Immunoregulatory effect of polysaccharides derived from chroogomphus rutilus on macrophage cell line RAW264.7 / 药学实践杂志

Objective To study the immunomodulatory effect of polysaccharides (CRPS25-Ⅱ) derived from Chroogomphus rutilus on mouse mononuclear macrophages, RAW264.7 cells. Methods RAW264.7 cells were resuspended and cultured, cell suspension was prepared. The blank control group and CRPS25-Ⅱ groups with different mass concentrations (1, 20, 40, 80 and 160 μg/ml) were set up. MTT assay was used to determine the cytotoxicity of CRPS25-Ⅱ on RAW264.7 cells. RT-PCR was used to detect the effects of CRPS25-Ⅱ on the secretion of immune regulatory factors IL-6 and TNF-α from RAW264.7 cells. Western blot was used to detect the effects of CRPS25-Ⅱ on the expression of p-P65 protein in NF-κB pathway of RAW264.7 cells. Results The results showed that CRPS25-Ⅱ (1−160 μg/ml) had no obvious cytotoxicity. CRPS25-Ⅱ (1−160 μg/ml) increased the secretion of cytokines, and thus promoted the mRNA expression of IL-6 and TNF-α. CRPS25-Ⅱ increased the phosphorylation of p-P65 protein and activated the NF-κB signaling pathway, and thus promoted the immune regulation of cells. CRPS25-Ⅱ (1−160 μg/ml) could increase the p-P65 protein, and the promoting effects of CRPS25-Ⅱshowed an upward trend in the concentration range of 1−40 μg/ml and gradually weakened in the concentration range of 40−160 μg/ml. Conclusion Polysaccharides derived from chroogomphus rutilus had no cytotoxicity to mouse macrophages, and could promote the secretion of inflammatory factors IL-6 and TNF-α and activate the NF-κB signaling pathway, thus playing an immunomodulatory role.

Clinical observation of three-needle therapy combined with acupuncture on complex regional pain syndrome after stroke / 中国针灸

OBJECTIVE@#To observe the clinical therapeutic effect of three-needle therapy combined with acupuncture on complex regional pain syndrome typeⅠ(CRPS-Ⅰ) after stroke.@*METHODS@#A total of 96 patients with CRPS-Ⅰ after stroke were randomized into an observation group and a control group, 48 cases in each one. In the control group, based on the routine treatment, acupuncture was applied at Neiguan (PC 6), Shuigou (GV 26), Sanyinjiao (SP 6) and other supplementary acupoints, once a day, 6 times a week for 3 weeks. Based on the treatment in the control group, three-needle therapy was added at coracoid process, greater tuberosity of humerus and infraglenoid tubercle, the muscular fascia was released by fan-shaped separation technique for 3-6 times, and the treatment was given once every 2 days, 3 times a week for 3 weeks. Visual analogue scale (VAS) score, hand swelling level, Fugl-Meyer assessment (FMA) score and Barthel index score were observed to evaluate the pain and swelling severity, motor function and living ability of patients before and after treatment.@*RESULTS@#① Compared before treatment, the VAS score, hand swelling level, the FMA score and the Barthel index after treatment and 40 days after treatment were improved in both of the two groups (0.05).@*CONCLUSION@# three-needle therapy combined with acupuncture can improve the pain severity and the motor function of affected limbs in patients with CRPS-Ⅰ after stroke, and the therapeutic effect may be sustained for a long term. However, the treatment seems to be ineffectual on extremity swelling.

A Case of Lead Migration Caused by Involuntary Movement in Implanted Spinal Cord Stimulation / 고신대학교의과대학학술지

Spinal cord stimulation (SCS) is a reliable clinical option for treatment of refractory chronic pain. It is known to be effective method for treating sympathetic pain, failed back surgery syndrome, and complex regional pain syndrome etc. The devices and implantation techniques for SCS are already highly developed and continuously improving, but there are some complications that can not be corrected easily. Lead migration is the most common complication after SCS. It can cause failure of SCS that can make discomfort to patients. Here we describe our experience of lead migration in implanted SCS which was inserted to a patient with complex regional pain syndrome patient.

