Swelling and oedema is often observed in patients after acute interruption of post-ganglionic sympathetic fibres such as a wide-spread sympathectomy

Swelling and oedema is often observed in patients with Raynaud's disease or causalgia after acute interruption of post-ganglionic sympathetic fibres such as a wide-spread sympathectomy. Complete sympathetic block dilates vein and capillary and increases peripheral pooling, which raises hydrostatic the shins and feet (fig 2), constipation and abdominal distention, and dysuria were observed. Oedema was not noted in the hands or face. There were no signs or abnormal laboratory data suggesting heart failure, renal failure, liver dysfunction, thyroid dysfunction or local inflammation. Venography of the left leg did not show obstruction in the deep veins.

We showed that the preganglionic sympathetic tract in the spinal cord was often disturbed in patients with multiple sclerosis with myelopathy.' Most patients with complete transection of the spinal cord due to injury showed swelling of the lower limbs or oedema, but they gradually subsided within several months even without restoration of somatic function. Probably some compensatory mechanism improves the hydrostatic condition in the chronic stage and explains why oedema is not noted in patients with chronic autonomic failure syndrome.
Journal of Neurology, Neurosurgery, and Psychiatry 1992;55:232-239

http://jnnp.bmj.com/content/55/3/232.1.full.pdf

peripheral sympathectomy causes a dramatic increase in NGF levels in the denervated organs

Increased Nerve Growth Factor Messenger RNA and Protein

Peripheral NGF mRNA and protein levels following
sympathectomy
It has been shown previously that peripheral sympathectomy
causes a dramatic increase in NGF levels in the denervated
organs (Yap et al., 1984; Kanakis et al., 1985; Korsching and
Thoenen, 1985).
Increased ,&Nerve Growth Factor Messenger RNA and Protein
Levels in Neonatal Rat Hippocampus Following Specific Cholinergic
Lesions
Scott R. Whittemore,” Lena Liirkfors,’ Ted Ebendal,’ Vicky R. Holets, 2,a Anders Ericsson, and HBkan Persson
Departments of Medical Genetics and’ Zoology, Uppsala University, S-751 23 Uppsala, Sweden, and *Department of
Histology, Karolinska Institute, S-104 01 Stockholm, Sweden

cervical sympathectomy induces mast cell hyperplasia and increases histamine and serotonin content in the rat dura mater

A. Bergerot, A.M. Reynier-Rebuffel, J. Callebert, P. Aubineau, 

Long-term superior cervical sympathectomy induces mast cell hyperplasia and increases histamine and serotonin content in the rat dura mater, 

Neuroscience 96 (2000) 205–213. 


Mast cells are critical players in allergic reactions, but they have also been shown to be important in immunity and recently also in inflammatory diseases, especially asthma. Migraines are episodic, typically unilateral, throbbing headaches that occur more frequently in patients with allergy and asthma implying involvement of meningeal and/or brain mast cells. These mast cells are located perivascularly, in close association with neurons especially in the dura, where they can be activated following trigeminal nerve, as well as cervical or sphenopalatine ganglion stimulation. Neuropeptides such as calcitonin gene-related peptide (CGRP), hemokinin A, neurotensin (NT), pituitary adenylate cyclase activating peptide (PACAP), and substance P (SP) activate mast cells leading to secretion of vasoactive, proinflammatory, and neurosensitizing mediators, thereby contributing to migraine pathogenesis. Brain mast cells can also secrete proinflammatory and vasodilatory molecules such as interleukin-6 (IL-6) and vascular endothelial growth factor (VEGF), selectively in response
to corticotropin-releasing hormone (CRH), a mediator of stress which is known to precipitate or exacerbate migraines. A better understanding of brain mast cell activation in migraines would be useful and could lead to several points of prophylactic intervention.

D 2005 Elsevier B.V. All rights reserved.

