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Normal sympathetic nervous system response in reflex sympathetic dystrophy.
María de Lourdes Figuerola1, Gloria Levin, Alicia Bertotti
1CEDIE, CONICET, Ricardo Gutiérrez Children's Hospital, Buenos Aires, Argentina. mfiguerola@intramed.net.ar
Functional Neurology
|September 13, 2002
Summary
This study on reflex sympathetic dystrophy found that steroid treatment increases endogenous opioid levels, suggesting a therapeutic effect beyond anti-inflammation. It indicates adaptive supersensitivity rather than sympathetic hyperactivity in this condition.
Area of Science:
- Neuroscience
- Endocrinology
- Pain Management
Background:
- Reflex sympathetic dystrophy (RSD) involves complex neuro-inflammatory pathways.
- Sympathetic nervous system (SNS) activity and opioid system involvement in RSD are not fully understood.
Purpose of the Study:
- To evaluate SNS activity using sympathetic skin response (SSR).
- To investigate sympathetic and opioid outflow in RSD patients before and after corticoid treatment.
- To explore the mechanism of action for steroid therapy in RSD.
Main Methods:
- Six patients with features of RSD were studied.
- Sympathetic skin response (SSR) recordings were performed.
- Plasma catecholamines (CAs), their metabolites, and metenkephalin (ME) were measured before and after two weeks of steroid treatment.
Main Results:
- Basal SSR showed normal latencies and amplitudes in most patients, with one exhibiting disturbed morphology.
- Plasma ME concentrations significantly increased in both affected and non-affected limbs post-steroid treatment.
- Basal plasma ME, CA, and metabolite levels were similar between affected and non-affected limbs.
Conclusions:
- Findings suggest adaptive supersensitivity, not sympathetic hyperactivity, in RSD.
- Steroid treatment appears to stimulate the endogenous opioid system, complementing its anti-inflammatory effects.
- This dual action of steroids may contribute to their therapeutic efficacy in RSD.