Electroconvulsive therapy for CRPS with depression: A case report

Complex regional pain syndrome (CRPS) is a chronic painful condition that may arise in the site of an earlier injury or operation to a limb. Like all chronic painful condition, it is associated with depressed mood. Electroconvulsive therapy (ECT) is a procedure when traditional management with systemic medications, nerve blocks, and behavioral pain management were unsuccessful. ECT has been used in the treatment of chronic pain for over 50 years. CRPS and comorbid depression have also been treated successfully with ECT. However, not much has been done to clarify the ECT target in patients, whether the pain or the depression. We report a case of intractable chronic regional pain syndrome with secondary depression in which both of that were treated successfully with an initial ECT course.

Percutaneous T2 and T3 Radiofrequency Sympathectomy for Complex Regional Pain Syndrome Secondary to Brachial Plexus Injury: A Case Series

Complex regional pain syndrome secondary to brachial plexus injury is often severe, debilitating and difficult to manage. Percuteneous radiofrequency sympathectomy is a relatively new technique, which has shown promising results in various chronic pain disorders. We present four consecutive patients with complex regional pain syndrome secondary to brachial plexus injury for more than 6 months duration, who had undergone percutaneous T2 and T3 radiofrequency sympathectomy after a diagnostic block. All four patients experienced minimal pain relief with conservative treatment and stellate ganglion blockade. An acceptable 6 month pain relief was achieved in all 4 patients where pain score remained less than 50% than that of initial score and all oral analgesics were able to be tapered down. There were no complications attributed to this procedure were reported. From this case series, percutaneous T2 and T3 radiofrequency sympathectomy might play a significant role in multi-modal approach of CRPS management.

Complex Regional Pain Syndrome (CRPS type-1) in an Adolescent Following Extravasation of Dextrose Containing Fluid-an Underdiagnosed Case

Due to its complex pathophysiology and wide spectrum of clinical manifestations, the diagnosis of CRPS is often missed in the early stage by primary care physicians. After being treated by a primary care physician for 5 months for chronic cellulitis, a 16-year-old girl was referred to our hospital with features of type-1 CRPS of the right upper extremity. Inability to diagnose early caused prolonged suffering to the girl with all the consequence of CRPS. The patient responded well with marked functional recovery from multimodal therapy. Ability to distinguish CRPS from other pain conditions, referral for specialty care at the appropriate time and full awareness of this condition and its clinical features among various healthcare professionals are essential in reducing patient suffering and stopping its progression towards difficult-to-treat situations.

Physical Therapy and Rehabilitation of Complex Regional Pain Syndrome in Shoulder Prosthesis

We report a 66-year-old woman with complex regional pain syndrome (CRPS) 1 treated with combined medical and active physical therapy. She was diagnosed with CRPS 1 following partial shoulder prosthesis due to proximal humerus fracture. Despite continuous medication and physical therapy, there was no improvement in her pain and functional outcome. Her overall pain was decresed by stellate ganglion block 3 times in two weeks conducted during the second month of the follow-up period. Following the ganglion blockades, pain and the other symptoms were decreased intermittently but range of motion (ROM) and functional status were not satisfied as much as expected. After the third month of follow-up, her passive and active ROM of the shoulder joint was increased after application of manipulation under general anesthesia. In conclusion, because CRPS 1 remains one of the most difficult pain syndromes, early diagnosis and treatment are important to have adequate functional results from physical therapy. Manipulation under general anesthesia may be an additional effective treatment tool to obtain functional improvement in some patients diagnosed with CRPS 1.