Brain Research Reviews 49 (2005) 65 – 76
The role of mast cells in migraine pathophysiology
Theoharis C. Theoharides*, Jill Donelan,
Kristiana Kandere-Grzybowska1

, Aphrodite Konstantinidou2

direct injury to the anatomic structure of the autonomic nervous system in the thoracic cavity, and postthoracotomy pain may contribute independently or in association with each other to the development of these arrhythmias

Anesthesiol Res Pract. 2013;2013:413985. doi: 10.1155/2013/413985. Epub 2013 Oct 23.

Supraventricular arrhythmias after thoracotomy: is there a role for autonomic imbalance?

Vretzakis G1, Simeoforidou M, Stamoulis K, Bareka M.

Author information

Abstract

Supraventricular arrhythmias are common rhythm disturbances following pulmonary surgery. The overall incidence varies between 3.2% and 30% in the literature, while atrial fibrillation is the most common form. These arrhythmias usually have an uneventful clinical course and revert to normal sinus rhythm, usually before patent's discharge from hospital. Their importance lies in the immediate hemodynamic consequences, the potential for systemic embolization and the consequent long-term need for prophylactic drug administration, and the increased cost of hospitalization. Their incidence is probably related to the magnitude of the performed operative procedure, occurring more frequently after pneumonectomy than after lobectomy. Investigators believe that surgical factors (irritation of the atria per se or on the ground of chronic inflammation of aged atria), direct injury to the anatomic structure of the autonomic nervous system in the thoracic cavity, and postthoracotomy pain may contribute independently or in association with each other to the development of these arrhythmias. This review discusses currently available information about the potential mechanisms and risk factors for these rhythm disturbances. The discussion is in particular focused on the role of postoperative pain and its relation to the autonomic imbalance, in an attempt to avoid or minimize discomfort with proper analgesia utilisation.

http://www.ncbi.nlm.nih.gov/pubmed/24235971

Since changes in old age show some similarities with those following chronic sympathectomy,

"For the tracheobronchial tree. surgical (sympathectomy) and chemical (with 6-hydroxydopamine or reserpine) interventions lead to histological disappearance of the NA and NPY." (p.435)

" Prejunctional supersensitivity to norepinephrine after sympathectomy or cocaine treatment." (p. 410)

"Following chronic sympathectomy, substance P expression in presumptive sensory nerves....and NPY-expression in parasympathetic nerves ...to autonomically innervated tissues have both been shown to increase... Experiments using NGF and anti-NGF antibodies (Kessler et al., 1983) have suggested that competition between sympathetic and sensory fibers for target-derived growth factors could explain these apparently compensatory interactions,..." (p. 33)

"Since changes in old age show some similarities with those following chronic sympathectomy, it is tempting to consider whether alterations in one group of nerves in tissues with multiple innervations trigger reciprocal changes in other populations of nerves, perhaps through the mechanism of competition for common, target-produced growth factors. The nature of these changes is such that they could be nonadaptive and even destabilizing of cardiovascular homeostasis. (p. 34) 

Impairment of sympathetic and neural function has been claimed in cholesterol-fed animals (Panek et al., 1985). It has also been suggested that surgical sympathectomy may be useful in controlling atherosclerosis in certain arterial beds (Lichter et al., 1987). Defective cholinergic arteriolar vasodilation has been claimed in atherosclerotic rabbits (Yamamoto et al., 1988) and, in our laboratory, we have recently shown impairment of response to perivascular nerves supplying the mesenteric, hepatic, and ear arteries of Watanabe heritable hyperlipidemic rabbits (Burnstock et al., 1991). 
   Loss of adrenergic innervation has been reported in alcoholism (Low et al., 1975), amyloidosis (Rubenstein et al., 1983), orthostatic hypotension (Bannister et al., 1981), and subarachnoid haemorrhage (Hara and Kobayashi, 1988). Recent evidence shows that there is also a loss of noradrenergic innervation of blood vessels supplying malignant, as compared to benign, human intracranial tumours (Crockard et al., 1987). (p. 14)  

