Complex regional pain syndrome secondary to sacrococcygeal dislocation following trauma to the lumbosacral region. case report

ABSTRACT Introduction: The complex regional pain syndrome (CRPS) is a rare condition characterized by inflammatory, vasomotor and central nervous system (CNS) involvement. Its clinical presentation can be subacute, acute or chronic, and may have severe effects on the patient's quality of life. Case description: 21-year-old female patient with trauma in the lumbosacral region associated with pain and functional limitation. Diagnostic imaging showed sacrococcygeal dislocation with subsequent inflammatory and acute and chronic autonomic symptoms that were treated medically and surgically. The patient responded to treatment with long-term improvement of the symptoms. Discussion: In this case, CRPS occurred after trauma and caused subacute symptoms that became even more acute until reaching a chronic presentation. Inflammation, vasomotor dysfunction and CNS involvement made this case a multidisciplinary diagnostic and therapeutic challenge. Conclusion: CRPS is a rare disease that is difficult to diagnose. However, diagnosis should be timely in order to initiate personalized treatment, since this disease considerably affects the patient's quality of life.

RESUMEN Introducción. El síndrome doloroso regional complejo (SDRC) es una patología poco frecuente que se caracteriza por causar compromiso a nivel inflamatorio, vasomotor y del sistema nervioso central (SNC). Su presentación clínica puede ser subaguda, aguda o crónica y puede afectar considerablemente la calidad de vida del paciente. Presentación del caso. Paciente femenina de 21 años con trauma en región lumbosacra asociado a dolor y limitación funcional, a quien se le practicaron imágenes diagnosticas que evidenciaron luxofractura sacrococcígea con posterior presencia de síntomas inflamatorios y autonómicos (agudos y crónicos) que se trataron con medicamentos y cirugía. La paciente respondió al tratamiento con mejoría de la sintomatología a largo plazo. Discusión. El SDRC se presentó posterior a un traumatismo y ocasionó sintomatología subaguda que se agudizó hasta llegar a la presentación crónica de la enfermedad. La inflamación, la disfunción vasomotora y el compromiso del SNC hacen de este caso un reto diagnóstico y terapéutico multidisciplinario. Conclusión. El SDRC es una patología poco frecuente y de difícil diagnóstico; sin embrago, es necesario diagnosticarlo de forma oportuna para poder iniciar un tratamiento personalizado, ya que es una enfermedad que compromete considerablemente la calidad de vida del paciente.

Síndrome doloroso regional complejo / Regional complex pain syndrome

RESUMEN Fundamento: el síndrome doloroso regional complejo es una condición incapacitante y a menudo crónica, que se ha mantenido como una de las enfermedades más enigmáticas desde su descubrimiento hace 150 años y se presenta entre el dos y el cinco por ciento de la población adulta, y hasta el 20 % de la población pediátrica. Objetivo: profundizar y actualizar los aspectos más importantes del síndrome doloroso regional complejo. Métodos: se realizó una revisión de la literatura en idioma español e inglés disponible en PubMed Central, Hinari y SciELO. Para ello se utilizaron los siguientes descriptores: complex regional pain syndrome, sympathetic reflex dystrophy, Sudeck dystrophy, algodystrophy. A partir de la información obtenida se realizó una revisión bibliográfica de un total de 167 artículos publicados, de ellas se seleccionaron 40 citas para realizar la revisión, 38 de los últimos cinco años. Resultados: se insistió en aquellos tópicos importantes dentro del tema como son: reseña histórica, epidemiología, fisiopatología, presentación clínica, diagnóstico, estudios complementarios y tratamiento. Conclusiones: el síndrome doloroso regional complejo es un trastorno doloroso enigmático y visible. La comprensión de la compleja fisiopatología ha logrado avances significativos, que llevarán a la desmitificación y a la mejoría en las terapias. A pesar de los tratamientos disponibles y los que se encuentran en estudio, no existen protocolos estandarizados que permitan un abordaje multidisciplinario.

