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Changes in cerebrospinal fluid levels of pro-inflammatory cytokines in CRPS

Alexander, Guillermo M.a,*; van Rijn, M. A.b; van Hilten, J. J.b; Perreault, Marielle J.a; Schwartzman, Robert J.a

doi: 10.1016/j.pain.2005.04.013

Complex Regional Pain Syndrome (CRPS) Types I and II are characterized by various combinations of sensory, autonomic and motor abnormalities. Pain disproportionate to the severity and duration of the inciting event is the most devastating symptom. In animal studies, conditions resulting in exaggerated pain states demonstrate elevated pro-inflammatory cytokines. In addition, pro-inflammatory cytokines have been shown to induce or increase neuropathic and inflammatory pain. Utilizing high sensitivity enzyme linked immunosorbent assay (ELISA), we compared the levels of the pro-inflammatory cytokines interleukin-1β (IL-1β), interleukin-6 (IL-6) and Tumor Necrosis Factor-alpha (TNF-α) in the cerebrospinal fluid (CSF) of patients afflicted with CRPS to CSF levels found in other patients with and without painful conditions. The results from this study demonstrated significant increases in IL-1β and IL-6, but not TNF-α in the CSF of individuals afflicted with CRPS as compared to controls. CSF cytokine levels in controls with painful conditions did not differ from levels in controls without pain. These increases showed no correlation with the patient's gender or weight. These results are consistent with studies that suggest that the pathogenesis of CRPS is due in part to central neuroimmune activation.

aDepartment of Neurology, Drexel University College of Medicine, Mail Stop 423, 245 North 15th Street, Philadelphia, PA 19102, USA

bDepartment of Neurology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands

*Corresponding author. Tel.: +1 215 762 1869; fax: +1 215 762 3161.


Received 17 November 2004; received in revised form 23 March 2005; accepted 7 April 2005.

© 2005 Lippincott Williams & Wilkins, Inc.
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