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Sympathetic innervation and function in reflex sympathetic dystrophy.

D S Goldstein1, C Tack, S T Li

  • 1Clinical Neurocardiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892-1620, USA.

Annals of Neurology
|July 14, 2000
PubMed
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Patients with reflex sympathetic dystrophy experience pain independent of sympathetic nerve activity. This study found decreased limb perfusion but symmetrical sympathetic innervation, suggesting pain is not primarily driven by sympathetic outflow.

Area of Science:

  • Neuroscience
  • Pain Management
  • Medical Imaging

Background:

  • Reflex sympathetic dystrophy (RSD) causes severe, disproportionate pain.
  • The role of sympathetic nervous system in maintaining RSD pain is unclear.

Purpose of the Study:

  • To investigate sympathetic neurocirculatory function in RSD patients.
  • To determine the role of sympathetic nerve traffic in chronic RSD pain.

Main Methods:

  • Positron emission tomography (PET) with 13N-ammonia for perfusion.
  • PET with 6-[18F]fluorodopamine for sympathetic innervation.
  • Measurement of norepinephrine spillover and metabolites.
  • Ganglion blockade with trimethaphan.

Main Results:

Related Experiment Videos

  • Decreased limb perfusion on the affected side.
  • Symmetrical sympathetic innervation and norepinephrine synthesis.
  • Variable decrease in norepinephrine release and turnover in the affected limb.
  • Ganglion blockade provided pain relief in only 2 of 12 patients.

Conclusions:

  • Chronic RSD involves reduced limb perfusion and intact sympathetic innervation.
  • Pain in most RSD patients appears independent of sympathetic neurocirculatory outflows.
  • Findings suggest augmented vasoconstriction and possibly impaired sympathetic neurotransmission.