Does a Viral Infection Cause Complex T. Regional Pain Syndrome?

Hiroaki Kimura, MD, PhD, Assistant Prof.
Tomohiro Asou, MD

Department of Rehabilitation, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, Japan 734-8551. Tel: +81-82-257-5566; Fax: +81-82-257-5594

In 1990 Omura, Y. reported that Herpes Simplex Virus Type 1 as the major cause of chronic intractable pain and its effective treatment using mixture of EPA & DHA with Selective Drug Uptake Enhancement Method. Subsequently among the other causes of pain, he included Chlamydia Trachomatis, Borrelia Burgdorferi, Mycobacterium Tuberculosis, human Herpes Virus type 6, and Circulatory Disturbances. In order to test possible involvement of viral infection in Complex Regional Pain Syndrome (CRPS), a disease which usually occurs in the extremities, we did a study of 17 patients with CRPS. They were examined for Herpes Simplex Virus (HSV) and Varicella Zoster Virus (VZV) by measuring IgG and IgM antibody titers, and 14 of these patients were also examined for Cytomegalo-Virus (CMV). As a control group 100 healthy Japanese employees at SRL, Inc. were also studied. In CRPS group, HSV IgG was positive in 12 of the 17 patients with an average antibody titer of 90.0 EIA value. VZV IgG was positive in all 17 patients with an average antibody titer of 26.8 EIA value. CMV IgG was positive in all 14 patients with an average antibody titer of 66.6 UA/ml. In control group, HSV IgG was positive in 54 subjects with an average antibody titer of 42.3 EIA value. VZV IgG was positive in 97 subjects with an average antibody titer of 26.2 EIA value. CMV IgG was positive in 82 subjects. There were no significant differences of positive rate of IgG antibody for the three viruses between patient and control groups. Although the difference was not significant, the average antibody titers of HSV in CRPS group were more than twice of those in healthy group. Antibody titers were almost equal in both groups for BZB. Possibly, some people in the control group who had latent virus, were also asymptomatic. In 2000, Takasaki, I. et al. In a separate animal study, inoculated with HSV Type-I the shin of the mouse causing allodynia and hyperalgesia (which are some of the characteristic findings seen in CRPS in humans). Also, VZV, which causes shingles which is sometimes followed by Post-Herpetic Neuralgia (PHN), is in the same family of HSV. As PHN resembles CRPS in symptoms, it is possible that HSV contributes to CRPS. Therefore, virus infection theory is an attractive hypothesis that accounts for many enigmas of CRPS.

Key Words: Complex regional pain syndrome (CRPS); Herpes simplex virus (HSV); Antibody titer; Enzyme immunoassay (EIA); Enzyme-linked fluorescent immunoassay (ELFA); Etiology

Address correspondence to Katsuhiro Toda, MD, PhD, (Present Address) Building 10/1N-118, 10 Center Drive Bethesda MD 20892 NIH/NIDCR/PNMB



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