title: Diurnal and nocturnal skin temperature regulation in chronic complex regional pain syndrome.
abstract: Skin temperature changes due to vasomotor disturbances are important features of complex regional pain syndrome (CRPS). Because this phenomenon has only been studied under controlled conditions, information on daily circadian variability is lacking. Also, studies in chronic CRPS patients with abnormal posturing, in which coldness of the affected extremity is more common, do not exist. We examined the response to external heating as well as circadian temperature changes over several days in the affected legs of 14 chronic CRPS patients with abnormal posturing and 17 controls. Skin temperatures were recorded hourly for 14 days using wireless sensors. Although the patients' affected extremities were significantly colder before external heating, the vasodilatory response was similar in the 2 groups. Additionally, median skin temperature differences between both legs and their variability was larger in patients than in controls during the day, but not during the night. These findings indicate that the mechanisms underlying impaired skin circulation in CRPS during daytime are reversible under certain circumstances. The large variation in skin temperature differences during the day questions the validity of using a single measurement in the diagnosis of CRPS, and our results indicate that only temperature differences >1.0 °C should be considered to reflect vasomotor disturbances.
  
  
  CONCLUSIONS
  This article shows that chronic CRPS patients have a normal vasodilatory response to external heating and that skin temperature differences between the affected and unaffected lower limbs, which were highly variable during daytime, disappeared during sleep. This indicates that part of the vasomotor regulation in these patients is still functional.
authors.affiliation: Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: j.c.m.schilder@lumc.nl.
authors.forename: Johanna C M
authors.initials: JC
authors.lastname: Schilder
authors.affiliation: Department of Experimental Anesthesiology, Erasmus Medical Center, University Medical Center, Rotterdam, The Netherlands.
authors.forename: Sjoerd P
authors.initials: SP
authors.lastname: Niehof
authors.affiliation: Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Johan
authors.initials: J
authors.lastname: Marinus
authors.affiliation: Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Jacobus J
authors.initials: JJ
authors.lastname: van Hilten
mesh_terms: D000328:Adult; D019540:Area Under Curve; D002908:Chronic Disease; D002940:Circadian Rhythm / Q000502:physiology*; D020918:Complex Regional Pain Syndromes / Q000175:diagnosis / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007866:Leg / Q000098:blood supply / Q000503:physiopathology*; D008297:Male; D017440:Photoperiod; D012372:ROC Curve; D012039:Regional Blood Flow / Q000502:physiology; D012680:Sensitivity and Specificity; D012867:Skin / Q000098:blood supply; D012881:Skin Temperature / Q000502:physiology*; D014664:Vasodilation / Q000502:physiology
keywords: Complex regional pain syndrome; skin temperature; thermoregulation; vasomotor disturbances