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Controlled Clinical Trial
. 2006 May 12:5:30.
doi: 10.1186/1475-925X-5-30.

Thermography imaging during static and controlled thermoregulation in complex regional pain syndrome type 1: diagnostic value and involvement of the central sympathetic system

Sjoerd P Niehof  1 , Frank J P M Huygen, Rick W P van der Weerd, Mirjam Westra, Freek J Zijlstra
Affiliations
Controlled Clinical Trial

Thermography imaging during static and controlled thermoregulation in complex regional pain syndrome type 1: diagnostic value and involvement of the central sympathetic system

Sjoerd P Niehof et al. Biomed Eng Online. .

Abstract

Background: Complex Regional Pain Syndrome type 1 (CRPS1) is a clinical diagnosis based on criteria describing symptoms of the disease. The main aim of the present study was to compare the sensitivity and specificity of calculation methods used to assess thermographic images (infrared imaging) obtained during temperature provocation. The secondary objective was to obtain information about the involvement of the sympathetic system in CRPS1.

Methods: We studied 12 patients in whom CRPS1 was diagnosed according to the criteria of Bruehl. High and low whole body cooling and warming induced and reduced sympathetic vasoconstrictor activity. The degree of vasoconstrictor activity in both hands was monitored using a videothermograph. The sensitivity and specificity of the calculation methods used to assess the thermographic images were calculated.

Results: The temperature difference between the hands in the CRPS patients increases significantly when the sympathetic system is provoked. At both the maximum and minimum vasoconstriction no significant differences were found in fingertip temperatures between both hands.

Conclusion: The majority of CRPS1 patients do not show maximal obtainable temperature differences between the involved and contralateral extremity at room temperature (static measurement). During cold and warm temperature challenges this temperature difference increases significantly. As a result a higher sensitivity and specificity could be achieved in the diagnosis of CRPS1. These findings suggest that the sympathetic efferent system is involved in CRPS1.

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Figures

Figure 1
Figure 1
A hypothetical temperature cycle and terms used in this study. A; maximum difference between fingertip temperature, B; temperature span during total temperature cycle.
Figure 2
Figure 2
Differences between controls and patients at baseline and during the temperature cycle. A, the absolute average temperature difference between fingertips at baseline. B, the maximum absolute average temperature difference between fingertips during the cycle. C, the asymmetry factor at baseline. D, the minimum asymmetry factor during the temperature cycle.
Figure 3
Figure 3
Representative graphs of temperature and asymmetry of three patients and one control. Left column A, B, C, D presents graphs of average temperatures of fingertips and temperature difference between the finger tips during the warm and cold temperature cycle in the three regulation types. Right column A1, B1, C1, D1 asymmetry factor during the warm and cold temperature cycle in the three regulation types.
Figure 4
Figure 4
Representative thermographic images of a patient during the temperature cycle. Left column, images of the contralateral side. Right column, images of the involved side. A, A1 baseline recordings. B, B1 maximum vasoconstriction. C, C1 maximum temperature difference. D, D1 maximum vasodilatation.
See this image and copyright information in PMC

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