Neuropathic Pain Research | Robert Schwartzman, M.D. | Guillermo Alexander, Ph.D. | | John Grothusen, Ph.D.
 Reflex Sympathetic Dystrophy (RSD) also known as Complex Regional Pain Syndrome (CRPS) is a severe peripherally induced pain state whose major clinical features are: 1) hypersensitivity at the site of injury; 2) mechanoallodynia; 3) thermal hyperalgesia; 4) hyperpathia; 5) extraterritoriality; 6) associated neurogenic inflammation, autonomic dysregulation and motor phenomena (Schwartzman et al., 2001).
There is a body of evidence that suggests that the activation of microglia and astrocytes in exaggerated pain states is central for the maintenance and spread of the pain. We are currently evaluating the pro- and anti-inflammatory cytokine profile as well as neuroactive peptides, amino acid and biogenic amine levels in the cerebrospinal fluid of individuals with RSD/CRPS. The values will be compared to both naive controls and patients affected with other pain complexes such as radiculopathies. The data from this study will provide much-needed information that would help in determining the degree of glial involvement in RSD/CRPS.
The laboratory maintains both the CASE IV (Computer-Aided Sensory Evaluator, Stillwater, MN) and the TSA-II Neurosensory Analyzer (Ramat-Yishai, Israel ) for precise quantitation of vibrotactile and thermal detection thresholds, as well as thermal pain thresholds. With extensive experience in the use of these devices, as well as with all of the currently used algorithms, the laboratory also has a great deal of expertise in many other aspects of neuropathic pain assessment, such as static and dynamic allodynia mapping, pressure algometry, pain scales, precision digital photography and edema quantification.
The Small Fiber Laboratory is a leader in the emerging field of segmental surface autonomic testing. This is accomplished with its state-of-the-art laser Doppler imager (moorLDI, Moor Instruments Ltd., Millwey, Axminster, Devon EX13 5HU, England). With the appropriate stressors, a great deal of information can be obtained about regional inflammatory and sympathetic responses. These techniques can be especially useful in distinguishing between sympathetically mediated and sympathetically independent pain conditions.
To contact Dr. Schwartzman: 
Department of Neurology
219 N. Broad Street
Philadelphia, PA 19107
(215) 762-6915 Fax: (215) 762-6914
Email: robert.j.schwartzman@drexelmed.edu
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