Effectiveness of Cold Stress Thermography in the Diagnosis of Complex Regional Pain Syndrome Type 1 / 대한통증학회지

BACKGROUND: Despite the enormous amount of basic research on neuropathic pain, there is the lack of an objective diagnostic test for complex regional pain syndrome (CRPS). The aim of this study was to evaluate the usefulness of cold stress thermography in the diagnosis of CRPS. METHODS: The study involved 12 patients with CRPS type 1, according to the IASP criteria, who were compared with 15 normal healthy volunteers. All subjects underwent thermographic examination under baseline conditions at 21degrees C. A cold stress test (CST; 10degrees C water for 1 minute) was then applied to both hands below the wrists, immediate, and after 10 and 20 minutes. RESULTS: The temperature asymmetry between the patients with CRPS and the volunteers showed significant discrimination at the baseline and after a 20 minute recovery period from the CST. Among the study subjects having temperature asymmetry of both hands of less than 1degrees C (8 out of 12 CRPS patients and 14 out of 15 volunteer), 7 (87.5%) of the 8 CRPS patients and 3 (21%) of the 14 volunteers showed a temperature difference of more than 1degrees C after the 20 minute recovery period. The actual temperature values during the four periods did not discriminate between the patients with CRPS and the volunteers. CONCLUSIONS: Thermography, under the CST, could be a more objective test for the diagnosis of CRPS. A temperature asymmetry greater than 1degrees C during the 20 minute recovery period following CST provides strong diagnostic information about CRPS, with both high sensitivity and specificity.

Cold-stress Test Involving Finger Skin Temperature Measurement for Evaluation of Raynaud's Disease and Nonspecific Cold Sensitive Patients / 대한마취과학회지

BACKGROUND: Cold-stress test is used for the objective diagnosis of Raynaud's disease and phenomenon, and the value of such test based on detection of recovery time of finger skin temperature, finger systolic blood pressure and finger color. We evaluate the finger skin temperature of recovery time after cold-stress test for Raynaud's disease and nonspecific cold sensitive patients. METHODS: Thirty-six subjects participated in the study: 9 Raynaud's disease (group 1), 13 nonspecific cold-sensitive patients (group 2) and 14 healthy adults (group 3). Subjects were adapted for 10 min in the test room, temperature 22-24degrees C, prior to measurements. Thermistor probe were attached to tips of both middle phalanges. After recording the baseline temperature, both hands were immersed to the level of the wrist in water controlled at 4degrees C. After 1 min immersion, both hands were removed from the water, recording the skin temperature at 5 min interval. RESULTS: Group 1 had the two types of recovery pattern. One; group 1 (-) was delayed recovery and the other; group 1 (+) was early recovery and hyperemic response. Group 2 showed delayed recovery. Recovery time to preimmersion temperature in group 3 were 20 min. CONCLUSIONS: Unlike results of prior report, some of Raynaud's disease (44%) with typical tricolor change had early recovery and hyperemic response after cold stress test in our study. It is suggested that Raynaud's disease has a different pathophysiology from nonspecific cold-sensitive patients. And appropriate check time is 20 min after cold immersion for the evaluation of vascular dysfunction of cold sensitive patients.