; D018121:Receptors, Cytokine / Q000097:blood; D012019:Reflex Sympathetic Dystrophy / Q000097:blood*; D019087:Selectins / Q000097:blood
chemical_list: D016207:Cytokines; D018836:Inflammation Mediators; D009479:Neuropeptides; D018121:Receptors, Cytokine; D019087:Selectins