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Complex regional pain syndrome: a focus on the autonomic nervous system

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Abstract

Purpose

Although autonomic features are part of the diagnostic criteria for complex regional pain syndrome (CRPS), the role of the autonomic nervous system in CRPS pathophysiology has been downplayed in recent years. The purpose of this review is to redress this imbalance.

Methods

We focus in this review on the contribution of the autonomic nervous system to CRPS pathophysiology. In particular, we discuss regional sympathetic and systemic autonomic disturbances in CRPS and the mechanisms which may underlie them, and consider links between these mechanisms, immune disturbances and pain.

Results

The focused literature research revealed that immune reactions, alterations in receptor populations (e.g., upregulation of adrenoceptors and reduced cutaneous nerve fiber density) and central changes in autonomic drive seem to contribute to regional and systemic disturbances in sympathetic activity and to sympathetically maintained pain in CRPS.

Conclusions

We conclude that alterations in the sympathetic nervous system contribute to CRPS pathology. Understanding these alterations may be an important step towards providing appropriate treatments for CRPS.

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Authors and Affiliations

  1. The Danish National Rehabilitation Centre for Neuromuscular Diseases, Aarhus, Denmark

    Lone F. Knudsen

  2. Danish Pain Research Center, Department of Neurology, Aarhus University Hospital, Aarhus, Denmark

    Astrid J. Terkelsen

  3. College of Science, Health, Engineering and Education, Murdoch University, Perth, WA, Australia

    Peter D. Drummond

  4. Department of Neurology, University Medical Center of the Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany

    Frank Birklein

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  1. Lone F. Knudsen
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  2. Astrid J. Terkelsen
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  3. Peter D. Drummond
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  4. Frank Birklein
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Correspondence to Frank Birklein.

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Knudsen, L.F., Terkelsen, A.J., Drummond, P.D. et al. Complex regional pain syndrome: a focus on the autonomic nervous system. Clin Auton Res 29, 457–467 (2019). https://doi.org/10.1007/s10286-019-00612-0

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