ABSTRACT Background: complex regional pain syndrome is a painful disabling and often chronic condition that remains as one of the most enigmatic diseases since its discovery 150 years ago and presents between the 2 % and the 5 % of adult population and up to the 20 % in children. Objective: to update and to deepen in the most important aspects of regional complex pain syndrome. Methods: a revision of the literature was made in English and Spanish, available in PubMed Central, Hinari and SciELO was carried out. The following descriptors were used: complex regional pain syndrome, sympathetic reflex dystrophy, Sudeck dystrophy, algodystrophy. Based on the obtained data, a bibliographic revision was made of 167 publishing articles, including 40 citations selected for the research, 38 of them of the last five years. Results: it was focus in those controversial topics like: history, epidemiology, physiopathology, clinical presentation, diagnosis, complementary studies and treatment. Conclusions: regional complex pain syndrome is a painful enigmatic and visible disorder. The understanding of the complex physiopathology has improved significant advances that will rule out the myth and will perform better therapies. Besides available treatments and which are in study, no standardized protocols are in hand which allows a multidisciplinary approach.

Research progresses of three-phase bone scintigraphy in diagnosis of complex regional pain syndrome type / 中国医学影像技术

Complex regional pain syndrome (CRPS) type I is a neuropathic pain syndrome with high disability rate. Its clinical symptoms are complex and diverse, which seriously reduce the quality of life of CRPS patients. At present, the diagnosis of CRPS mainly depends on the disease history, symptoms and signs, the diagnostic standard of CRPS in the form of objective tests has not been established. In recent years, as a complementary imaging technology, three-phase bone scintigraphy (TPBS) has been applied in the diagnosis of CRPS, especially of CRPS . The research progresses of TPBS in diagnosis of CRPS were reviewed in this article.

Treatment of severe pain in a patient with complex regional pain syndrome undergoing dental treatment under general anesthesia: A case report

Complex regional pain syndrome (CRPS) is rare, characterized by pain from diverse causes, and presents as extreme pain even with minor irritation. General anesthesia may be required for dental treatment because the pain may not be controlled with local anesthesia. However, treatment under general anesthesia is also challenging. A 38-year-old woman with CRPS arrived for outpatient dental treatment under general anesthesia. At the fourth general anesthesia induction, she experienced severe pain resulting from her right toe touching the dental chair. Anesthesia was induced to calm her and continue the treatment. After 55 minutes of general anesthesia, the patient still complained of extreme toe pain. Subsequently, two administrations for intravenous sedation were performed, and discharge was possible in the recovery room approximately 5 h after the pain onset. The pain was not located at the dental treatment site. Although the major factor causing pain relief was unknown, ketamine may have played a role.

Complex Regional Pain Syndrome of Non-hemiplegic Upper Limb in a Stroke Patient: A Case Report

Complex regional pain syndrome (CRPS) type I in stroke patients is usually known to affect the hemiplegic upper limb. We report a case of CRPS presented in an ipsilesional arm of a 72-year-old female patient after an ischemic stroke at the left middle cerebral artery territory. Clinical signs such as painful range of motion and hyperalgesia of her left upper extremity, swollen left hand, and dystonic posture were suggestive of CRPS. A three-phase bone scintigraphy showed increased uptake in all phases in the ipsilesional arm. Diffusion tensor tractography showed significantly decreased fiber numbers of the corticospinal tract and the spinothalamic tract in both unaffected and affected hemispheres. Pain and range of motion of the left arm of the patient improved after oral steroids with a starting dose of 50 mg/day.

The Legal Doctrine on the Liability of Physicians in Medical Malpractice Lawsuits Involving Complex Regional Pain Syndrome

BACKGROUND: Complex regional pain syndrome (CRPS) involves severe pain and it is difficult to identify the exact cause or pathogenesis. Therefore, there are controversies regarding legal issues related to the establishment of damage in medical malpractice lawsuits involving CRPS. This study aimed to analyze malpractice lawsuits involving CRPS, which occurred after the disputed medical treatment, to provide information on the courts' opinion and characteristics of the cases. METHODS: This study analyzed 23 lawsuit judgments involving CRPS that were sentenced from 2005 to 2015. RESULTS: A total of 12 of the 23 cases were partially ruled in favor of the plaintiff. The average amount (KRW) claimed was 470,638,385 ± 860,634,092 (21,000,000 to 4,020,000,000), and that awarded was 72,906,843 ± 53,389,367 (15,000,000 to 181,080,803). Sixteen of the 23 cases had CRPS type I. In 11 of 23 cases, the site of the pain was located in the lower limb and in 14 cases there was no presence of trauma or event prior to medical treatment. CONCLUSION: Nerve injury was the most frequent reason for taking responsibility in compensating damage in malpractice cases involving CRPS. Physicians should consider various possibilities of such complications in medical practices. It is important to identify and improve areas which need to be improved for patient safety through analyzing the lawsuit judgment cases.

