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Kompleks Bölgesel Ağrı Sendromu Olan ve Olmayan Hastalarda Cilt İletkenlik Monitörü Kullanılarak Sempatik Aktivitenin Karşılaştırılması

Amaç: Sempatik sinir sistem disfonksiyonu, kompleks bölgesel ağrı sendromu patofizyolojisinde yer alan teoriler arasında tanımlanmıştır. Kompleks bölgesel ağrı sendromu olan hastalarda etkilenen ekstremitenin sempatik aktivitesinin objektif ölçümü, literatürde normal denekler ile karşılaştırılmamıştır. Cilt iletkenlik monitörü, invazif olmayan ve ekstremitenin cilt sempatik aktivitesini objektif olarak ölçebilen bir monitördür. Bu çalışmada, kompleks bölgesel ağrı sendromu olan ve olmayan deneklerde ekstremitelerin sempatik aktivitesindeki farklılıkların bir cilt iletkenlik monitörü kullanılarak karşılaştırılması amaçlanmıştır. Gereç ve Yöntemler: Sempatik cilt yanıtları, alt ekstremite kompleks bölgesel ağrı sendromu tip 1 olan 13 hastada etkilenen ekstremitelerden alınan 25 ölçüm ve kontrol grubundaki 50 normal denekten alınan 50 ölçüm olmak üzere 63 denekte değerlendirildi. Cilt iletkenlik endeksleri arasında "saniyede tepe sayısı (0,02)" endeksi, ana sempatik cilt yanıt endeksi olarak kullanıldı. Tanımlayıcı kriterler ve sempatik cilt yanıt ölçümlerinin ortalama değerleri karşılaştırıldı. Bulgular: Cilt iletkenlik monitörü ile “saniyede tepe sayısı (0,02)” endeksi kullanılarak sempatik cilt yanıtları karşılaştırıldığında, kompleks bölgesel ağrı sendromu olan grup ile kompleks bölgesel ağrı sendromu tanısı olmayan kontrol grubu arasında ekstremitelerde sempatik aktivite açısından istatistiksel olarak anlamlı bir fark bulunmadı (p=0,837). Sonuç: Bu çalışmada, kompleks bölgesel ağrı sendromu olan hastaların etkilenen ekstremitelerindeki cilt sempatik sinir aktivitesi, kompleks bölgesel ağrı sendromu tanısı olmayan normal denekler ile benzerdi. Kompleks bölgesel ağrı sendromunda sempatik aktivitedeki değişiklikleri değerlendirmek için daha ileri çalışmalara ihtiyaç vardır.

Anahtar Kelimeler:

kompleks bölgesel ağrı sendromu, refleks sempatik distrofi, Cilt iletkenliği, sempatik sistem, kozalji

Comparison of Sympathetic Activity by Use of Skin Conductance Monitor in Patients with and without Complex Regional Pain Syndrome

Aim: Sympathetic system dysfunction has been described among the theories involved in the pathophysiology of complex regional pain syndrome. Objective measurement of the sympathetic activity of the affected extremity in patients with complex regional pain syndrome has not been compared to normal subjects in the literature. The skin conductance monitor is a non-invasive monitor that can objectively measure sympathetic skin activity of the extremity. In this study, we aimed to compare the differences in sympathetic activity of extremities in subjects with and without complex regional pain syndrome by using a skin conductance monitor. Material and Methods: Sympathetic skin responses were evaluated in 63 subjects, including 25 measurements on the affected extremities in 13 patients with lower extremity complex regional pain syndrome type 1 and 50 measurements in 50 normal subjects in the control group. Among the skin conductance indices, the "peaks per second (0.02)" index was used as the main sympathetic skin response index. Descriptive criteria and the mean values of sympathetic skin response measurements were compared. Results: When sympathetic skin responses were compared with a skin conductance monitor using the "peaks per second (0.02)" index, no statistically significant difference was found between the complex regional pain syndrome and control groups in terms of sympathetic activity in the extremities (p=0.837). Conclusion: In this study, skin sympathetic nerve activity in the affected limb of patients with complex regional pain syndrome was similar to normal subjects. Further studies are required to assess the changes in sympathetic activity in complex regional pain syndrome.

