Abstract
Background and Objectives. Impaired microcirculation during the chronic stage of complex regional pain syndrome (CRPS) is related to increased vasoconstriction, tissue hypoxia, and metabolic tissue acidosis in the affected limb. Endothelial dysfunction is suggested to be the main cause of diminished blood flow. The aim of this study was to examine the distribution of endothelial nitric oxide synthase (eNOS) and endothelin-1(ET-1) relative to vascular density represented by the endothelial marker CD31-immunoreactivity in the skin tissue of patients with chronic CRPS. Methods. We performed immunohistochemical staining on sections of skin specimens obtained from the amputated limbs (one arm and one leg) of two patients with CRPS. Results. In comparison to proximal specimens we found an increased number of migrated endothelial cells as well as an increase of eNOS activity in distal dermis specimens. Conclusions. We found indications that endothelial dysfunction plays a role in chronic CRPS.
Highlights
Complex regional pain syndrome 1 (CRPS) is defined as “a syndrome in which the central nervous system representations of the somatosensory, somatomotor, and sympathetic systems are altered concomitantly with important peripheral changes such as edema, signs of inflammation, sympatheticafferent coupling, and trophic changes” [1]
Growing evidence [9] suggests that endothelial dysfunction is the main cause of diminished blood flow in chronic cold complex regional pain syndrome (CRPS)
Endothelial immunoreactivity was more prominent in distal than in proximal specimens
Summary
Complex regional pain syndrome 1 (CRPS) is defined as “a syndrome in which the central nervous system representations of the somatosensory, somatomotor, and sympathetic systems are altered concomitantly with important peripheral changes such as edema, signs of inflammation, sympatheticafferent coupling, and trophic changes” [1]. During the chronic stage of CRPS, increased vasoconstriction [2], tissue hypoxia [3], and metabolic tissue acidosis [4, 5] indicate that microcirculation is impaired, which affects the nutritive blood flow in superficial and deep tissues [6, 7]. Growing evidence [9] suggests that endothelial dysfunction is the main cause of diminished blood flow in chronic cold CRPS. The few papers on this topic describe clearly visible abnormalities of the entire microvascular system, including an increase in the number of capillaries [11, 12], endothelial swelling, and changes in the vessel laminal wall [13]. Impaired microcirculation during the chronic stage of complex regional pain syndrome (CRPS) is related to increased vasoconstriction, tissue hypoxia, and metabolic tissue acidosis in the affected limb. We found indications that endothelial dysfunction plays a role in chronic CRPS
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