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Warm and cold complex regional pain syndromes

Differences beyond skin temperature?

From the Department of Neurology (T.E., B.D., H.H.K., C.G., M.F., F.B.), Johannes Gutenberg University Mainz; and Department of Physiology (W.M.), Ruprecht-Karls-Universität Heidelberg, Faculty of Medicine Mannheim, Germany.

Address correspondence and reprint requests to Dr. Tatiana Eberle, Department of Neurology, Johannes Gutenberg University, Langenbeckstrasse 1, 55101 Mainz, Germany eberlet{at}uni-mainz.de

Objective: To investigate clinical differences in warm and cold complex regional pain syndrome (CRPS) phenotypes.

Background: CRPS represents inhomogeneous chronic pain conditions; approximately 70% patients with CRPS have "warm" affected limbs and 30% have "cold" affected limbs.

Methods: We examined 50 patients with "cold" and "warm" CRPS (n = 25 in each group). Both groups were matched regarding age, sex, affected limb, duration of CRPS, and CRPS I and II to assure comparability. Detailed medical history and neurologic status were assessed. Moreover, quantitative sensory testing (QST) was performed on the affected ipsilateral and clinically unaffected contralateral limbs.

Results: Compared with patients who had warm CRPS, patients who had cold CRPS more often reported a history of serious life events (p < 0.05) and chronic pain disorders (p < 0.05). In cold CRPS, the incidence of CRPS-related dystonia was increased (p < 0.05), and cold-induced pain had a higher prevalence (p < 0.01). Furthermore, QST revealed a predominant sensory loss in patients with cold CRPS (p < 0.05). In contrast, patients with warm CRPS were characterized by mechanical hyperalgesia (p < 0.05) in the QST of affected limbs.

Conclusion: Our results indicate that warm and cold complex regional pain syndromes (CRPS) are associated with different clinical findings, beyond skin temperature changes. This might have implications for the understanding of CRPS pathophysiology.

Abbreviations: A = anxiety; ANOVA = analysis of variance; CDT = cold detection threshold; CPT = cold pain threshold; CRPS = chronic regional pain syndrome; D = depression; DMA = dynamic mechanical allodynia; HADS = Hospital Anxiety and Depression Scale; HPT = heat pain threshold; MDT = mechanical detection threshold; MPS = mechanical pain sensitivity; MPT = mechanical pain threshold; NRS = numeric rating scale; NS = not significant; PHS = paradoxical heat sensations; PPT = pressure pain threshold; TSL = thermal sensory limen; QST = quantitative sensory testing; VDT = vibration detection threshold; WDT = warm detection threshold; WUR = windup ratio.

Supplemental data at www.neurology.org

Supported by the German Research Foundation, DFG Bi 579/1 and Bi 579/4 to F.B., and by the Bundesministerium für Bildung und Forschung (DFNS; Grant: 01EM0506).

Disclosure: The authors report no disclosures.

Received July 2, 2008. Accepted in final form October 31, 2008.

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				Warm and Cold Complex Regional Pain Syndrome Journal Watch Neurology, March 24, 2009; 2009(324): 3 - 3. [Full Text]

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