Treatment of complex regional pain syndrome type I with oral phenoxybenzamine: rationale and case reports

Pain Practice : the Official Journal of World Institute of Pain
Mario A Inchiosa, Grigory Kizelshteyn

Abstract

The nonselective alpha-adrenergic antagonist, phenoxybenzamine, has been used in the treatment of neuropathic pain syndromes, specifically, complex regional pain syndrome (CRPS) types I and II. This agent has also previously been used in intravenous regional peripheral blocks for treatment of CRPS I; however, an intravenous preparation of phenoxybenzamine is not currently available in the U.S.A. In this case series, systemic administration was more appropriate for three of the four patients, as their syndromes had spread beyond the initial area of surgery or trauma. We report an apparent clinical benefit in three of the four patients following oral administration. We postulate that this may be due to the noncompetitive (irreversible) blockade of alpha(1)- and alpha(2)-adrenergic receptors. We further hypothesize that this blockade could reduce stimulation of an increased population of adrenergic receptors in hyperalgesic skin, blunt the stimulation by norepinephrine of alpha(2)-adrenergic receptors on macrophages, and ultimately reduce the release of proinflammatory cytokines from cellular elements.

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Citations

May 17, 2012·Journal of Neuroimmune Pharmacology : the Official Journal of the Society on NeuroImmune Pharmacology·Karen E Binkley
Sep 26, 2012·Case Reports in Neurological Medicine·D Ryan OrmondRaj Murali
Jan 24, 2014·Anesthesiology Research and Practice·Mario A Inchiosa
Jan 15, 2014·Autonomic Neuroscience : Basic & Clinical·Tanja SchlerethFrank Birklein
May 5, 2009·The Journal of Pain : Official Journal of the American Pain Society·Kathleen C LightWilliam Maixner
Sep 3, 2010·Pain Practice : the Official Journal of World Institute of Pain·Frank van EijsFrank Huygen
Nov 17, 2015·European Journal of Pain : EJP·Eleanor S DrummondPeter D Drummond
May 3, 2018·Physiological Reviews·Florent Elefteriou
Feb 20, 2016·Anesthesia and Analgesia·Jijun XuJianguo Cheng

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