Wandering around PubMed

From the neurology/psychophysiology journal Pain, 2009 Feb 3:
The association between ACE inhibitors and the complex regional pain syndrome: Suggestions for a neuro-inflammatory pathogenesis of CRPS.

de Mos M, Huygen FJ, Stricker BH, Dieleman JP, Sturkenboom MC.

Erasmus University Medical Center, Pharmaco-epidemiology Unit, Departments of Medical Informatics and Epidemiology & Biostatistics, Dr. Molewaterplein 50, Room 2157, 3015 GE, Rotterdam, The Netherlands.

Antihypertensive drugs interact with mediators that are also involved in complex regional pain syndrome (CRPS), such as neuropeptides, adrenergic receptors, and vascular tone modulators. Therefore, we aimed to study the association between the use of antihypertensive drugs and CRPS onset. We conducted a population-based case-control study in the Integrated Primary Care Information (IPCI) database in the Netherlands. Cases were identified from electronic records (1996-2005) and included if they were confirmed during an expert visit (using IASP criteria), or if they had been diagnosed by a medical specialist. Up to four controls per cases were selected, matched on gender, age, calendar time, and injury. Exposure to angiotensin converting enzyme (ACE) inhibitors, angiotensin II receptor antagonists, beta-blockers, calcium channel blockers, and diuretics was assessed from the automated prescription records. Data were analyzed using multivariate conditional logistic regression. A total of 186 cases were matched to 697 controls (102 confirmed during an expert visit plus 84 with a specialist diagnosis). Current use of ACE inhibitors was associated with an increased risk of CRPS (OR(adjusted): 2.7, 95% CI: 1.1-6.8). The association was stronger if ACE inhibitors were used for a longer time period (OR(adjusted): 3.0, 95% CI: 1.1-8.1) and in higher dosages (OR(adjusted): 4.3, 95% CI: 1.4-13.7). None of the other antihypertensive drug classes was significantly associated with CRPS. We conclude that ACE inhibitor use is associated with CRPS onset and hypothesize that ACE inhibitors influence the neuro-inflammatory mechanisms that underlie CRPS by their interaction with the catabolism of substance P and bradykinin.

PMID: 19195784 [PubMed - as supplied by publisher]

In looking through previous publications by some of these authors, it looks as if a few are quite dedicated to CRPS research, making good use of the Integrated Primary Care Information (IPCI) project, a general practice (GP) database in the Netherlands. de Mos has investigated past medical histories to see if any particular illnesses/events correlate with the onset of CRPS*, also researching the role of estrogen to see if it increases the risk of contracting CRPS, studying allodynia, and determining familial incidence.
*click here for complete text of that study

de Mos participated in another study that, well... it just tickles my fancy. Here is the pertinent abstract from 2007 (or click here for complete text):

Applied information retrieval and multidisciplinary research: new mechanistic hypotheses in complex regional pain syndrome.

(From The Journal of Biomedical Discovery and Collaboration, 2007 May 4;2:2)

Hettne KM, de Mos M, de Bruijn AG, Weeber M, Boyer S, van Mulligen EM, Cases M, Mestres J, van der Lei J.

Safety Assessment, AstraZeneca R&D Mölndal, Sweden. k.hettne@erasmusmc.nl

BACKGROUND: Collaborative efforts of physicians and basic scientists are often necessary in the investigation of complex disorders. Difficulties can arise, however, when large amounts of information need to reviewed. Advanced information retrieval can be beneficial in combining and reviewing data obtained from the various scientific fields. In this paper, a team of investigators with varying backgrounds has applied advanced information retrieval methods, in the form of text mining and entity relationship tools, to review the current literature, with the intention to generate new insights into the molecular mechanisms underlying a complex disorder. As an example of such a disorder the Complex Regional Pain Syndrome (CRPS) was chosen. CRPS is a painful and debilitating syndrome with a complex etiology that is still unraveled for a considerable part, resulting in suboptimal diagnosis and treatment.

RESULTS: A text mining based approach combined with a simple network analysis identified Nuclear Factor kappa B (NFkappaB) as a possible central mediator in both the initiation and progression of CRPS.

CONCLUSION: The result shows the added value of a multidisciplinary approach combined with information retrieval in hypothesis discovery in biomedical research. The new hypothesis, which was derived in silico, provides a framework for further mechanistic studies into the underlying molecular mechanisms of CRPS and requires evaluation in clinical and epidemiological studies.



I have lots of reading and "unpacking" to do. I feel guilt at least once a day for not being proactive, for not having made the ketamine coma happen, for having decided to just get by.