F Birklein

..This favors the possibility that CRPS patients share genetic similarities. The future search for genetic commonalities will help us to further unravel the "mystery" CRPS...

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..Therefore, sudometry is a useful tool for identifying patients with neutralizing ABAs and might be helpful for identifying reasons for BoNT/A treatment failure...

..The recognition of these mechanisms in individual CRPS patients is the prerequisite for a mechanism-oriented treatment...

..In conclusion our results suggest that cold pain tolerance may be at least partially inherited. Genetic or environmental factors might explain family clustering of cold pain sensitivity...

..Analysis by iodine-starch staining and QSART indicated that botulinum toxin type B suppresses sudomotor function effectively, in a concentration-dependent manner...

..In contrast, the analgesic effect of BoNT/A was very limited. Therefore we assume that other than neuropeptide mechanisms must be important for BoNT/A induced pain relief in clinical pain syndromes...

..These mechanism could be targeted specifically by drugs, or non-drug therapy, enabling more effective treatment of neuropathic pain...

..To test the contribution of neurogenic inflammation and neuropeptide release to the pathophysiology of complex regional pain syndrome (CRPS)...

..However, future research has to focus on exploring tools to recognise individual pain mechanisms in single patients. Thereby treatment will become more effective...

..Whether SNS activation is causally responsible for analgesia needs to be further investigated...

..This mechanism might underlie increased perception of noxious stimuli in patients with chronic pain or mood disorders...

..These findings may represent reasonable explanations for sympathetic hyperactivity, which occurs, for example, after hemispheric stroke...

..Our results show that minimal mechanical trauma is sufficient to induce significant TNF-alpha release in the skin. These results may be relevant to the treatment of posttraumatic pain disorders...

..We conclude that neurogenic inflammation is facilitated in CRPS. Our results suggest an increased releasability of neuropeptides in CRPS...

..As there is evidence for central pathophysiology which might be related to an altered opioidergic neurotransmission, we investigated the cerebral opioid receptor status under resting conditions in this patient population...

..The underlying mechanism might be impaired SP inactivation. Thus, our results further support the hypothesis that neurogenic inflammation plays an important role in the initiation of CRPS...

..First reports of attenuation of chronic pain by VNS indicate that the method might be an option for pain treatment in the future...

..Our results suggest that hyperalgesia to protons is present in patients with CRPS. Further, we could demonstrate that pain is not only restricted to the skin but is also generated in deep somatic tissue of the affected limb...

..Our findings suggest that NEP but not ACE is most important for CGRP degradation in human skin. This may be of particular importance for the understanding of pain disorders like migraine or complex regional pain syndrome...

..This might have clinical implications for the understanding of stress-related disorders, which are frequently accompanied by increased sympathetic activity as well as muscle tone...

..Despite the clinical similarity, additional changes in the peripheral or central nervous system are required for CRPS. In the light of our observations, it seems unlikely that CRPS is a simple exaggeration of post-traumatic inflammation...

..9 +/- 56.3 pg/mL) and controls (1,239.5 +/- 42.9 pg/mL). This study suggests involvement of TNF-alpha in mechanical hyperalgesia of CRPS...

..Our results indicate that, in healthy human skin, exogenously supplied alpha-adrenoreceptor agonists alone do not activate nociceptors sufficiently to induce axon reflex flare...

..31 vs. 0.21 microl/cm2/min, p<0.01), which might be attributed to an increased effectiveness of synchronized discharge in sympathetic fibers upon electrical stimulation...

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..This study was conducted to identify the brain regions associated with the affective-motivational component of tonic skin and muscle pain...

..Application of this standardized QST protocol in patients and human surrogate models will allow to infer underlying mechanisms from somatosensory phenotypes...

..These results suggest that the opioid receptor system is involved in the perception not only of pain but also of non-painful somatosensory stimuli...

..In contrast, in a healthy control group, no mislocalizations were found. Thus, our results further support the concept of pain-induced reorganization in the somatosensory system of CRPS patients...

..Therefore, our study may contribute to the current understanding of human pain and will promote future research on this field...

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..95 mmol/L; control subjects 1.74 mmol/L; p < 0.005). These results suggest enhanced anaerobic glycolysis, probably as a result of chronic tissue hypoxia...

..These results indicate a reliable memory for magnitude and duration of experimentally induced pain. The data further suggest that the consolidation of this memory is an important interim stage, and may take up to one day...

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

..In summary, the results of this study suggest that substantial adaptive changes within the central nervous system may contribute to motor symptoms in CRPS...

..To use magnetoencephalography to assess possible cortical reorganization in the primary somatosensory cortex (S1) of patients with complex regional pain syndrome (CRPS)...

..These findings resemble human 'cold' CRPS and suggest that ET 1 plays an important role in the pathogenesis of CRPS with nerve injury...

..Additional to non-enzymatic oxidation, DA increase probably reflects metabolic degradation of tyramine by non-neuronal pathways and therefore does not reflect local sympathetic innervation...

..Clinical studies of extracorporeal shock wave therapy (ESWT) provided conflicting results depending on the use of local anesthesia (LA)...

..The results might furthermore serve as a basis for future investigations of the connection between these cortical regions in the generation of stress-related diseases...

..The course of advanced diabetic neuropathy (DN) is largely unknown...

..Differential diagnostic evaluation should include CRPS in patients with persistent or progressive pain in the distal extremity after acetabular fracture. Early diagnosis and therapy contribute significantly to a successful outcome...

..In this way autonomic dysfunction e.g. after nerve lesions, in polyneuropathies, central lesions and certain pain disorders can be assessed. The sudomotor function tests complete the conventional electrophysiological methods...

