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AMC Scientists Find Basis for Chronic Pain Syndrome: Study Published in the Journal Pain
   February 23, 2006

     

ALBANY, N.Y., February 23, 2006 — It’s an illness that is as mysterious as it is devastating. It may start when an individual suffers a seemingly minor hand or foot injury, and before long it develops into severe, constant pain throughout the entire arm or leg. Pain treatments often don’t help, and the caress of a breeze blowing across arm hair, for instance, can feel “like a blowtorch.” 

 

In extreme cases, patients have had their limbs amputated in an effort to free them from the crushing burden of unceasing, unrelenting torture. Despite the devastating effects of Complex Regional Pain Syndrome (CRPS) Type I, there remains within the medical community debate over whether the syndrome (also known as Reflex Sympathetic Dystrophy or RSD) is a real physical affliction.

 

Now, thanks to a landmark study conducted under the expertise and direction of Frank L. Rice, Ph.D., and Phillip J. Albrecht, Ph.D., of the Center for Neuropharmacology and Neuroscience at Albany Medical College, there is incontrovertible proof that severe pathological changes occurred in the skin, nerves, and blood vessels in at least some patients suffering from CRPS Type I. Scientists at Amgen and the University of California, San Francisco assisted in the study.

 

The controversy over CRPS Type I had been deepened by two additional factors. First, ordinary neurological tests typically reveal nothing that would indicate the source of the pain. In contrast to another form of CRPS, Type II, which can occur when nerves have obviously been injured, no studies had shown nerve involvement in CRPS Type I. Second, given that an initiating injury often seems negligible, there have been concerns that some CRPS Type I patients may be malingerers.

 

In the article featured on the cover of the February issue of the prestigious journal Pain, the investigators published the results of intricate analyses of skin specimens from two Israeli patients, one who had had a rotator cuff injury and the other a broken toe. In a last-ditch attempt to alleviate the severity of their CRPS Type I pain, both patients had a limb amputated by a medical team at the Rambam Medical Center and Technicon-Israeli Institute of Technology in Haifa, Israel.

 

The subsequent microscopic examination of the specimens showed that any site in the skin that is a recipient of nerve endings – including hair follicles, blood vessels, sweat glands and epidermis – had marked alterations from normal. 

 

Dr. Rice says, “The changes that we see in the nerve endings are, in fact, consistent with the symptoms that the patients described when they were diagnosed with CRPS Type I in the first place. In other words, the pain most likely is not ‘all in their heads;’ there really is a physical problem. ”

 

The study marks “a landmark advance in the study of CRPS,” according to Gary Bennett, M.D., of McGill University, one of the leading authorities in the field. “In time we hope to understand what causes these painful changes in the body and how to treat or prevent them,” Dr. Rice says. 

 

The CRPS study was one part of an extensive program of research in Dr. Rice’s laboratory on a variety of nerve and skin pathologies including shingles, diabetic neuropathy, carpal tunnel syndrome, scleroderma, neurofibromatosis and complications related to paralysis from spinal injuries.

 

Albany Medical Center is northeastern New York’s only academic health sciences center. It consists of Albany Medical College, Albany Medical Center Hospital; and the Albany Medical Center Foundation, Inc. Additional information about Albany Medical Center can be found at www.amc.edu.

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