Keywords:

Complex regional pain syndrome, Reflex sympathetic dystrophy, skin conductance, sympathetic system, causalgia,

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Bruehl S. Complex regional pain syndrome. BMJ. 2015;351:h2730.
Knudsen LF, Terkelsen AJ, Drummond PD, Birklein F. Complex regional pain syndrome: a focus on the autonomic nervous system. Clin Auton Res. 2019;29(4):457-67.
iasp-pain.org [Internet]. International Association for the Study of Pain. [Cited: 2021 Jan 31]. Available from: http://www.iasp-pain.org/files/Content/ContentFolders/Publications2/ClassificationofChronicPain/Part_II-A.pdf.
Bruehl S, Maihöfner C, Stanton-Hicks M, Perez RS, Vatine JJ, Brunner F, et al. Complex regional pain syndrome: evidence for warm and cold subtypes in a large prospective clinical sample. Pain. 2016;157(8):1674-81.
Gungor S, Rana B, Fields K, Bae JJ, Mount L, Buschiazzo V, et al. Changes in the skin conductance monitor as an end point for sympathetic nerve blocks. Pain Med. 2017;18(11):2187-97.
van Dooren M, de Vries JJ, Janssen JH. Emotional sweating across the body: Comparing 16 different skin conductance measurement locations. Physiol Behav. 2012;106(2):298-304.
Harden NR, Bruehl S, Perez RSGM, Birklein F, Marinus J, Maihofner C, et al. Validation of proposed diagnostic criteria (the "Budapest Criteria") for complex regional pain syndrome. Pain. 2010;150(2):268-74.
Gungor S, Storm H, Bae JJ, Rotundo V, Christos PJ. The effect of emotional stressors on postoperative skin conductance indices: a prospective cohort pilot study. Rev Bras Anestesiol. 2020;70(4):325-32.
Storm H. Changes in skin conductance as a tool to monitor nociceptive stimulation and pain. Curr Opin Anaesthesiol. 2008;21(6):796-804.
Storm H, Fremming A, Ødegaard S, Martinsen ØG, Moerkrid L. The development of a software program for analyzing spontaneous and externally elicited skin conductance changes in infants and adults. Clin Neurophysiol. 2000;111(10):1889-98.
Bini G, Hagbarth KE, Hynninen PT, Wallin BG. Thermoregulatory and rhythm‐generating mechanisms governing the sudomotor and vasoconstrictor outflow in human cutaneous nerves. J Physiol. 1980;306(1):537-52.
Ledowski T, Bromilow J, Paech MJ, Storm H, Hacking R, Schug SA. Monitoring of skin conductance to assess postoperative pain intensity. Br J Anaesth. 2006;97(6):862-5.
Ledowski T, Bromilow J, Wu J, Paech MJ, Storm H, Schug SA. The assessment of postoperative pain by monitoring skin conductance: results of a prospective study. Anaesthesia. 2007;62(10):989-93.
Hansen JO, Storm H, Boglino‐Hörlin A, Le Guen M, Gayat E, Fischler M. Skin conductance as a pain assessment tool during chest tube removal: an observational study. Eur J Pain. 2017;21(6):987-96.
Gjerstad AC, Wagner K, Henrichsen T, Storm H. Skin conductance versus the modified COMFORT sedation score as a measure of discomfort in artificially ventilated children. Pediatrics. 2008;122(4):e848-53.
Günther AC, Bottai M, Schandl AR, Storm H, Rossi P, Sackey PV. Palmar skin conductance variability and the relation to stimulation, pain and the motor activity assessment scale in intensive care unit patients. Crit Care. 2013;17(2):R51.
Hullett B, Chambers N, Preuss J, Zamudio I, Lange J, Pascoe E, et al. Monitoring electrical skin conductance: a tool for the assessment of postoperative pain in children? Anesthesiology. 2009;111(3):513-7.
Aslanidis T, Grosomanidis V, Karakoulas K, Chatzisotiriou A. Electrodermal activity monitoring during endotracheal suction in sedated adult intensive care unit patients. Folia Med (Plovdiv). 2018;60(1):92-101.
Storm H, Myre K, Rostrup M, Stokland O, Lien MD, Raeder JC. Skin conductance correlates with perioperative stress. Acta Anaesthesiol Scand. 2002;46(7):887-95.
Albrecht PJ, Hines S, Eisenberg E, Pud D, Finlay DR, Connolly KM, et al. Pathologic alterations of cutaneous innervation and vasculature in affected limbs from patients with complex regional pain syndrome. Pain. 2006;120(3):244-66.
Oaklander AL, Rissmiller JG, Gelman LB, Zheng L, Chang Y, Gott R. Evidence of focal small-fiber axonal degeneration in complex regional pain syndrome-I (reflex sympathetic dystrophy). Pain. 2006;120(3):235-43.