• J George Groeneweg, Frank J P M Huygen, Claudia Heijmans-Antonissen, Sjoerd Niehof, and Freek J Zijlstra.
• Department of Anesthesiology, subdivision Pain Treatment Center, Erasmus MC Rotterdam, The Netherlands. j.groeneweg@erasmusmc.nl
• Bmc Musculoskel Dis. 2006 Nov 30; 7: 91.

BackgroundIn complex regional pain syndrome type 1 (CRPS1) pro-inflammatory mediators and vascular changes play an important role in the sustained development and outcome of the disease. The aim of this study was to determine the involvement of vasoactive substances endothelin-1 (ET-1) and nitric oxide (NO) during early chronic CRPS1.MethodsIncluded were 29 patients with CRPS 1 who were diagnosed during the acute stage of their disease and observed during follow-up visits. Disease activity and impairment were determined and artificial suction blisters were made on the CRPS1 and the contralateral extremities for measurements of IL-6, TNF-alpha, ET-1 and nitrate/nitrite (NOx).ResultsThe levels of IL-6, TNF-alpha and ET-1 in blister fluid in the CRPS1 extremity versus the contralateral extremity were significantly increased and correlated with each other, whereas NOx levels were decreased.ConclusionThe NOx/ET-1 ratio appears to be disturbed in the intermediate stage of CRPS, resulting in vasoconstriction and consequently in a diminished tissue blood distribution.

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