Gustatory Change after Sympathetic Ganglion Block in Complex Regional Pain Syndrome Type I Patient: A case report

Some reports provide conclusive evidence of close interactive regulation between the taste receptor and sympathetic nervous system. We report a middle-aged male patient with gustatory change after cervical sympathetic ganglion block (CSGB) who had been suffering from hypersensitivity to sour taste since developing complex regional pain syndrome (CRPS) type 1, diagnosed according to the revised CRPS criteria. Despite receiving two high doses of prednisolone therapy, he experienced the recurrence of CRPS symptoms. We attempted other therapy treatments, including pamidronate intravenous infusion, non-steroidal anti-inflammatory drugs, opioids, tricyclic antidepressants, and CSGB. Following each CSGB administration, the patient reported decreased hypersensitivity to sour-tasting foods, such as kimchi and oranges, with decreased pain and reduction of dysautonomic symptoms. This case demonstrates that overactivation of the sympathetic nervous system may influence sensitivity and regulation of gustatory receptors; therefore, a patient demonstrating CRPS symptoms, including taste alterations, may respond positively to CSGB therapy.

Pathogenesis of Complex Regional Pain Syndrome (review) / 中国康复理论与实践

@# Complex regional pain syndrome (CRPS) is a neuropathic pain disorder, characterized with persistent and severe pain after trauma or surgery. This paper would review the epidemiology, mechanisms and pathophysiology of CRPS.

The Sphenopalatine Ganglion Radiofrequency Thermocoagulation on a Patient of CRPS with Facial Pain and Pruritus:A report of 2 cases / 대한통증학회지

Complex regional pain syndrome (CRPS) type 1 is characterized by the presence of pain, which is severe, diffuse and associated with allodynia, and is also associated with autonomic and trophic changes. The sensitization phenomena of CRPS also cause allodynia and itching, as well as pain. These symptoms are the issues associated with the treatment of CRPS. Under normal conditions, an antagonistic interaction exists between the pain and itching, but the patterns of peripheral and central sensitization phenomena for the pain and itching are very similar. The chronic pain and chronic itch have similar characteristics in their developmental and therapeutical principles. Herein, our experience of 2 cases of CRPS, which showed improvement of these facial symptoms after sphenopalatine ganglion radiofrequency thermocoagulation, but were not controlled by spinal cord stimulation or other conservative treatments, is reported.

The Usefulness of Three-phase Bone Scan and Thermography for Making the Diagnosis of CRPS-I / 대한통증학회지

BACKGROUND: Complex regional pain syndrome (CRPS) is a painful and disabling disease, yet the diagnosis of this can be difficult to confirm by purely objective measures. Therefore, we performed three-phasic bone scans and thermography as a work up in order to determine their predictive value and usefulness for making the diagnosis of CRPS. METHODS: 44 patients who had been diagnosed with CRPS type-1, according to the modified criteria, were evaluated. All the patients were examined by performing a three-phasic bone scan and thermography as part of a work-up for diagnostic confirmation. The diffuse increased tracer uptake in the delayed image (phase III) was estimated by the positive findings. The findings were considered positive for CRPS if the thermographic findings showed temperature asymmetries between the affected and non-affected extremities of more than 1.00 degrees C RESULTS: A review of the three-phasic bone scan for 44 patients indicated that 16 patients (36.4%) had diffusely positive scans, and thermographic abnormalities were noted in 35 of 44 patients (79.5%). CONCLUSIONS: The use of thermography in clinical settings can play an important role in the diagnosis of CRPS. However, a three-phasic bone scan alone cannot provide a completely accurate diagnosis, so it is imperative that the three-phasic bone scan data be integrated with the clinical evaluation and the other relevant tests.

