title: Identification and Treatment of New Inflammatory Triggers for Complex Regional Pain Syndrome: Small Intestinal Bacterial Overgrowth and Obstructive Sleep Apnea.
abstract: Complex regional pain syndrome (CRPS) is evoked by conditions that may be associated with local and/or systemic inflammation. We present a case of long-standing CRPS in a patient with Ehlers-Danlos syndrome in which prolonged remission was attained by directing therapy toward concomitant small intestinal bacterial overgrowth, obstructive sleep apnea, and potential increased microglia activity. We theorize that cytokine production produced by small intestinal bacterial overgrowth and obstructive sleep apnea may act as stimuli for ongoing CRPS symptoms. CRPS may also benefit from the properties of low-dose naltrexone that blocks microglia Toll-like receptors and induces production of endorphins that regulate and reduce inflammation.
authors: From the Departments of *Anesthesia and †Internal Medicine, Washington University School of Medicine, St. Louis, Missouri; ‡Specialists in Gastroenterology, LLC, St. Louis, Missouri; §Department of Neurology, Vanderbilt University, Nashville, Tennessee; ‖Sleep and EEG Laboratory, Barnes Jewish West County, BJC Medical Group Center for Sleep Medicine, St. Louis, Missouri; Departments of ¶Psychology, #Anesthesiology, and **Rheumatology, Neuroinflammation, Pain and Fatigue Lab, University of Alabama, Birmingham, Alabama; ††Pain Management Center, Department of Anesthesia, Warren Alpert Medical School of Brown University, Providence, Rhode Island; and ‡‡Department of Anesthesia, Washington University School of Medicine, St. Louis, Missouri.
authors: Leonard B
authors: LB
authors: Weinstock
authors: Trisha L
authors: TL
authors: Myers
authors: Arthur S
authors: AS
authors: Walters
authors: Oscar A
authors: OA
authors: Schwartz
authors: Jarred W
authors: JW
authors: Younger
authors: Pradeep J
authors: PJ
authors: Chopra
authors: Anthony H
authors: AH
authors: Guarino
mesh_terms: D001765:Blind Loop Syndrome / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D002097:C-Reactive Protein / Q000378:metabolism; D020918:Complex Regional Pain Syndromes / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D008875:Middle Aged; D009271:Naltrexone / Q000627:therapeutic use; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement / Q000379:methods; D012294:Rifamycins / Q000627:therapeutic use; D000078262:Rifaximin; D020181:Sleep Apnea, Obstructive / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D018836:Inflammation Mediators; D012294:Rifamycins; D009271:Naltrexone; D002097:C-Reactive Protein; D000078262:Rifaximin