Inflammatory mediators are altered in the acute phase of posttraumatic complex regional pain syndrome

Clin J Pain. Mar-Apr 2006;22(3):235-9. doi: 10.1097/01.ajp.0000169669.70523.f0.

Abstract

Objectives: Complex regional pain syndrome type 1 (CRPS 1) is a disorder that can affect an extremity after minor trauma or surgery. The pathogenesis of this syndrome is unclear. It has clinical signs of severe local inflammation as a result of an exaggerated inflammatory response, but neurogenic dysregulation also may contribute to it.

Methods: For further insights into the pathogenesis of CRPS 1, the authors investigated inflammatory and neurogenic mediators-C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-8 (IL-8), soluble tumor necrosis factor receptor I/II (sTNFR I/II), sE-selectin, sL-selectin, sP-selectin, substance P, neuropeptide Y, and calcitonin gene-related peptide-in venous blood from both the healthy arm and the arm with acute CRPS I from 25 patients and from 30 healthy volunteers.

Results: Levels of IL-8 and sTNFR I/II were significantly elevated in patients, whereas all soluble forms of selectins were significantly suppressed. There was no significant difference in white blood cell count (WBC), CRP, and IL-6. Substance P was significantly elevated in patients. The other two neuropeptides were unchanged. None of the parameters studied showed any differences between the CRPS I-affected arm and the normal arm.

Conclusions: Elevated IL-8 and sTNFR I/II levels indicate an association between CRPS I and an inflammatory process. Normal WBC, CRP, and IL-6 give evidence for localized inflammation. The hypothesis of neurogenic-induced inflammation mediated by neuropeptides is supported by elevated substance P levels.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Biomarkers / blood
  • Cytokines / blood*
  • Female
  • Humans
  • Inflammation Mediators / blood*
  • Interleukin-8 / blood*
  • Male
  • Middle Aged
  • Receptors, Tumor Necrosis Factor / blood*
  • Reflex Sympathetic Dystrophy / blood*
  • Reflex Sympathetic Dystrophy / etiology
  • Substance P / blood*
  • Wounds and Injuries / blood*
  • Wounds and Injuries / complications

Substances

  • Biomarkers
  • Cytokines
  • Inflammation Mediators
  • Interleukin-8
  • Receptors, Tumor Necrosis Factor
  • Substance P