Similar microvascular dysfunction in CRPS patients and animals with chronic post-ischemia pain

摘要

There is a growing body of evidence suggesting that CRPS may depend on micro-vascular dysfunction and tissue ischemia secondary to trauma. Skin capillary hemoglobin oxygenation (HbO2) is reduced and skin lactate is increased in CRPS limbs7,17. CRPS patients with cold limbs also have impaired nutritive skin blood flow18. Muscle tissue obtained amputated CRPS limbs were found to exhibit lipofuscin pigment, atrophic fibers, and severely thickened basal membrane layers of the capillaries2,35. Subcutaneous tissue in CRPS limbs exhibit increased density of perfused vessels, lower capillary filtration capacity and arteriovenous shunting21,32. Evidence suggests there is high arterial flow to the CRPS limb, but low oxygen consumption and high lactate flux11. There is also an impairment of high-energy phosphate metabolism and mitochondrial oxygen deficiency in muscle tissue of CRSP limbs14. All of these observations suggest that microvascular dysfunction and ischemia contribute to the induction and maintenance of CRPS.