Complex regional pain syndrome: intradermal injection of phenylephrine evokes pain and hyperalgesia in a subgroup of patients with upregulated α1-adrenoceptors on dermal nerves

P.D. Drummond; N. Morellini; P.M. Finch; F. Birklein; L.F. Knudsen

doi:10.1097/j.pain.0000000000001335

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Complex regional pain syndrome: intradermal injection of phenylephrine evokes pain and hyperalgesia in a subgroup of patients with upregulated α1-adrenoceptors on dermal nerves

Journal article

Peer reviewed

Complex regional pain syndrome: intradermal injection of phenylephrine evokes pain and hyperalgesia in a subgroup of patients with upregulated α1-adrenoceptors on dermal nerves

P.D. Drummond, N. Morellini, P.M. Finch, F. Birklein and L.F. Knudsen

PAIN, Vol.159(11), pp.2296-2305

2018

DOI: https://doi.org/10.1097/j.pain.0000000000001335

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Abstract

The aim of this study was to determine whether upregulated cutaneous expression of α1-adrenoceptors (α1-AR) is a source of pain in patients with complex regional pain syndrome (CRPS). Immunohistochemistry was used to identify α1-AR on nerve fibres and other targets in the affected and contralateral skin of 90 patients, and in skin samples from 38 pain-free controls. The distribution of α1-AR was compared between patients and controls, and among subgroups of patients defined by CRPS duration, limb temperature asymmetry, and diagnostic subtype (CRPS I vs CRPS II). In addition, α1-AR expression was investigated in relation to pain and pinprick hyperalgesia evoked by intradermal injection of the α1-AR agonist phenylephrine. Expression of α1-AR on nerve bundles in the CRPS-affected limb was greater in patients who reported prolonged pain and pinprick hyperalgesia around the phenylephrine injection site than in patients with transient pain after the injection. In addition, α1-AR expression in nerve bundles was greater in patients with CRPS II than CRPS I, and was greater in acute than more long-standing CRPS. Although less clearly associated with the nociceptive effects of phenylephrine, α1-AR expression was greater on dermal nerve fibres in the painful than contralateral limb. Together, these findings are consistent with nociceptive involvement of cutaneous α1-AR in CRPS. This involvement may be greater in acute than chronic CRPS, and in CRPS II than CRPS I.

Details

Title: Complex regional pain syndrome: intradermal injection of phenylephrine evokes pain and hyperalgesia in a subgroup of patients with upregulated α1-adrenoceptors on dermal nerves
Authors/Creators: P.D. Drummond (Author/Creator) - Murdoch University
N. Morellini (Author/Creator) - Murdoch University
P.M. Finch (Author/Creator) - Murdoch University
F. Birklein (Author/Creator) - University Medical Center of the Johannes Gutenberg University Mainz
L.F. Knudsen (Author/Creator) - Danish Pain Research Center
Publication Details: PAIN, Vol.159(11), pp.2296-2305
Publisher: Wolters Kluwer N.V.
Identifiers: 991005544535207891
Copyright: © 2018 International Association for the Study of Pain
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: Anesthesiology; Clinical Neurology; Neurosciences
ESI research areas: Neuroscience & Behavior