Serum and salivary oxidative analysis in Complex RegionalPain Syndrome
Serum and salivary oxidative analysis in Complex RegionalPain SyndromeElon Eisenberga,e, Shalom Shtahlb,e, Rimma Gellera, Abraham Z. Reznickc,e,Ordi Sharfa,b,e, Meirav Ravbinovicha,b, Adam Erenreicha,b, Rafael M. Naglerd,e,*aPain Relief Unit, Rambam Medical Center, Haifa, IsraelbDepartment of Hand Surgery, Rambam Medical Center, Haifa, IsraelcDepartment of Anatomy and Cell Biology, Rambam Medical Center, Haifa, IsraeldOral and Maxillofacial Surgery Department and Oral Biochemistry Laboratory, Rambam Medical Center, Bat Galim, 31096 Haifa, IsraeleBruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, IsraelReceived 13 November 2007; received in revised form 9 April 2008; accepted 15 April 2008
Although both inﬂammatory and neural mechanisms have been suggested as potential contributors to Complex Regional PainSyndrome type I (CRPS-I), the pathogenesis of the syndrome is still unclear. Clinical trials have shown that free radical scavengerscan reduce signs and symptoms of CRPS-I, indirectly suggesting that free radicals and increased oxidative stress are involved in thepathogenesis of CRPS-I. This study investigated this premise by determining the levels of antioxidants in the serum and saliva of 31patients with CRPS-I and in a control group of 21 healthy volunteers. Serum lipid peroxidation products (MDA) and all antioxidative parameters analyzed were signiﬁcantly elevated in CRPS-I patients: median salivary peroxidase and superoxide dismutase(SOD) activity values, uric acid (UA) concentration and total antioxidant status (TAS) values were higher in CRPS-I patientsby 150% (p = 0.01), 280% (p = 0.04), 60% (p = 0.0001), and 200% (p = 0.0003), respectively, as compared with controls. Similar although not as extensive pattern of oxidative changes were found in the serum: mean serum UA and MDA concentrations andTAS value in the CRPS-I patients were higher by 16% (p = 0.04), 25% (p = 0.02), and 22% (p = 0.05), respectively, than in the controls. Additionally, median salivary albumin concentration and median salivary LDH activities in the patients were 2.5 times(p = 0.001) and 3.1 (p = 0.004) times higher than in the controls. The accumulated data show that free radicals are involved inthe pathophysiology of CRPS-I, which is reﬂected both in serum and salivary analyses. These data could be used for both diagnosticand therapeutic purposes in CRPS-I patients. 2008 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.
Keywords: Complex Regional Pain Syndrome type I (CRPS-I); Neuropathic pain; Inﬂammation; Ischemia; Oxidative stress; Antioxidants; Freeradical
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