复杂区域疼痛综合征

目的:总结并分析复杂区域疼痛综合征发生机制、分类和治疗方法,促进对此疾病的进一步研究。资料来源:应用计算机检索Medline1980-01/2005-06关于复杂区域疼痛综合征的文章。检索词“complexregionalpainsyndrome,reflexsympatheticdystrophy(RSD),casualgia等”并限定文章的语种为英文。资料选择:对检索到的160多篇资料进行初审,纳入标准:关于复杂区域疼痛综合征的概念、分类、发病机制和治疗方法。排除标准:排除重复性研究。资料提炼:共收集到关于复杂区域疼痛综合征的文献53篇。其中研究内容相似的,以近10年内发表的文章优先。对符合标准的29篇文献进行分析。资料综合:复杂区域疼痛综合征是机制不清楚的难治性神经病理性疼痛疾病之一,目前认为其产生和维持是多种因素共同作用的结果。根据与交感神经的关系和有无明确的神经损伤分为Ⅰ型和Ⅱ型。临床表现以患肢疼痛和痛觉超敏、自主神经功能紊乱、运动功能和营养异常等为特征。康复、疼痛治疗和心理治疗是复杂区域疼痛综合征的重要治疗手段。结论:复杂区域疼痛综合征病因十分复杂、治疗极其困难,需要大量的临床和实验研究来探索其发病机制,寻求有效的预防和治疗方法。     

Complex regional pain syndrome

Purpose : This paper provides a review of the current concepts of complex regional pain syndrome (CRPS) and current diagnostic criteria are presented. Etiology and pathophysiological mechanisms of painful disorders, previously addressed as reflex sympathetic dystrophy (RSD) remain doubtful. Issues : The supposition of a sympathetic hyperactivity in the development of this syndrome could not be confirmed. Up to now no diagnostic test that would be specific for the diagnosis of CRPS is available. The diagnosis relies on clinical findings and the exclusion of conditions that could account for the degree of pain and dysfunction. Pain relief and functional restoration are the primary goals of all therapeutic intervention and should start as early as possible.     

复杂区域疼痛综合征

目的：总结并分析复杂区域疼痛综合征发生机制．分类和治疗方法，促进对此疾病的进一步研究。资料来源：应用计算机检索Medline 1980-01／2005—06关于复杂区域疼痛综合征的文章。检索词“complex regional pain syndrome，reflex sympathetic dystrophy（RSD），casualgia等”并限定文章的语种为英文。资料选择：对检索到的160多篇资料进行初审，纳入标准：关于复杂区域疼痛综合征的概念、分类、发病机制和治疗方法。排除标准：排除重复性研究。资料提炼：共收集到关于复杂区域疼痛综合征的文献53篇。其中研究内容相似的，以近10年内发表的文章优先。对符合标准的29篇文献进行分析。资料综合：复杂区域疼痛综合征是机制不清楚的难治性神经病理性疼痛疾病之一，目前认为其产生和维持是多种因素共同作用的结果。根据与交感神经的关系和有无明确的神经损伤分为Ⅰ型和Ⅱ型。临床表现以患肢疼痛和痛觉超敏、自主神经功能紊乱、运动功能和营养异常等为特征。康复、疼痛治疗和心理治疗是复杂区域疼痛综合征的重要治疗手段。结论：复杂区域疼痛综合征病因十分复杂、治疗极其困难，需要大量的临床和实验研究来探索其发病机制，寻求有效的预防和治疗方法。     

Complex regional pain syndrome

Complex regional pain syndrome (CRPS), formerly known as reflex sympathetic dystrophy, is a regional, posttraumatic, neuropathic pain problem that most often affects 1 or more limbs. Like most medical conditions, early diagnosis and treatment increase the likelihood of a successful outcome. Accordingly, patients with clinical signs and symptoms of CRPS after an injury should be referred immediately to a physician with expertise in evaluating and treating this condition. Physical therapy is the cornerstone and first-line treatment for CRPS. Mild cases respond to physical therapy and physical modalities. Mild to moderate cases may require adjuvant analgesics, such as anticonvulsants and/or antidepressants. An opioid should be added to the treatment regimen if these medications do not provide sufficient analgesia to allow the patient to participate in physical therapy. Patients with moderate to severe pain and/or sympathetic dysfunction require regional anesthetic blockade to participate in physical therapy. A small percentage of patients develop refractory, chronic pain and require long-term multidisciplinary treatment, including physical therapy, psychological support, and pain-relieving measures. Pain-relieving measures include medications, sympathetic/somatic blockade, spinal cord stimulation, and spinal analgesia.     

