Laser Doppler imaging: usefulness in chronic pain medicine

Sympathetic nervous system dysfunction is thought to be a factor in neuropathic pain conditions such as Complex Regional Pain Syndrome and in vascular conditions such as Raynaud's phenomenon. Laser Doppler fluxmetry has been used as a fast non-invasive method to quantify changes in skin capillary blood flow which reflect activation of sympathetically mediated vasoconstriction of the arterioles that supply the capillaries. Studies of dynamic change of skin capillary blood flow with sympathetic activation such as cold or inspiratory gasp have generally used single point laser Doppler systems where the probe is in contact with the skin. The results are a single line tracing representing the capillary flow at a single point on the skin a few millimeters in diameter. Laser Doppler imaging (moorLDI laser Doppler imager, Moor Instruments Ltd.) allows for non-contact recording of skin blood flow of an area as large as 50 centimeters square with a resolution of 256 by 256 pixels and 4 milliseconds per pixel. Most work with laser Doppler imaging has studied changes that occur between successive scans. We have found it useful to look at changes that occur during a scan. In this way we obtain data that is comparable to the time resolution of single point laser Doppler methods, but with the larger spatial information that is available with laser Doppler imaging. We present a small series of case reports in which inspiratory gasp during laser Doppler imaging was able to provide quick, useful and unequivocal clinical information regarding the status of regional bilateral skin capillary response to sympathetic activation. This may be useful for distinguishing sympathetically mediated from sympathetically independent pain. We believe the methods described may provide the basis for future quantitative studies similar to those that use single point laser Doppler methods.