Clinical studies on the combiantion of single lower limb traction and massage therapy for the lumbosacral tunnel syndrome / 国际中医中药杂志

Objective To observe the therapeutic effect of single lower limb traction plus massage for the lumbosacral tunnel syndrome.Methods The selected 80 candidate patients were divided into the observation group with 38 patients and treatment group with 39 patients. The observation group received single lower limb traction plus massage and the treatment group received pelvic traction plus massage. Both groups therapy last 5 days, The Japanese orthopaedic association scores (JOA) was evaluated for subjective symptoms, signs, functional activity and bladder function score. The therapeutic effect was evaluated.Results The total effective rate (94.7% vs. 82.1%;χ2=12.160,P=0.007) in the observation group was significantly higher than that in the control group. O, The scores of JOA at one week after treatment (20.2 ± 2.0 vs. 18.3 ± 2.8;t=3.419, P<0.01) and two weeks after treatment (24.4 ± 1. 4vs. 22.6 ± 3.0;t=3.359,P<0.01) in the observation group were significantly higher than those in the control group.Conclusions The single lower limb traction plus massage can improve the clinical symptoms of patients with lumbosacral tunnel syndrome, and be superior to the pelvic traction plus massage.

Ultrasound-guided placement of a permanent peripheral nerve stimulator in a patient with complex regional pain syndrome: A case report

A 56-year-old man complained of continuous pain in the right foot that began 6 months after undergoing surgery on the right calcaneus bone. The patient was diagnosed with complex regional pain syndrome (CRPS) type I and was treated with medication, lumbar sympathetic ganglion blocks, epidural nerve blocks, and spinal cord stimulation. However, all treatments were halted because they were ineffective or complications developed. Peripheral nerve stimulation (PNS) was planned after confirming the analgesic effects of a sciatic nerve block, and the patient received PNS via minimally invasive ultrasound-guided electrode placement. PNS reduced the pain intensity and the incidence of paroxysmal pain. Other than discomfort at the battery insertion site (resolved with re-implantation), the patient developed no complications. These results suggest that ultrasound-guided minimally invasive PNS is a safe and effective treatment for patients with CRPS in the lower extremities.

Relationship Between HbA1c and Complex Regional Pain Syndrome in Stroke Patients With Type 2 Diabetes Mellitus

OBJECTIVE: To investigate the relationship between glycosylated hemoglobin A (HbA1c) and complex regional pain syndrome (CRPS) in stroke patients with type 2 diabetes mellitus (T2DM). METHODS: A retrospective chart review was performed of stroke patients from January 2012 to December 2013. We reviewed 331 patients and included 200 in the analysis. We divided them into CRPS and non-CRPS groups and compared them by age, gender, stroke lesion, cause of stroke, duration of T2DM, HbA1c (%), National Institutes of Health Stroke Scale score, affected shoulder flexor muscle strength, Fugl-Meyer Assessment score, motricity index, Functional Independence Measure, Korean version of Modified Barthel Index, blood glucose level on admission day, duration from stroke onset to HbA1c check, and duration from stroke onset to three-phase bone scan for CRPS diagnosis. Thereafter, we classified the patients into five groups by HbA1c level (group 1, 5.0%–5.9%; group 2, 6.0%–6.9%; group 3, 7.0%–7.9%; group 4, 8.0%–8.9%; and group 5, 9.0%–9.9%) and we investigated the difference in CRPS prevalence between the two groups. RESULTS: Of the 200 patients, 108 were in the CRPS group and 92 were in the non-CRPS group. There were significant differences in HbA1c (p<0.05) between the two groups but no significant differences in any other factors. Across the five HbA1c groups, there were significant differences in CRPS prevalence (p<0.01); specifically, it increased as HbA1c increased. CONCLUSION: This study suggests that higher HbA1c relates to higher CRPS prevalence and thus that uncontrolled blood glucose can affect CRPS occurrence in stroke patients with diabetes.