..Therefore, nowadays therapy is still symptomatic. However, recent research led to a better understanding of the disease and to the beginning of a pathophysiologically orientated therapy...

..Finally, a schematic overview is given on the most common pathology, considering additional clinical signs and symptoms...

..Unraveling the detailed molecular mechanisms of how this interaction of SNS and pain is established in health and disease will help us to treat pain more successfully in the future...

..Neurology 49, 189-194]. Botulinum toxins block motor nerves as well as autonomic fibres [Rand, M.J., Whaler, B.C., 1965. Impairment of sympathetic transmission by botulinum toxin. Nature 206, 588-591]...

..Pathophysiology explaining pain in diabetic neuropathy (DN) is still unknown...

..To investigate cerebral activations underlying touch-evoked pain (dynamic-mechanical allodynia) in patients with neuropathic pain...

..Latencies and relative quantitative changes were closely correlated.Thus, cw Doppler is a valid alternative approach to laser Doppler flowmetry in healthy volunteers...

..The lack of protein extravasation indicates that an initiating trauma is necessary to induce neuropeptide up-regulation in primary afferents...

..83, P < 0.004). Intracutaneous electrical stimulation of C-fibers and scanning the flare with LDI is a sensitive tool to reliably detect small fiber impairment in diabetic SFN subjects and even increased neuropeptide release in NO-Ns...

..Secondary hyperhidrosis develops due to dysfunction of the central or peripheral nervous system...

..The common therapeutic aim is to maintain or restore normal function of the affected extremity. Beyond highlighting pathophysiologic concepts, this article describes recent therapeutic approaches...

..These data give evidence that the opioidergic system plays a role in the right hemispheric dominance of the vestibular cortical system in right-handers...

..Hypaesthesia (numbness) often encountered in clinical pain can be reproduced by experimental nociceptive stimulation. The time course of effects suggests a mechanism involving central plasticity...

..Organic cation transporters are not predominantly involved in the release of non-neuronal acetylcholine from the human skin...

..The aim of our study was to compare both tests at three different sites on the leg: foot, lower leg and thigh...

..01), but not the amount of sweat, was reduced by SP. ACh-induced skin blood flow was significantly increased by CGRP (P < 0.01), but unaltered by VIP and SP. The results indicate that CGRP amplifies axon reflex sweating in human skin...

..In conclusion, the in vivo release of ACh from the human skin appears to be regulated by external stimuli like sunlight and tactile stimuli...

..We describe differences, similarities, and reproducibility of these human pain models. These data might help to interpret past and future results of human pain studies using experimental pain...

..These findings support basal ganglia-prefrontal cortex models of WM whereby the basal ganglia play a gatekeeper role and allow only relevant information to enter prefrontal cortex where this information then is actively maintained in WM...

..These findings suggest that NEP and ACE do not have additive effects regarding neuropeptide degradation. In contrast, inhibition of ACE seems to augment CGRP catabolism...

..We suggest that these midcerebellar regions are indirectly involved in covert visual attention via oculomotor control mechanisms. Thus, specific cerebellar structures do influence attentional orienting, whereas others do not...

..In some neuropathies, however, there is increased axon reflex sweating, a response pattern that has never been observed for vasodilator flares...

..Treatment was generally well tolerated. This study indicates that gabapentin should be considered as a treatment option for the neuropathic pain of Fabry disease...

..To determine which brain regions might be involved in such visual phenomena, we used new brain imaging and lesion analysis tools that allow a direct comparison with control patients...

..Its clinical use should be further validated in prospective studies...

..001). Our results demonstrate that sustained alpha(2)-receptor stimulation induces vasodilation in a dose-dependent way, which is mediated by nitric oxide and prostaglandin mechanisms in human skin...

..To characterize reorganization of the primary somatosensory cortex (S1) during healing process in complex regional pain syndrome (CRPS)...

..The results of our study indicate a complex cortical network activated during pin-prick hyperalgesia in CRPS. The underlying neuronal matrix comprises areas not only involved in nociceptive, but also in cognitive and motor processing...

..Impairment of nutritive blood flow in the affected limb may be one factor contributing to atrophy and ulceration in chronic CRPS. The investigation of patients after surgery revealed that edema could not be the only reason for hypoxia...

..With the free kappa and lambda light chains, new markers to diagnose intrathecal synthesis are available...

..The results imply a difference in cortical pain processing between complex regional pain syndrome and other chronic neuropathic pain...

..Autoimmune etiology of CRPS is a new pathophysiological concept and may have severe impact on the treatment of this often chronic disease...

..To investigate whether vagus nerve stimulation (VNS) reduces pruritus in humans...

..s.) and AECA were not associated with parvovirus B19 seropositivity. Our findings suggest the involvement of parvovirus B19, but not autoantibody-mediated endothelial cell damage, in the pathogenesis of CRPS...

..Sensory testing showed a predominant loss of small fiber-related modalities in the patient group. The shift towards a pro-inflammatory cytokine profile in patients with CRPS suggests a potential pathogenic role in the generation of pain...

..A significant improvement of clinical variables was observed 24 h after infliximab treatment. Almost complete remission was reached within 8 wk, but sensory signs improved only after 6 mo. No adverse events were observed...

..Chronic painful disease is associated with pain on movement, which is presumed to be caused by noxious stimulation. We investigated whether motor imagery, in the absence of movement, increases symptoms in patients with chronic arm pain...

..The objective was to measure the normal range and topographic differences in HbO(2)% and rel. Hb conc. in tissue transfers before establishing this as a clinical method for monitoring perfusion and vitality...