A Theoretical Role for the Genomic Oxidative-Reductive Balance in the Development of Complex Regional Pain Syndrome

Howard S. Smith, MD

Associate Professor
Academic Director—Pain Management
Department of Anesthesiology
Albany Medical College
Delmar, NY

The endogenous antioxidant system consists of a number of proteins (eg, antioxidant enzymes) and small molecules that maintain the reducing environment of the body and prevent potentially damaging reactions initiated by reactive oxygen species. Recent evidence suggests that imbalance in the endogenous antioxidant system and increased oxidative stress may contribute to complex regional pain syndrome (CRPS)—a chronic pain condition of unknown etiology that is marked by intense burning or aching pain, and at times swelling, skin discoloration, altered temperature, abnormal sweating, and allodynia in the affected area. Here, Dr. Smith hypothesizes that genetic alterations in the endogenous antioxidant system may increase or decrease an individual’s susceptibility to developing CRPS after surgery or trauma. This theory may allow identification of at-risk individuals, which would guide clinical decision-making and aid in the development of prevention or intervention strategies.

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