Bloqueo ganglio estrellado guiado por ultrasonografia / Ultrasound-guided stellate ganglion block

The stellate ganglion block has multiple indications for pain management. The technique has evolved from using anatomical landmarks to image-guided puncture with fluoroscopy and ultrasound. Ultrasonography is a very useful tool that allows for real time visualization of the vascular structures (carotid, vertebral artery), the visceral structures (esophagus) and thus helps in preventing puncture injuries. This article offers a description of the indications, the ultrasound-guided technique and complications under the author's point of view.

El bloqueo del ganglio estrellado tiene múltiples indicaciones para el manejo del dolor, para este fin la técnica ha evolucionado desde la realización por medio de referencias anatómicas, hasta la punción guiada por imágenes como son el fluoroscopio y la ecografía. La ultrasonografia es una herramienta muy útil ya que se puede ver en tiempo real las estructuras vasculares (carótida, arteria vertebral), las estructuras viscerales (esófago) y así evitar puncionarlas. En el presente artículo se hará una descripción de las indicaciones, la técnica guiada por ultrasonografía y las complicaciones, bajo la perspectiva del autor.

Predictive Value of Sympathetic Skin Response in Diagnosing Complex Regional Pain Syndrome: A Case-Control Study

OBJECTIVE: To investigate the predictive value of the sympathetic skin response (SSR) in diagnosing complex regional pain syndrome (CRPS) by comparing three diagnostic modalities-SSR, three-phasic bone scans (TPBS), and thermography. METHODS: Thirteen patients with severe limb pain were recruited. Among them, 6 were diagnosed with CRPS according to the proposed revised CRPS clinical diagnostic criteria described by the International Association for the Study of Pain. SSR was measured in either the hands or feet bilaterally and was considered abnormal when the latency was prolonged. A positive TPBS finding was defined as diffuse increased tracer uptake on the delayed image. Thermographic findings were considered positive if a temperature asymmetry greater than 1.00degrees C was detected between the extremities. RESULTS: Five of 6 CRPS patients showed prolonged latency on SSR (83% sensitivity). TPBS was positive in the 5 CRPS patients who underwent TPBS (100% sensitivity). Thermography was positive in 4 of 5 CRPS patients who underwent the procedure (80% sensitivity). The remaining 7 non-CRPS patients differed on examination. SSR latencies within normal limit were noted in 4 of 7 non-CRPS patients (57% specificity). Results were negative in 4 of 5 non-CRPS patients who underwent TPBS (80% specificity), and negative in 3 of 5 non-CRPS patients who underwent thermography (60% specificity). CONCLUSION: SSR may be helpful in detecting CRPS.

Complex Regional Pain Syndrome Following Percutaneous Trigger Thumb Release / 대한정형외과학회잡지

Trigger finger is one of the most common causes of hand pain and disability. Persistent trigger finger after conservative treatment has been managed with surgical release of the A1 pulley. Percutaneous A1 pulley release is being increasingly performed and many authors have reported comparable outcomes with open surgical release. However, complications have been reported, including incomplete release, flexor tendon injury, and neurovascular injury due to the blind nature of the procedure. We report on a case of a 49-year-old female who presented with features of a type I complex regional pain syndrome (CRPS) following percutaneous A1 pulley release. CRPS is a relatively common complication occurring after trauma and surgical procedures of the upper extremities. We experienced a case of CRPS following percutaneous A1 pulley release which was treated effectively following early diagnosis and through a multidisciplinary approach including physical therapy and medication.

