Highlights
- •We examined skin temperature features in affected and unaffected legs in CRPS.
- •Chronic CRPS patients showed a normal dilatory response to external heating.
- •Skin temperature differences between the 2 legs disappeared during the night.
- •Because of the large variability, a single measurement does not suffice for diagnosis.
Abstract
Skin temperature changes due to vasomotor disturbances are important features of complex
regional pain syndrome (CRPS). Because this phenomenon has only been studied under
controlled conditions, information on daily circadian variability is lacking. Also,
studies in chronic CRPS patients with abnormal posturing, in which coldness of the
affected extremity is more common, do not exist. We examined the response to external
heating as well as circadian temperature changes over several days in the affected
legs of 14 chronic CRPS patients with abnormal posturing and 17 controls. Skin temperatures
were recorded hourly for 14 days using wireless sensors. Although the patients' affected
extremities were significantly colder before external heating, the vasodilatory response
was similar in the 2 groups. Additionally, median skin temperature differences between
both legs and their variability was larger in patients than in controls during the
day, but not during the night. These findings indicate that the mechanisms underlying
impaired skin circulation in CRPS during daytime are reversible under certain circumstances.
The large variation in skin temperature differences during the day questions the validity
of using a single measurement in the diagnosis of CRPS, and our results indicate that
only temperature differences >1.0°C should be considered to reflect vasomotor disturbances.
Perspective
This article shows that chronic CRPS patients have a normal vasodilatory response
to external heating and that skin temperature differences between the affected and
unaffected lower limbs, which were highly variable during daytime, disappeared during
sleep. This indicates that part of the vasomotor regulation in these patients is still
functional.
Key words
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Article info
Publication history
Published online: December 03, 2014
Accepted:
November 22,
2014
Received in revised form:
October 29,
2014
Received:
August 11,
2014
Footnotes
This study is part of TREND (Trauma RElated Neuronal Dysfunction), a Dutch Consortium that integrates research on epidemiology, assessment technology, pharmacotherapeutics, biomarkers, and genetics on CRPS type 1. The consortium aims to develop concepts on disease mechanisms that occur in response to tissue injury, its assessment, and treatment. TREND is supported by a grant of the Dutch Ministry of Economic Affairs (BSIK03016). The authors declare that there are no conflicts of interest.
Identification
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© 2015 American Pain Society. Published by Elsevier Inc. All rights reserved.
