Skin biopsy in complex regional pain syndrome: case series and literature review Full Text
Kharkar S et al. – 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.Methods
- 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.