TY - JOUR
T1 - Complex regional pain syndrome
T2 - a focus on the autonomic nervous system
AU - Knudsen, Lone
AU - Terkelsen, Astrid Juhl
AU - Drummond, Peter D.
AU - Birklein, Frank
PY - 2019/8
Y1 - 2019/8
N2 - Purpose: Although autonomic features are part of the diagnostic criteria for complex regional pain syndrome (CRPS), the role of the autonomic nervous system in CRPS pathophysiology has been downplayed in recent years. The purpose of this review is to redress this imbalance. Methods: We focus in this review on the contribution of the autonomic nervous system to CRPS pathophysiology. In particular, we discuss regional sympathetic and systemic autonomic disturbances in CRPS and the mechanisms which may underlie them, and consider links between these mechanisms, immune disturbances and pain. Results: The focused literature research revealed that immune reactions, alterations in receptor populations (e.g., upregulation of adrenoceptors and reduced cutaneous nerve fiber density) and central changes in autonomic drive seem to contribute to regional and systemic disturbances in sympathetic activity and to sympathetically maintained pain in CRPS. Conclusions: We conclude that alterations in the sympathetic nervous system contribute to CRPS pathology. Understanding these alterations may be an important step towards providing appropriate treatments for CRPS.
AB - Purpose: Although autonomic features are part of the diagnostic criteria for complex regional pain syndrome (CRPS), the role of the autonomic nervous system in CRPS pathophysiology has been downplayed in recent years. The purpose of this review is to redress this imbalance. Methods: We focus in this review on the contribution of the autonomic nervous system to CRPS pathophysiology. In particular, we discuss regional sympathetic and systemic autonomic disturbances in CRPS and the mechanisms which may underlie them, and consider links between these mechanisms, immune disturbances and pain. Results: The focused literature research revealed that immune reactions, alterations in receptor populations (e.g., upregulation of adrenoceptors and reduced cutaneous nerve fiber density) and central changes in autonomic drive seem to contribute to regional and systemic disturbances in sympathetic activity and to sympathetically maintained pain in CRPS. Conclusions: We conclude that alterations in the sympathetic nervous system contribute to CRPS pathology. Understanding these alterations may be an important step towards providing appropriate treatments for CRPS.
KW - Central disturbances in autonomic activity
KW - Complex regional pain syndrome
KW - Immune system
KW - Sympathetic nervous system
UR - http://www.scopus.com/inward/record.url?scp=85066107113&partnerID=8YFLogxK
U2 - 10.1007/s10286-019-00612-0
DO - 10.1007/s10286-019-00612-0
M3 - Review
C2 - 31104164
AN - SCOPUS:85066107113
SN - 0959-9851
VL - 29
SP - 457
EP - 467
JO - Clinical Autonomic Research
JF - Clinical Autonomic Research
IS - 4
ER -