Regulation of peripheral blood flow in complex regional pain syndrome: clinical implication for symptomatic relief and pain management.
BACKGROUND
During the chronic stage of Complex Regional Pain Syndrome (CRPS), impaired microcirculation is related to increased vasoconstriction, tissue hypoxia, and metabolic tissue acidosis in the affected limb. Several mechanisms may be responsible for the ischemia and pain in chronic cold CPRS.


CONCLUSIONS
The diminished blood flow may be caused by either sympathetic dysfunction, hypersensitivity to circulating catecholamines, or endothelial dysfunction. The pain may be of neuropathic, inflammatory, nociceptive, or functional nature, or of mixed origin.


CONCLUSIONS
The origin of the pain should be the basis of the symptomatic therapy. Since the difference in temperature between both hands fluctuates over time in cold CRPS, when in doubt, the clinician should prioritize the patient's report of a persistent cold extremity over clinical tests that show no difference. Future research should focus on developing easily applied methods for clinical use to differentiate between central and peripheral blood flow regulation disorders in individual patients.
Department of Anesthesiology, Subdivision Pain Treatment Centre, Erasmus MC, Rotterdam, the Netherlands. j.groeneweg@erasmusmc.nl
George
G
Groeneweg
Frank J P M
FJ
Huygen
Terence J
TJ
Coderre
Freek J
FJ
Zijlstra
D000818:Animals; D020918:Complex Regional Pain Syndromes / Q000503:physiopathology* / Q000628:therapy*; D019468:Disease Management; D006801:Humans; D010146:Pain / Q000503:physiopathology; D059408:Pain Management; D010147:Pain Measurement / Q000379:methods; D012039:Regional Blood Flow / Q000502:physiology*; D014661:Vasoconstriction / Q000502:physiology