Morphological macrovascular alterations in complex regional pain syndrome type I demonstrated by increased intima-media thickness

Nicola Derenthal,Elena Krumova,Christoph Maier,Alfried Germing,Tim Maecken

doi:10.1186/1471-2377-13-14

Nicola Derenthal, Elena Krumova + Show 3 more

Open Access

https://doi.org/10.1186/1471-2377-13-14

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Abstract

BackgroundAlthough intima-media thickness (IMT) was increased in several inflammatory diseases, studies investigating whether the inflammatory processes lead to macrovascular alteration with increased IMT in complex regional pain syndrome (CRPS) lack.MethodsUsing ultrasound (high-resolution B-mode), we compared bilaterally the IMT of the common carotid artery (CCA-IMT), the radial artery (RA-IMT), the brachial artery (BRA-IMT) and the quotient QRA/CCA, in CRPS type I (n=17), peripheral nerve injury (PNI, n=17) and pain-free controls (PFC, n=22, matched to CRPS by gender, age and traditional cardiovascular risk factors). Statistics: Spearman’s correlation, paired t-test, ANOVA (p<0.05).ResultsCompared to PFC, RA-IMT were significantly increased in both patient groups bilaterally (mean±standard deviation, CRPS affected side vs. PFC dominant side: 0.32±0.08 mm vs. 0.19±0.08 mm, p<0.001; PNI affected side vs. PFC dominant side: 0.27±0.09 mm vs. 0.19±0.08 mm, p< 0.05; CRPS non-affected side vs. PFC non-dominant side: 0.30±0.10 mm vs. 0.19±0.09 mm, p<0.001; PNI non-affected side vs. PFC non-dominant side: 0.25±0.10 mm vs. 0.19±0.09 mm, p<0.05) and QRA/CCA (CRPS affected-side vs. PFC dominant side: 0.49±0.12 vs. 0.30±0.11, p<0.001; PNI affected side vs. PFC dominant side: 0.41±0.10 vs. 0.30±0.11, p<0.05; CRPS non-affected side vs. PFC non-dominant side: 0.43±0.19 vs. 0.30±0.13, p<0.001; PNI non-affected side vs. PFC non-dominant side: 0.39±0.14 vs. 0.30±0.13, p<0.05), and BRA-IMT - only on the affected side in CRPS (CRPS: 0.42±0.06 mm vs. PFC: 0.35±0.08 mm; p<0.05). In CRPS, QRA/CCA was significantly higher on the affected side compared to PNI (p<0.05). However, only CRPS displayed within-group side-to-side differences with a significantly increased RA-IMT and QRA/CCA on the affected side (p<0.05). The CCA-IMT was comparable between all groups and sides.ConclusionsThe increased IMT of peripheral arteries in CRPS suggests ongoing inflammatory process. Until now, only endothelial dysfunction has been reported. The presented morphological macrovascular alterations might explain the treatment resistance of some CRPS patients.

Highlights

Intima-media thickness (IMT) was increased in several inflammatory diseases, studies investigating whether the inflammatory processes lead to macrovascular alteration with increased intima-media thickness (IMT) in complex regional pain syndrome (CRPS) lack
In CRPS, QRA/common carotid artery (CCA) was significantly higher on the affected side compared to Peripheral nerve injury (PNI) (p
The pain duration was less than 12 months in only one patient of the PNI group vs. ten of the CRPS patients (p

Summary

Introduction

Intima-media thickness (IMT) was increased in several inflammatory diseases, studies investigating whether the inflammatory processes lead to macrovascular alteration with increased IMT in complex regional pain syndrome (CRPS) lack. Locally increased levels of pro-inflammatory cytokines like tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL-6) were found in the affected limb of CRPS patients compared to the non-affected limb [3]. The systemic mRNA levels of some anti-inflammatory cytokines (interleukin-10) were decreased [4], whereas the systemic levels of pro-inflammatory neuropeptides including calcitonin gene-related peptide, bradikinin and substance P were increased [2]. In CRPS patients with allodynia the concentration of plasma neuropeptid Y was lower on the painful side [6]. Lower concentration of plasma noradrenalin was found in CRPS patients with widespread allodynia as well as in those with hyperhidrosis [7]

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