Vascular Innervation and Receptor Mechanisms: New    Perspectives 

Rolf Uddman

Academic Press, 2 Dec 2012 - Medical - 498 pages

Postganglionic sympathetic efferents play a critical role in several types of pathological pain

Postganglionic sympathetic efferents play a critical role in several types of pathological pain (Gibbs et al., 2008; Jänig and McLachlan, 1994; Jänig et al., 1996; Raja, 1995). For example, sympathetic stimulation may excite sensory neurons in animals with inflamed peripheral tissue or after peripheral nerve injury (Devor et al., 1994; Sato and Kumazawa, 1996; Sato and Perl, 1991). Sympathectomy relieves hyperalgesic and allodynic behaviors in several pathological pain models (Kim et al., 1993; Kinnman and Levine, 1995; Malmberg and Basbaum, 1998). Clinical observations and experimental studies suggest that a crosstalk between sympathetic efferents and sensitized primary afferent nociceptors is produced by the release of norepinephrine, adenosine 5′-triphosphate (ATP) and/or neuropeptide Y from sympathetic efferents onto dorsal root ganglion (DRG) neurons (Chung et al., 1996; Devor et al., 1994), at the site of nerve injury (Devor and Seltzer, 1999) and in the skin (Lin et al., 2003,2004; Sato and Perl, 1991).

Many studies reveal that neurogenic inflammation and the resulting pain induced by intradermal injection of capsaicin (CAP) are sympathetically dependent (Coderre et al., 1989; Lin et al., 2003,2004; Ren et al., 2005,2006). Activation of transient receptor potential vanilloid-1 (TRPV1) receptors in primary afferent nociceptive neurons and their axons evoked by CAP injection produces an efferent function that initiates neurogenic inflammation (Kessler et al., 1999; Szolcsanyi, 1996,2004) by the release of neuropeptides from the nociceptors (Garcia-Nicas et al., 2001; Li et al., 2008; Lin et al., 2007). We proposed in our previous studies that neurogenic inflammation is likely to be sympathetically-mediated by influencing the sensitivity of primary afferent nociceptive neurons and/or their terminals (Ren et al., 2005,2006). However, no direct evidence has so far been provided to show if this process is done by modulation of TRPV1receptors.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2824038/

Exp Neurol. Author manuscript; available in PMC Mar 1, 2011.

Published in final edited form as:

Exp Neurol. Mar 2010; 222(1): 93–107.

Published online Dec 28, 2009. doi:  10.1016/j.expneurol.2009.12.011

sympathectomy leads to fluctuation of vasoconstriction alternated with vasodilation in an unstable fashion. Following sympathectomy the involved extremity shows regional hyper - and hypothermia

"To quote Nashold, referring to sympathectomy, "Ill- advised surgery may tend to magnify the entire symptom complex"(38). Sympathectomy is aimed at achieving vasodilation. The neurovascular instability (vacillation and instability of vasoconstrictive function), leads to fluctuation of vasoconstriction alternated with vasodilation in an unstable fashion (39). Following sympathectomy the involved extremity shows regional hyper - and hypothermia in contrast, the blood flow and skin temperature on the non- sympathectomized side are significantly lower after exposure to a cold environment (39). This phenomenon may explain the reason for spread of CRPS. In the first four weeks after sympathectomy, the Laser Doppler flow study shows an increased of blood flow and hyperthermia in the extremity (40). Then, after four weeks, the skin temperature and vascular perfusion slowly decrease and a high amplitude vasomotor constriction develops reversing any beneficial effect of surgery (39). According to Bonica , "about a dozen patients with reflex sympathetic dystrophy (RSD) in whom I have carried out preoperative diagnostic sympathetic block with complete pain relief, sympathectomy produced either partial or no relief (40)"

Chronic Pain: 

 Reflex Sympathetic Dystrophy : Prevention and Management

Hooshang Hooshmand

CRC PressINC, 1993 - Medical - 202 pages