Are the complex regional pain syndromes due to neurogenic inflammation?
Bibliographic record
Abstract
Complex regional pain syndromes (CRPS) types I and II (formerly RSD [I] and causalgia [II]) nearly always follow some sort of trauma, and frequently a seemingly minor one such as an ankle sprain. Their clinical presentations are identical, but in type II there is a clinically verified nerve injury. For both types, the early stage presents with pain (both spontaneous and stimulus-evoked); edema; abnormal vasomotor, sudomotor, and (sometimes) pilomotor function; hypertrophy of hair and nail growth; and motor dysfunction characterized by weakness, tremor, or dystonia. This clinical picture is similar to the classic post-injury inflammatory phenomena—rubor, calor, dolor, tumor, and functio laesa. It is thus natural to ask whether RSD and causalgia are pathologic expressions of the normal responses to injury. The sensory innervation of a tissue contributes importantly to the classic signs of inflammation. For example, primary afferent nociceptor sensitization contributes to dolor, and the release of the primary afferent neuropeptides, substance P (SP) and calcitonin gene-related peptide (CGRP), play a major role in edema and vasodilatation (thus, tumor, rubor, and calor). The original hypothesis, attributed to Sudeck,1 linking CRPS and inflammation invoked “inflammation” in its then current and now most general sense. Modern versions of the hypothesis (e.g., references 2-5⇓⇓⇓) emphasize the possibility of an abnormality of the neural contribution to inflammation or “neurogenic” inflammation. In this issue of Neurology , Birklein et …
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.004 |
| Scholarly communication | 0.002 | 0.004 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.004 | 0.002 |
| Insufficient payload (model declined to judge) | 0.008 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".