Infrared Thermal Imaging in Hemiplegic Patients of Upper Extremity by Stroke

OBJECTIVE: To investigate the usefulness of infrared thermal imaging for define the cause of shoulder pain on hemiplegic patients. METHOD: Subjects were 91 stroke patients who admitted to rehabilitation department from January 2002 to June 2003. Retrospective study was done by review of medical records. The subjects were divided into the control group (n=42) without shoulder pain and study group (n=49) who had the shoulder pain. The study group were also divided into subluxation, adhesive capsulitis, complex regional pain syndrome (CRPS) type I by main cause of pain. RESULTS: In the control group, the result revealed hypothermia on the involved upper extremity compared with the opposite intact side (p <0.05). In the study group, it revealed hyperthermia on the hand and forearm who diagnosed with CRPS type I. CONCLUSION: Distal infrared thermal imaging is considered to be useful diagnostic tool of CRPS type I in hemiplegic patient with shoulder pain.

Experience of Right Leg Pain Control by Left Epidural Space Inserted Spinal Cord Stimulator: A case report / 대한통증학회지

Spinal cord stimulation (SCS) was first attempted by Shearly et al for the relief of intractable pain. A spinal cord stimulator has traditionally been used for failed back surgery syndrome (FBSS) angina pectoris, complex regional pain syndrome (CRPS) and ischemic pain in the extremity. However, the complications associated with the use of a spinal cord stimulator, such as wound infection, hematoma, lead migration and device malfunction; make its long term application difficult. Here, our experience of an interesting case, in which intractable right leg pain was controlled using a spinal cord stimulator placed in the left epidural space, is reported, with a review of the literature.

Reflex Sympathetic Dystrophy Syndrome

Reflex Sympathetic Dystrophy (RSD) or Complex Regional Pain Syndome Type-I (CRPS-I), a disease of unknown prevalance, complicates any minor trauma, stroke, myocardial infection, colle’s fracture, peripheral nerve injury and in one-fourth of cases without any precipitant factor. An awareness of RSD and the injuries, illnesses and drugs that can provoke it is the first step to learn for an early treatment and better outcome. Here we present a neglected case of RSD following minor trauma who presented to us after 6-7 months of onset of disease. Delay in treatment resulted in partial recovery of the patient.

The Effect of Intravenous Regional Block with Ropivacaine, Ketamine and Clonidine on Complex Reginal Pain Syndrome Type I: A case report / 대한마취과학회지

There is no treatment either to prevent the development of complex regional pain syndromes (CRPS), or to adequately and specifically control established pain. Symptom-based analysis of pain is important for disease progress assessments and treatment outcomes. An intravenous regional block (IVRB) with local anesthetics can contribute to the management of CRPS. We observed that by the IVRB using ropivacaine, ketamine and clonidine, the patient with CRPS type I who was resistant to sympathetic ganglion block and medical treatment with gabapentin, carbamazepine and antidepressant, was relieved of neuropathic pain.

Effects of Gabapentin (Neurontin(R)) in the Post-Stroke Reflex Sympathetic Dystrophy

OBJECTIVE: To evaluate effects of gabapentin in post-stroke reflex sympathetic dystrophy (RSD). METHOD: To 20 RSD patients after stroke, gabapentin was administrated. We started medication with 300 mg per day and increased dosage by 300 mg per two days up to maximum 900~1,200 mg. We evaluated RSD symptom severities with hand pain, hand swelling and shoulder pain before gabapentin administration. Severity of each symptoms was graded and scored (0: no pain/swelling, 1: mild, 2: moderate, 3: severe). Severities of RSD symptoms were reevaluated on every dose increasing and on 1 week, 2 weeks and 4 weeks later after administrating maximum dosage. We defined as no effect group didn't have any improvement in symptom severity score in comparison with baseline score. Medications other than gabapentin were administrated in no effect group. RESULTS: Among 19 subjects whom we could follow-up, 4 subjects were defined as no effect group. 15 (78.9%) subjects showed improvement in symptom severity score. Statistically significant symptom improvements were observed after 4 weeks in comparison with baseline in hand pain and shoulder pain (p=0.000). From gabapentin 300~600 mg dosage, hand and shoulder pain showed significant pain decrease. Improvement of hand edema was observed after 4 weeks, but it was statistically insignificant. CONCLUSION: We conclude the gabapentin is effective for RSD pain, however further control study is required.