Six years follow-up of the levels of TNF-α and IL-6 in patients with complex regional pain syndrome type 1

In an earlier study, levels of the proinflammatory cytokines TNF-α and IL-6 are higher in blisters fluid from the complex regional pain syndrome type 1 (CRPS1) side obtained at 6 and 30 months (median) after the initial event. The aim of this follow-up study is to determine the involvement of these cytokines in long lasting CRPS1. Twelve CRPS1 patients, with median disease duration of 72 months, participated. The levels of TNF-α and IL-6 were measured in blister fluid; disease activity was reevaluated by measuring pain and differences in temperature, volume, and mobility between both extremities. Differences in levels of IL-6 and TNF-α and mobility between both sides were significantly decreased. Pain and differences in temperature and volume were not significantly altered. No correlation was found between the cytokines and the disease characteristics. These results indicate that IL-6 and TNF-α are only partially responsible for the signs and symptoms of CRPS1.</p

Six Years Follow-up of the Levels of TNF-α and IL-6 in Patients with Complex Regional Pain Syndrome Type 1

In an earlier study, levels of the proinflammatory cytokines TNF-α and IL-6 are higher in blisters fluid from the complex regional pain syndrome type 1 (CRPS1) side obtained at 6 and 30 months (median) after the initial event. The aim of this follow-up study is to determine the involvement of these cytokines in long lasting CRPS1. Twelve CRPS1 patients, with median disease duration of 72 months, participated. The levels of TNF-α and IL-6 were measured in blister fluid; disease activity was reevaluated by measuring pain and differences in temperature, volume, and mobility between both extremities. Differences in levels of IL-6 and TNF-α and mobility between both sides were significantly decreased. Pain and differences in temperature and volume were not significantly altered. No correlation was found between the cytokines and the disease characteristics. These results indicate that IL-6 and TNF-α are only partially responsible for the signs and symptoms of CRPS1

Effect of tadalafil on blood flow, pain, and function in chronic cold Complex Regional Pain Syndrome: a randomized controlled trial

Background. This double-blind, randomized, controlled trial investigated the effect of the phosphodiesterase-5 inhibitor tadalafil on the microcirculation in patients with cold Complex Regional Pain Syndrome (CRPS) in one lower extremity. Methods. Twenty-four patients received 20 mg tadalafil or placebo daily for 12 weeks. The patients also participated in a physical therapy program. The primary outcome measure was temperature difference between the CRPS side and the contralateral side, determined by measuring the skin temperature with videothermography. Secondary outcomes were: pain measured on a Visual Analogue Scale, muscle force measured with a MicroFet 2 dynamometer, and level of activity measured with an Activity Monitor (AM) and walking tests. Results. At the end of the study period, the temperature asymmetry was not significantly reduced in the tadalafil group compared with the placebo group, but there was a significant and clinically relevant reduction of pain in the tadalafil group. Muscle force improved in both treatment groups and the AM revealed small, non-significant improvements in time spent standing, walking, and the number of short walking periods. Conclusion. Tadalafil may be a promising new treatment for patients that have chronic cold CRPS due to endothelial dysfunction, and deserves further investigation. Trial Registration. The registration number in the Dutch Trial Register is ISRCTN60226869

Thermography as a method of acquiring competences in Physiology. Application case for hand blood flow control

5 p.The present work proposes a methodological structure as part of the learning of the circulatory system. For this, the application of thermal stress is used, by immersing the hands in cold water to visualize the reperfusion of the hands. Learning, based on the visualization and analysis of thermographic images, allows the acquisition of specific competences at the university level. In graduate studies such as physiotherapy and nursing, the use of virtual tools and materials that allow the acquisition of skills and technical knowledge is essential for the job performance of future professionals. The application of this methodology is proposed in practical sessions of subjects in the area of knowledge of Physiology, to demonstrate and facilitate the understanding of the circulatory system. This approach is framed within the discipline of virtual laboratories since the virtual materials generated can be used for the acquisition of skills and practical competencies, as well as for the evaluation of competencies in e-learning courses. In this way, by recording a pedagogical video that shows a short practice, 5 minutes long, it is possible to establish the necessary knowledge bases to expand them later. This material is easily implementable in any learning management system.S

Thermography imaging during static and controlled thermoregulation in complex regional pain syndrome type 1: diagnostic value and involvement of the central sympathetic system

BACKGROUND: Complex Regional Pain Syndrome type 1 (CRPS1) is a clinical diagnosis based on criteria describing symptoms of the disease. The main aim of the present study was to compare the sensitivity and specificity of calculation methods used to assess thermographic images (infrared imaging) obtained during temperature provocation. The secondary objective was to obtain information about the involvement of the sympathetic system in CRPS1. METHODS: We studied 12 patients in whom CRPS1 was diagnosed according to the criteria of Bruehl. High and low whole body cooling and warming induced and reduced sympathetic vasoconstrictor activity. The degree of vasoconstrictor activity in both hands was monitored using a videothermograph. The sensitivity and specificity of the calculation methods used to assess the thermographic images were calculated. RESULTS: The temperature difference between the hands in the CRPS patients increases significantly when the sympathetic system is provoked. At both the maximum and minimum vasoconstriction no significant differences were found in fingertip temperatures between both hands. CONCLUSION: The majority of CRPS1 patients do not show maximal obtainable temperature differences between the involved and contralateral extremity at room temperature (static measurement). During cold and warm temperature challenges this temperature difference increases significantly. As a result a higher sensitivity and specificity could be achieved in the diagnosis of CRPS1. These findings suggest that the sympathetic efferent system is involved in CRPS1

