title: No recovery of cold complex regional pain syndrome after transdermal isosorbide dinitrate: a small controlled trial.
abstract: The microcirculation appears to be impaired in cold chronic complex regional pain syndrome (CRPS). This double-blind, placebo-controlled, randomized trial investigated the effect of the nitric oxide (NO) donor isosorbide dinitrate (ISDN) on the peripheral blood flow in patients with chronic CRPS. Twenty-four patients received 1% ISDN in Vaseline or a placebo ointment applied to the dorsum of the affected hand four times daily for 10 weeks. The patients participated in a physical therapy program to improve activity. The primary outcome measure was blood distribution in the affected extremity, which was determined by measuring the skin temperature using videothermography. We also measured NO and endothelin-1 concentrations in blister fluid, pain using the visual analog scale, and activity limitations using an upper limb activity monitor and the Disabilities of Arm Shoulder and Hand Questionnaire. ISDN failed to produce a significant improvement in temperature asymmetry in chronic cold CRPS patients, and it did not result in the expected reduction in pain and increase in activity compared with placebo either. There may be other central or peripheral factors contributing to the disturbed vasodynamics in cold chronic CRPS that are not influenced by NO substitution. This study does not show an improvement of the regional blood distribution by ISDN in the involved extremity of patients with cold-type CRPS.
authors.affiliation: Pain Treatment Centre, Erasmus Medical Center, Rotterdam, The Netherlands. j.groeneweg@erasmusmc.nl
authors.forename: J George
authors.initials: JG
authors.lastname: Groeneweg
authors.forename: Frank J P M
authors.initials: FJ
authors.lastname: Huygen
authors.forename: Sjoerd P
authors.initials: SP
authors.lastname: Niehof
authors.forename: Feikje
authors.initials: F
authors.lastname: Wesseldijk
authors.forename: Johannes B J
authors.initials: JB
authors.lastname: Bussmann
authors.forename: Fabienne C
authors.initials: FC
authors.lastname: Schasfoort
authors.forename: Dirk L
authors.initials: DL
authors.lastname: Stronks
authors.forename: Freek J
authors.initials: FJ
authors.lastname: Zijlstra
mesh_terms: D000279:Administration, Cutaneous; D000328:Adult; D003080:Cold Temperature; D020918:Complex Regional Pain Syndromes / Q000188:drug therapy* / Q000503:physiopathology; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007548:Isosorbide Dinitrate / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D026741:Physical Therapy Modalities; D012039:Regional Blood Flow / Q000187:drug effects / Q000502:physiology; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D014665:Vasodilator Agents; D007548:Isosorbide Dinitrate