Article

Complex regional pain syndrome type I (CRPS-I) is a chronic pain syndrome with no
clinical evidence of nerve injury; however, recently, changes in muscle tissue
have been found in case of CRPS-I. Our aim was to search for histological changes
in peripheral nerves of amputated limbs from patients with therapy-resistant
CRPS-I that could justify muscle tissue changes. Fifteen patients with CRPS-I
(duration >1 year) were included. Multiple nerve samples were taken from upper
(n=4) and lower (n=11) amputated limbs. Histological changes (signs of nerve
fiber loss and regeneration), fiber diameters, fiber diameter distribution, and
fiber density were studied through microscopy and morphometry. Samples from three
healthy sural nerves were used as control data as well as data from the
literature. All patients (93% of tissue samples) showed histological signs of
nerve fiber loss and fiber regeneration, varying in severity. No specific
preference was found for any nerve or the location within the nerve. Sural nerves
showed loss of especially larger nerve fibers (>12 mum) in comparison with
control data. Sympathectomy did not influence this finding. The morphometric
results of the other nerves are more difficult to interpret because of the
absence of good-quality control data from the literature. However, the
percentages of nerve fibers greater than 12 mum seem to lie within the normal
range. Besides the known pathology of thin nerve fibers innervating the skin or
blood vessels in CRPS-I, this study also shows pathological changes more proximal
in the nerves, especially in the sural nerve.

Langue : ANGLAIS