Síndrome de dolor regional complejo / Complex regional pain synndrome

El Síndrome de Dolor Regional Complejo (SDRC) es una enfermedad crónica, que se caracteriza por dolor y alteraciones sensitivas, motoras y autonómicas, a menudo sigue a trauma de un miembro, su curso es variable y, tanto su fisiopatología como el tratamiento, no están claramente establecidos. El objetivo de esta revisión es presentar una actualización de los aspectos generales de la enfermedad y mostrar parte de la evidencia existente en relación a las alternativas terapéuticas de la misma, tanto las conservadoras como las intervencionales. Es importante tener en consideración algunos puntos que limitan el objetivo de obtención de evidencia de buena calidad para el tratamiento de este síndrome. Lo primero es que el diagnóstico es clínico y los criterios para realizarlo han variado en el tiempo. Segundo, es la ausencia de criterios estandarizados para medir los resultados al tratamiento. Y, por último, ya que se trata de un síndrome crónico cuya manifestación principal es el dolor, existe respuesta a placebo...

The Regional Pain Syndrome Complex (CRPS ) is a chronic disease, which is characterized by pain and sensory, motor and autonomic disturbances, often follows trauma, the course and the pathophysiology are variable. The aim of this review is to provide an update on the general aspects of the disease and show the evidence in relation to therapeutic alternatives...

Antiallodynic effects of vitamin C and vitamin E in chronic post-ischemia pain rat model / 대한마취과학회지

BACKGROUND: Recent research has shown that reactive oxygen species (ROS) play a significant role in the development and persistence of neuropathic pain through central sensitization via N-methyl-D-aspartate (NMDA) receptor activation. In the present study, we examined whether the intraperitoneal administration of vitamins C and E alone or together could alleviate mechanical allodynia in a chronic post-ischemia pain (CPIP) rat model. METHODS: Vitamins C and E were administered intraperitoneally to 48 male Sprague Dawley rats once per day for 3 days before hindpaw ischemia-reperfusion (I/R) injury was induced. On the third day, the CPIP rat model was produced by inducing ischemia in the left hindpaw by applying an O-ring for 3 h, followed by reperfusion. Three days after reperfusion, hindpaw mechanical allodynia was assessed by measuring the withdrawal response to von Frey filament stimulation. The rats were sacrificed immediately after behavioral testing to determine the phosphorylated NMDA receptor subunit 1 (pNR1) and extracellular-signal-regulated kinases (pERK) levels in the spinal cord. RESULTS: When the antioxidant vitamins C and E were administered intraperitoneally to CPIP rats, I/R injury-induced mechanical allodynia was attenuated, and pNR1 and pERK levels were decreased in the rat spinal cord. Additionally, the co-administration of both vitamins had an increased antiallodynic effect. CONCLUSIONS: The reduced phosphorylated NR1 and ERK levels indicate that vitamins C and E inhibit the modulation of spinal cord neuropathic pain processing. Co-administration of vitamins C and E had a greater antiallodynic effect.

Expression and function of macrophage migration inhibitory factor in a rat tibia fracture model of complex regional pain syndrome type I / 第二军医大学学报

Objective To investigate the expression of macrophage migration inhibitory factor (MIF) in complex regional pain syndrome I (CRPS I) rat model and the possible efficacy of MIF blockage in treatment of CRPS I. Methods Fifty healthy male SD rats were randomly divided into the following 5 groups: control, sham, model, DMSO control, and ISO-1 (inhibitor of MIF) treatment. CRPSI models were created in the last 3 groups; rats in the ISO-1 treatment group were subcutaneously treated with ISO-1 dissolved in 10 μl 5% DMSO at 1 mg/(kg • d) for 14 d. DMSO control group was only given 10 μl 5% DMSO. The pain threshold and thickness of the hindpaws were measured before and after treatment and were compared. The levels of MIF protein were examined in the serum, skin, spinal cord, sciatic nerve, and cerebrospinal fluid using ELISA and Western blotting analysis. Results Rats in the model group had noticeable hindpaw edema and significantly decreased pain threshold compared with the baselihe and that of the control group(P<0. 01). The hindpaw edema and pain threshold were significantly improved in ISO-1 treatment group compared with those in the model group(P<0. 05). MIF levels in the serum, skin, spinal cord, cerebrospinal fluid and sciatic nerve were higher in the model, DMSO control, and ISO-1 groups compared with those in the control group (P<0. 05 or P<0. 01). Conclusion MIF is a key inflammatory factor of CRPS I, and anti-MIF treatment might be a new therapy for human CRPS I.

