Terkelsen Astrid J, Bach Flemming W, Jensen Troels S
Danish Pain Research Center, University Hospital Aarhus, Norrebrogade 44, Building 1A, DK-8000 Aarhus, Denmark.
Anesthesiology. 2008 Aug;109(2):297-307. doi: 10.1097/ALN.0b013e31817f4c9d.
Complex regional pain syndrome is a painful condition of unknown etiology. Clinical and experimental observations suggest that limb immobilization may induce symptoms and signs characteristic of complex regional pain syndrome. This study examined the effect of forearm immobilization on regional sensory and autonomic functions in healthy subjects.
Thermal and mechanical sensitivity, skin temperature, and vasoconstrictor responses were measured in 30 healthy subjects before and 0, 3, and 28 days after scaphoid cast immobilization. Fifteen subjects served as nonimmobilized controls.
At cast removal, 27 subjects experienced pain at joint movement. Cast immobilization induced cold hyperalgesia in glabrous and hairy skin on the immobilized hand and induced significant skin temperature differences between the control and the immobilized hand at cast removal and after 3 days. Immobilization also reduced pain threshold at skin fold testing at all time points after cast removal. All measures except pain threshold at skin fold testing were normalized after 28 days. Immobilization did not affect thermal detection, heat pain, and pressure pain thresholds; resting skin perfusion; or vasoconstrictor responses induced by mental stress or deep inspirations.
Four weeks of forearm immobilization caused transient changes in skin temperature, mechanosensitivity, and thermosensitivity, without alteration in the sympathetically mediated vascular tone.
复杂性区域疼痛综合征是一种病因不明的疼痛性疾病。临床和实验观察表明，肢体固定可能诱发复杂性区域疼痛综合征的症状和体征。本研究检测了前臂固定对健康受试者局部感觉和自主神经功能的影响。
在30名健康受试者舟骨石膏固定前、固定后0天、3天和28天测量其热敏感性、机械敏感性、皮肤温度和血管收缩反应。15名受试者作为未固定的对照。
拆除石膏时，27名受试者在关节活动时出现疼痛。石膏固定导致固定手的无毛和有毛皮肤出现冷超敏反应，并在拆除石膏时和3天后导致对照手与固定手之间出现显著的皮肤温度差异。固定还降低了拆除石膏后所有时间点皮肤褶皱测试的疼痛阈值。除皮肤褶皱测试的疼痛阈值外，所有测量指标在28天后均恢复正常。固定不影响热觉、热痛和压痛阈值；静息皮肤灌注；或精神应激或深呼吸诱导的血管收缩反应。
四周的前臂固定导致皮肤温度、机械敏感性和热敏感性出现短暂变化，而交感神经介导的血管张力无改变。
