Cytokines, particularly tumor necrosis factor-�, may play an important role in the mediation of mechanical hyperalgesia and autonomic signs in complex regional pain syndrome 1. We performed an IV regional block with low-dose administration of the tumor necrosis factor- � antibody, infliximab, in a patient with typical clinical signs of complex regional pain syndrome 1 (moderate pain, edema, hyperhidrosis, elevated skin temperature compared with the contralateral side). 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. (Anesth Analg 2007;105:1148–51) Matthias Karst, MD* Chronic complex regional pain syndrome (CRPS) is characterized by spontaneous pain that is often accompanied by somatosensory disturbances such as mechanical allodynia, and thermal or mechanical hyperalgesia
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