Spinal Cord Stimulation in Pain Management: A Review

Spinal cord stimulation has become a widely used and efficient alternative for the management of refractory chronic pain that is unresponsive to conservative therapies. Technological improvements have been considerable and the current neuromodulation devices are both extremely sophisticated and reliable in obtaining good results for various clinical situations of chronic pain, such as failed back surgery syndrome, complex regional pain syndrome, ischemic and coronary artery disease. This technique is likely to possess a savings in costs compared with alternative therapy strategies despite its high initial cost. Spinal cord stimulation continues to be a valuable tool in the treatment of chronic disabling pain.

Relationship between Complex Regional Pain Syndrome and Working Life: A Korean Study

Complex regional pain syndrome affects the quality of life of the patient. The aim of this study was to investigate the epidemiological features of this syndrome and evaluate its effect on the patient's working life. We demonstrated that the disease has a male preponderance and is 3 times more likely to affect the lower extremities. In this study, 11 participants (20%) retained their employment, whereas 44 (80%) became unemployed. Mean age and pain score were lower in the employment group than in the unemployment group (29.1 +/- 16.8 yr vs 40.1 +/- 12.6 yr, P = 0.021, and 4.5 +/- 2.9 vs 7.0 +/- 2.0, P = 0.002, respectively). Subjects diagnosed within 8 months (P = 0.044), those who had achieved higher levels of education (P = 0.028), and those working in white-collar jobs (P = 0.011) had higher employment-retention rates. Therefore, patients must manage their jobs (lower physical demand and decrease the number of working hours) if they are to improve their occupational life. To achieve satisfactory outcomes and a high employment-retention rate, clinicians must be aware of the importance of an early diagnosis (within 8 months), appropriate treatment, and a reduction in the patient's pain score.

Incidência de síndrome dolorosa regional após cirurgia para descompressão do túnel do carpo: existe correlação com a técnica anestésica realizada? / Incidence of regional pain syndrome after carpal tunnel release: is there a correlation with the anesthetic technique? / Incidencia del síndrome doloroso regional posterior a la cirugía para la descompresión del túnel del carpo: ¿ existe una correlación con la técnica anestésica realizada?

JUSTIFICATIVA E OBJETIVOS: A síndrome dolorosa complexa regional (SDCR), anteriormente conhecida como distrofia simpático-reflexa, descreve um conjunto de sinais e sintomas que incluem dor, sudorese e instabilidade vasomotora. A dor geralmente é desencadeada por estímulo nocivo em um nervo periférico e se mostra desproporcional ao estímulo desencadeante. Seu aparecimento após cirurgia não é incomum, variando com a intervenção. Após descompressão do túnel do carpo (DTC), descreve-se incidência de 2,1 por cento a 5 por cento. O bloqueio simpático pode prevenir o aparecimento de SDCR, mas nenhum estudo validou essa técnica como prevenção da SCR após cirurgia para DTC. O objetivo do estudo foi definir a incidência de SDCR após cirurgia de DTC e sua relação com quatro técnicas de anestesia. MÉTODO: Os pacientes foram distribuídos aleatoriamente e receberam uma das técnicas: anestesia geral, anestesia venosa regional com lidocaína, anestesia venosa regional com lidocaína e clonidina ou bloqueio de plexo axilar. No pós-operatório, foram acompanhados por uma enfermeira que desconhecia a técnica utilizada, fazendo-se o seguimento pelo prontuário eletrônico até 6 meses depois da anestesia. Nesse período, foram pesquisados sinais e sintomas típicos de SDCR e, em caso positivo, instituiu-se o tratamento. Foi realizada avaliação descritiva, empregando-se o Qui-quadrado. RESULTADOS: Foram estudados 301 pacientes. Destes, 25 desenvolveram SDCR configurando uma incidência de 8,3 por cento. Não houve predominância entre as técnicas de anestesia. Foram pesquisados outros fatores como: tabagismo, profissão e outras doenças concomitantes e nenhum mostrou relação com o desenvolvimento de SDCR após DTC. CONCLUSÕES: A incidência de SDCR após cirurgia para DTC é de 8,3 por cento sem relação com as técnicas anestésicas estudadas.

