Activation of Cutaneous Immune Responses in Complex Regional Pain Syndrome

F. Birklein; P.D. Drummond; W. Li; T. Schlereth; N. Albrecht; P.M. Finch; L.F. Dawson; J.D Clark; W.S. Kingery

doi:10.1016/j.jpain.2014.01.490

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Activation of Cutaneous Immune Responses in Complex Regional Pain Syndrome

Journal article

Open access

Peer reviewed

Activation of Cutaneous Immune Responses in Complex Regional Pain Syndrome

F. Birklein, P.D. Drummond, W. Li, T. Schlereth, N. Albrecht, P.M. Finch, L.F. Dawson, J.D Clark and W.S. Kingery

The Journal of Pain, Vol.15(5), pp.485-495

2014

DOI: https://doi.org/10.1016/j.jpain.2014.01.490

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Abstract

The pathogenesis of complex regional pain syndrome (CRPS) is unresolved, but tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL-6) are elevated in experimental skin blister fluid from CRPS-affected limbs, as is tryptase, a marker for mast cells. In the rat fracture model of CRPS, exaggerated sensory and sympathetic neural signaling stimulate keratinocyte and mast cell proliferation, causing the local production of high levels of inflammatory cytokines leading to pain behavior. The current investigation used CRPS patient skin biopsies to determine whether keratinocyte and mast cell proliferation occur in CRPS skin and to identify the cellular source of the up-regulated TNF-α, IL-6, and tryptase observed in CRPS experimental skin blister fluid. Skin biopsies were collected from the affected skin and the contralateral mirror site in 55 CRPS patients and the biopsy sections were immunostained for keratinocyte, cell proliferation, mast cell markers, TNF-α, and IL-6. In early CRPS, keratinocytes were activated in the affected skin, resulting in proliferation, epidermal thickening, and up-regulated TNF-α and IL-6 expression. In chronic CRPS, there was reduced keratinocyte proliferation, leading to epidermal thinning in the affected skin. Acute CRPS patients also had increased mast cell accumulation in the affected skin, but there was no increase in mast cell numbers in chronic CRPS.

Details

Title: Activation of Cutaneous Immune Responses in Complex Regional Pain Syndrome
Authors/Creators: F. Birklein (Author/Creator) - University Medical Center of the Johannes Gutenberg University Mainz
P.D. Drummond (Author/Creator) - Murdoch University
W. Li (Author/Creator) - VA Palo Alto Health Care System
T. Schlereth (Author/Creator) - University Medical Center of the Johannes Gutenberg University Mainz
N. Albrecht (Author/Creator) - University Medical Center of the Johannes Gutenberg University Mainz
P.M. Finch (Author/Creator) - Murdoch University
L.F. Dawson (Author/Creator) - Murdoch University
J.D Clark (Author/Creator) - VA Palo Alto Health Care System
W.S. Kingery (Author/Creator) - VA Palo Alto Health Care System
Publication Details: The Journal of Pain, Vol.15(5), pp.485-495
Publisher: Elsevier
Identifiers: 991005545348107891
Copyright: Elsevier
Murdoch Affiliation: School of Psychology and Exercise Science
Language: English
Resource Type: Journal article

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Collaboration types: Domestic collaboration; International collaboration
Citation topics: 1 Clinical & Life Sciences; 1.43 Anesthesiology; 1.43.1905 Complex Regional Pain Syndrome
Web Of Science research areas: Clinical Neurology; Neurosciences
ESI research areas: Neuroscience & Behavior