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Skin biopsy in complex regional pain syndrome: case series and literature review
Journal article   Open access   Peer reviewed

Skin biopsy in complex regional pain syndrome: case series and literature review

Siddharth Kharkar, Yedatore S Venkatesh, John R Grothusen, Luisa Rojas and Robert J Schwartzman
Pain physician, v 15(3), pp 255-266
May 2012
DOI: https://doi.org/10.36076/ppj.2012/15/255
PMID: 22622910
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.36076/ppj.2012/15/255View
Published, Version of Record (VoR)Maybe Open Access (Publisher Bronze),  Open

Abstract

Adult Aged Biopsy Female Humans Male Middle Aged Nerve Fibers - pathology Reflex Sympathetic Dystrophy - pathology Reflex Sympathetic Dystrophy - physiopathology Retrospective Studies Sensory Thresholds Skin - innervation Skin - pathology
Accumulating experimental and clinical evidence supports the hypothesis that complex regional pain syndrome type I (CRPS-I) may be a small fiber neuropathy. To evaluate the use of commercially available standard biopsy methods to detect intradermal axon pathology in CRPS-I, and to ascertain if these structural changes can explain quantitative sensory testing (QST) findings in CRPS-I. Retrospective review of charts and laboratory data. Outpatient clinic Skin biopsies from 43 patients with CRPS-I were stained with PGP 9.5, and epidermal nerve fiber density, sweat gland nerve fiber density and morphological abnormalities were evaluated. Thirty-five patients had quantitative sensory testing. Alterations in skin innervation were seen in approximately 20% of CRPS-I patients with commercial processing. There were no patient characteristics, including duration of disease, that predicted a decreased epidermal nerve fiber density (ENFD). There was no consistent relationship between QST changes and ENFD measured by standard commercial skin biopsy evaluation procedures. Commercial processing of tissue does not utilize stereologic quantitative analysis of nerve fiber density. Biopsy material is utilized from a proximal and distal source only, and differences in denervation of a partial nerve territory may be missed. The functional attributes of small fibers cannot be assessed. The negative results indicate that CRPS-I may be associated with changes in the ultramicroscopic small fiber structure that cannot be visualized with commercially available techniques. Alternatively, functional rather than structural alterations of small fibers or pathological changes at a more proximal site such as the spinal cord or brain may be responsible for the syndrome.

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Web of Science research areas
Anesthesiology
Clinical Neurology
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