Abnormal contralateral pain responses from an intradermal injection of phenylephrine in a subset of patients with complex regional pain syndrome (CRPS)
Abnormal contralateral pain responses from an intradermal injection of phenylephrine in a subset of patients with complex regional pain syndrome (CRPS)
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DOI：
10.1016/j.pain.2004.07.019
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发表时间：
2004-10-01
期刊：
影响因子：
7.4
通讯作者：
Bennett, GJ
中科院分区：
文献类型：
--
作者：
Mailis-Gagnon, A;Bennett, GJ
我们研究了皮内注射去氧肾上腺素（1 mg/0.1 ml）（一种 α-1-肾上腺素受体激动剂）对正常受试者以及交感独立性疼痛 (SIP) 和交感神经维持性疼痛 (SMP) 患者的影响。正常受试者和 SIP 患者仅经历短暂的刺痛，而交感神经切除和非交感神经切除的 SMP 患者亚组（分别为 6/9 和 4/8）经历了额外的异常疼痛反应，并伴有注射部位周围的机械异常性疼痛。皮内去氧肾上腺素后的正常和异常疼痛反应与皮内去甲肾上腺素观察到的相似。与文献中先前的报道相反，我们发现三名交感神经切除的 SMP 患者（然而，尽管交感神经阻滞后疼痛得到很好的缓解，但手术交感神经切除后疼痛未能缓解）在将去氧肾上腺素注射到有症状的交感神经切除肢体的对侧肢体时也经历了异常疼痛和机械性异常性疼痛。 SNIP 患者同侧症状肢体注射去甲肾上腺素或去氧肾上腺素引起的异常疼痛反应可能是由于损伤引起的伤害感受器对儿茶酚胺的反应所致。然而，对侧无症状肢体的这种反应表明另一个因素很可能是中枢起源的，并且可能与交感神经切除术及其治疗疼痛的成功或失败有关，也可能无关。 (C) 2004 年国际疼痛研究协会。由 Elsevier B.V. 出版。保留所有权利。
We have examined the effect of an intradermal injection of phenylephrine (1 mg/0.1 ml), an alpha-1-adrenoceptor agonist in normal subjects, and patients with sympathetically-independent (SIP) and sympathetically-maintained pain (SMP). Normal subjects and SIP patients experienced only brief stinging pain, while subsets of both sympathectomized and non-sympathectomized SMP patients (6/9 and 4/8, respectively) experienced an additional abnormal pain response accompanied by mechano-allodynia around the injection site. Both the normal and abnormal pain response after intradermal phenylephrine are similar to those observed with intradermal norepinephrine. In contrast to previous reports in the literature, we found that three sympathectomized SMP patients (who, however, had failed to experience pain relief after surgical sympathectomy despite very good relief after sympathetic blocks) also experienced abnormal pain and mechano-allodynia when phenylephrine was injected to a limb contralateral to the symptomatic sympathectomized extremity. Abnormal pain response evoked by norepinephrine or phenylephrine injection in the ipsilateral symptomatic limb of SNIP patients may be due to injury-evoked nociceptor responsiveness to catecholamines. However, such a response in contralateral asymptomatic limbs suggests an additional factor that more likely than not is of central origin and may or may not be related to sympathectomy and its success or failure to treat pain. (C) 2004 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.