Pulse transit time as a proxy for vasoconstriction in younger and older adults

Objectives: Changes of vasoconstriction may be measured non-invasively using pulse transit time. This study assessed the sensitivity, test-retest reliability and validity of pulse transit time during vasoconstriction provocation and active standing, and the predictive value of pulse transit time for blood pressure drop.Methods: Fifty-five younger (age &lt; 65 years) and 31 older adults (age &gt; 70 years) underwent electrocardiography, wrist and finger photoplethysmography and continuous blood pressure and total peripheral resistance measurements during vasoconstriction provocation using a cold pressor test (21 younger adults), or active stand tests (all other participants). Pulse transit time was defined as the time lag between the electrocardiography R-peak and the peak in the photoplethysmography first derivative; sensitivity as a significant decrease relative to baseline; test-retest reliability as the intra class correlation between different repeats of the same test; validity as the association between total peripheral resistance and pulse transit time; predictive value as the association between supine resting pulse transit time and mean arterial pressure drop during active standing. Results: Finger pulse transit time was sensitive and reliable (ICC 0.2-0.8) during vasoconstriction provocation, but wrist pulse transit time was poorly reliable (ICC 0 – 0.5); only finger pulse transit time was sensitive to and reliable (ICC 0.4 – 0.8) during active standing in both younger and older adults. Finger pulse transit time was not associated with total peripheral resistance. Supine resting pulse transit time had predictive value for blood pressure drop during active standing in older adults (β -0.16; p 0.025). Conclusions: Pulse transit time was sensitive to and reliable during vasoconstriction provocation and active standing, but did not significantly differ between younger and older adults. Pulse transit time could not be demonstrated to particularly reflect vasoconstriction, but it had predictive value for blood pressure drop during active standing

Pulse transit time as a proxy for vasoconstriction in younger and older adults

Item does not contain fulltextObjectives: Changes of vasoconstriction may be measured non-invasively using pulse transit time. This study assessed the sensitivity, test-retest reliability and validity of pulse transit time during vasoconstriction provocation and active standing, and the predictive value of pulse transit time for blood pressure drop.Methods: Fifty-five younger (age &lt; 65 years) and 31 older adults (age &gt; 70 years) underwent electrocardiography, wrist and finger photoplethysmography and continuous blood pressure and total peripheral resistance measurements during vasoconstriction provocation using a cold pressor test (21 younger adults), or active stand tests (all other participants). Pulse transit time was defined as the time lag between the electrocardiography R-peak and the peak in the photoplethysmography first derivative; sensitivity as a significant decrease relative to baseline; test-retest reliability as the intra class correlation between different repeats of the same test; validity as the association between total peripheral resistance and pulse transit time; predictive value as the association between supine resting pulse transit time and mean arterial pressure drop during active standing. Results: Finger pulse transit time was sensitive and reliable (ICC 0.2-0.8) during vasoconstriction provocation, but wrist pulse transit time was poorly reliable (ICC 0 – 0.5); only finger pulse transit time was sensitive to and reliable (ICC 0.4 – 0.8) during active standing in both younger and older adults. Finger pulse transit time was not associated with total peripheral resistance. Supine resting pulse transit time had predictive value for blood pressure drop during active standing in older adults (β -0.16; p 0.025). Conclusions: Pulse transit time was sensitive to and reliable during vasoconstriction provocation and active standing, but did not significantly differ between younger and older adults. Pulse transit time could not be demonstrated to particularly reflect vasoconstriction, but it had predictive value for blood pressure drop during active standing

Pulse transit time as a proxy for vasoconstriction in younger and older adults

Objectives: Changes of vasoconstriction may be measured non-invasively using pulse transit time. This study assessed the sensitivity, test-retest reliability and validity of pulse transit time during vasoconstriction provocation and active standing, and the predictive value of pulse transit time for blood pressure drop. Methods: Fifty-five younger (age 70 years) underwent electrocardiography, wrist and finger photoplethysmography and continuous blood pressure and total peripheral resistance measurements during vasoconstriction provocation using a cold pressor test (21 younger adults), or active stand tests (all other participants). Pulse transit time was defined as the time lag between the electrocardiography R-peak and the peak in the photoplethysmography first derivative; sensitivity as a significant decrease relative to baseline; test-retest reliability as the intra class correlation between different repeats of the same test; validity as the association between peripheral resistance and pulse transit time; predictive value as the association between supine resting pulse transit time and mean arterial pressure drop during active standing. Results: Finger pulse transit time was sensitive and reliable (ICC 0.2–0.8) during vasoconstriction provocation, but wrist pulse transit time was poorly reliable (ICC 0–0.5); only finger pulse transit time was sensitive to and reliable (ICC 0.4–0.8) during active standing in both younger and older adults. Finger pulse transit time was not associated with total peripheral resistance. Supine resting pulse transit time had predictive value for blood pressure drop during active standing in older adults (β −0.16; p 0.025). Conclusions: Pulse transit time was sensitive to and reliable during vasoconstriction provocation and active standing, but did not significantly differ between younger and older adults. Pulse transit time could not be demonstrated to particularly reflect vasoconstriction, but it had predictive value for blood pressure drop during active standing