Faculty Collaboration Database

Value of autonomic testing in reflex sympathetic dystrophy. Mayo Clin Proc 1995 Nov;70(11):1029-40

Date

11/01/1995

Pubmed ID

7475332

DOI

10.4065/70.11.1029

Scopus ID

2-s2.0-0028885511 (requires institutional sign-in at Scopus site)   107 Citations

Abstract

OBJECTIVE: To attempt to characterize reflex sympathetic dystrophy (RSD) and to determine factors that would predict a response to sympathetic block.

DESIGN: We undertook a retrospective analysis on 396 patients with chronic limb pain referred for autonomic testing during a 5-year period.

MATERIAL AND METHODS: Clinical endpoints were relief of pain after sympathetic block and a composite RSD diagnostic probability score, based on the clinical attributes of allodynia, protopathia, swelling, and vasomotor alterations. We compared the results of three autonomic tests--resting sweat output (RSO), resting skin temperature (RST), and quantitative sudomotor axon reflex test (QSART).

RESULTS: Increased RSO predicted the diagnosis of RSD with 94% specificity, and the specificity was 98% when RSO was considered in conjunction with an abnormal QSART result, the best laboratory correlate (P = 0.003) of the clinical diagnosis. Shorter duration of pain correlated with a warmer limb (P < 0.001), even in the absence of RSD. Response to a single sympathetic block did correlate with the diagnosis (P = 0.031) but correlated most significantly with short duration of pain in the arm (P = 0.001) and laboratory findings in the leg, where increased RST (P < 0.001) and QSART (P < 0.001) were near-perfect predictors of response.

CONCLUSION: Sweating abnormalities correlate strongly with the clinical syndrome of RSD, and alterations in RST may be superior to clinical findings in predicting the response to sympathetic block. The findings provide physiologic support for the unproven view of a natural disease progression ("stages"), with better treatment response and a warmer extremity initially. Because certain physiologic trends occur in all patients, general alterations of autonomic function with pain are suggested.

Author List

Chelimsky TC, Low PA, Naessens JM, Wilson PR, Amadio PC, O'Brien PC

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Aged, 80 and over
Autonomic Nervous System
Child
Diagnosis, Differential
Female
Humans
Logistic Models
Male
Mental Disorders
Middle Aged
Multivariate Analysis
Pain
Pain Management
Predictive Value of Tests
Reflex Sympathetic Dystrophy
Retrospective Studies
Severity of Illness Index
Single-Blind Method
Skin Temperature
Sweating
Treatment Outcome