Complex regional pain syndrome and chiropractic

OBJECTIVE: Complex regional pain syndromes (CRPS) represent curious and difficult syndromes for both patient and clinician. CRPS presents as a triad of signs and symptoms, usually after a seemingly trivial injury to a peripheral joint or appendage. The clinical triad includes severe pain, vasomotor changes in and around the affected area, and trophic changes in the affected limb. Many of the acute symptoms are similar to those seen after many acute injuries, which makes an early diagnosis often times difficult. Current treatment protocols revolve around aggressive physical therapy plus pharmacologic interventions aimed at limiting sympathetic nervous system activity. OBJECTIVE: To review the literature on CRPS regarding symptoms, diagnosis, treatment, and causal mechanisms and to discuss alternative treatment approaches and the possible role of chiropractic care in patient rehabilitation. Data Sources: Texts, review articles, and randomized clinical trials investigating treatments, causes, and epidemiology. CONCLUSIONS: Recent research calls into question the predominant theories that view excessive sympathetic nervous system activity as the cause of CRPS. No evidence of an increase in sympathetic nervous system activity has been found, and new theories suggest that an increase in the sensitivity of neurotransmitter receptors may be the cause of CRPS. Alternatively, other research has suggested that a local inflammatory process may in fact cause CRPS. Although no research has been completed examining the role of chiropractic care in the treatment of CRPS, there is reason to believe that spinal manipulation may be beneficial to patients with CRPS.     

Complex regional pain syndrome in stroke patients

The objective of this study was to investigate the incidence, and the factors influencing the development, of complex regional pain syndrome-I in the upper extremity in hemiplegic patients within the first 28 weeks following a stroke. We followed up 82 stroke patients. All patients were evaluated at weeks 2, 6, 14 and 28 after suffering a stroke. Outcomes were assessed using passive range of motion of shoulder, presence of subluxation, Ashworth score, Motricity index arm score, Brunnstrom stages and depression score. The incidence of complex regional pain syndrome-I was 48.8% in the first 28 weeks. Significant correlation was found between complex regional pain syndrome-I and the presence of subluxation, Ashworth score, Motricity index arm score, Brunnstrom stage and depression score (r=0.259, P=0.019; r=0.271, P=0.014; r=-0.393, P<0.001; r=-0.385, P<0.001; r=0.293, P=0.008, respectively). In this study, there was a relationship between complex regional pain syndrome-I and subluxation, loss of range of motion, spasticity of shoulder muscles and muscle strength. In order to prevent the development of complex regional pain syndrome-I, exercises directed at increasing the range of motion for the glenohumeral joint, strengthening shoulder muscles and reduction of spasticity will establish the integrity of the shoulder joint.     

Complex regional pain syndrome as a stress response

A man in his 50's with a prior traumatic brain injury and multiple psychiatric disorders developed acute pain and swelling in his left leg distal to the mid shin. These symptoms arose during an exacerbation of his post-traumatic stress disorder (PTSD). Among his traumatic memories, he reported having witnessed the combat injury and death of a friend who had lost his left leg distal to the mid shin. A diagnosis of conversion disorder was technically excluded because the findings met criteria for Complex Regional Pain Syndrome (CRPS) type I. Based on recent research into the neurobiology of CRPS, PTSD and conversion disorder, we propose a supraspinal mechanism which could explain how emotional stress can produce both symptoms and signs.     

Complex regional pain syndrome in children and adolescents

Complex regional pain syndrome (CRPS) is a disorder characterised by pain, sensory and motor disturbances and represents a significant medical entity. This report discusses two cases of CRPS in children and adolescents, highlighting several critical issues for clinicians in the diagnosis and management of CRPS in these populations. Early diagnosis, referral and appropriate intervention are essential in decreasing pain, suffering and resorting function for children and adolescents with CRPS.     

Complex regional pain syndrome type I in cancer patients

Complex regional pain syndrome type I (CRPS-I) is infrequently associated with various malignancies, and may lead to severe pain in already debilitated patients. The causal relationship between CRPS-I and paraneoplastic syndrome, controversies in diagnosis and treatment, and new treatment modalities are presented.     

Complex regional pain syndrome in adults: concise guidance

Complex regional pain syndrome (CRPS) is a debilitating, painful condition in a limb associated with sensory, motor, autonomic, skin and bone abnormalities. Pain is typically the leading symptom, but is often associated with limb dysfunction and psychological distress. Prompt diagnosis and early treatment is required to avoid secondary physical problems related to disuse of the affected limb and the psychological consequences of living with undiagnosed chronic pain. UK guidelines have recently been developed for diagnosis and management in the context of primary and secondary care. The purpose of this concise guideline is to draw attention to these guidelines. Information in this article has been extracted from the main document and adapted to inform the management of CRPS as it presents to physicians in the course of their daily practice.     

Complex regional pain syndrome type-I after rubella vaccine.

Complex regional pain syndrome type I (CRPS-I) is a complex disorder characterised by pain, autonomic dysfunction, and decreased range of motion. The syndrome was believed as a well-recognized disorder in adults but, less commonly recognized in children. CRPS-I after vaccination has been rarely reported. We reported an 11-year-old young girl with CRPS-I due to rubella vaccine.     

Complex regional pain syndromes

Complex regional pain syndromes (CRPS) (formerly reflex sympathetic dystrophy and causalgia) are neuropathic pain conditions that are initiated by an extremity trauma or peripheral nerve lesion. Clinical definition and scientific understanding of CRPS are still evolving; however, both the clinical picture and therapeutic options are significantly influenced by a dysfunction of the sympathetic nervous system. Recent investigations suggest functional central abnormalities and a peripheral inflammatory component in the pathophysiology of CRPS. Interdisciplinary treatment includes physical, pharmacologic, and invasive interventional therapy, as well as stimulation techniques.     

Complex regional pain syndrome. Sympathetic reflex dystrophy and causalgia

Complex regional pain syndromes (CRPS) occur as the inadequate response to painful trauma in a distal extremity. With CRPS I (sympathetic reflex dystrophy), no lesion of the nerve is present. Aside from sensory disturbances, burning deep spontaneous pain and mechanical allodynia are characteristic. Disturbances in the skin blood circulation,sweating,edema,and trophic disturbances of the skin, joints, and bones are typical. Reduction in muscle strength, tremor, and late dystonic changes comprise the motor disturbances. All symptoms are distributed in the distal extremity and not limited to the region of the peripheral nerves. Complex regional pain syndrome II (causalgia),develops following a partial peripheral nerve lesion. The distally generalized symptoms are identical. Successful therapy depends on an early start of interdisciplinary treatment. In addition to the pain therapy,physiotherapy plays a decisive role in rehabilitation. During the acute phase, freedom from pain at rest and retrogression of the edema must be achieved. With slight spontaneous pain, a conservative therapeutic method may be applied (analgesics, rest, raised position). In case of insufficient improvement and in difficult cases, the effect of intervention (sympathetic blockade) should be tested and possibly a blockade series performed. After reduced spontaneous pain,physiotherapy should be increased stepwise.     

Complex regional pain syndrome: A review of evidence-supported treatment options

Complex regional pain syndrome consists of pain and other symptoms that are unexpectedly severe or protracted after an injury. In type II complex regional pain syndrome, major nerve injury, often with motor involvement, is the cause; in complex regional pain syndrome I, the culprit is a more occult lesion, often a lesser injury that predominantly affects unmyelinated axons. In florid form, disturbances of vasoregulation (eg, edema) and abnormalities of other innervated tissues (skin, muscle, bone) can appear. Because of these various symptoms and the difficulty in identifying causative lesions, complex regional pain syndrome is difficult to treat or cure. Complex regional pain syndrome has not been systematically investigated; there are few controlled treatment trials for established complex regional pain syndrome. This article reviews the existing studies (even if preliminary) to direct clinicians toward the best options. Treatments for other neuropathic pain syndromes that may be efficacious for complex regional pain syndrome also are discussed. Some common treatments (eg, local anesthetic blockade of sympathetic ganglia) are not supported by the aggregate of published studies and should be used less frequently. Other treatments with encouraging published results (eg, neural stimulators) are not used often enough. We hope to encourage clinicians to rely more on evidence-supported treatments for complex regional pain syndrome.