BACKGROUND AND OBJECTIVE: Complex regional pain syndrome (CRPS) previously known as reflex sympathetic dystrophy refers to a set of signs and symptoms that include pain, increased sweating, and vasomotor instability. Pain is usually triggered by a noxious stimulus in a peripheral nerve, which is disproportionate to the triggering stimulus. Its development after surgery is not uncommon varying with the type of intervention. An incidence of 2.1 to 5 percent has been reported after carpal tunnel release (CTR). Sympathetic blockade may prevent the onset of CRPS. However, there is no study validating this technique to prevent CRPS after CTR. The objective of the present study was to define the incidence of CRPS after CTR and its relationship with four anesthetic techniques. METHODS: Patients were randomly distributed to undergo one of the following techniques: general anesthesia, regional intravenous anesthesia with lidocaine, regional intravenous anesthesia with lidocaine and clonidine, or axillary plexus block. Postoperatively, they were followed-up by a nurse who was unaware of the anesthetic technique used, and follow-up was done through electronic patient records for up to 6 months after the anesthesia. During this period signs and symptoms typical of CRPS were investigated and, if positive, treatment was instituted. A descriptive evaluation using the chi-square test was performed. RESULTS: Three-hundred and one patients were investigated. Twenty-five of them developed CRPS, an incidence of 8.3 percent. Predominance was not observed among the anesthetic techniques used. Other factors such as smoking, profession, and other concomitant diseases were also investigated, and none showed a relationship with the development of post-CTR CRPS. CONCLUSIONS: Complex regional pain syndrome has an incidence of 8.3 percent after CTR surgery without association with the anesthetic techniques investigated.

JUSTIFICATIVA Y OBJETIVOS: El síndrome doloroso complejo regional (SDCR), anteriormente conocido como distrofia simpático refleja, es un conjunto de señales y de síntomas que incluyen dolor, sudoresis e inestabilidad vasomotora. El dolor generalmente se desencadena por un estímulo nocivo en un nervio periférico, y no es proporcional al estímulo que lo desencadena. Su aparición después de la cirugía no es algo poco frecuente, variando con la intervención. Posteriormente a la descompresión del túnel del carpo (DTC), vemos una incidencia de 2,1-5 por ciento. El bloqueo simpático puede prevenir la aparición de SDCR. Pero ningún estudio ha refrendado esa técnica como prevención de la SCR después de una cirugía para DTC. El objetivo del estudio fue definir la incidencia de SDCR después de una cirugía de DTC y su relación con cuatro técnicas de anestesia. MÉTODO: Los pacientes se distribuyeron aleatoriamente y recibieron una de las siguientes técnicas: anestesia general, anestesia venosa regional con lidocaína, anestesia venosa regional con lidocaína y clonidina o bloqueo del plexo axilar. En el postoperatorio, estuvieron acompañados por una enfermera que no conocía la técnica utilizada, y se hizo el seguimiento por medio de los datos de la historia clínica electrónica hasta 6 meses después de la anestesia. En ese período, se investigaron las señales y los síntomas típicos de SDCR y en caso positivo, se inició el tratamiento. Fue realizada una evaluación descriptiva, usando el Xi-Cuadrado (Xi²). RESULTADOS: Se estudiaron 301 pacientes. De ellos, 25 desarrollaron SDCR, configurando una incidencia de un 8,3 por ciento. No hubo una predominancia entre las técnicas de anestesia. Se investigaron otros factores, como el tabaquismo, la profesión y otras enfermedades concomitantes, y ningún caso se registró con relación al desarrollo de SDCR posterior a la DTC. CONCLUSIONES: La incidencia de SDCR después de la cirugía para DTC está en el umbral del 8,3 por ciento sin que exista una relación con las técnicas anestésicas estudiadas.

Diagnosis and Treatment of Complex Regional Pain Syndrome / 한양의대학술지

Complex regional pain syndromes (CRPS) are neuropathic pain disorders of one or more extremities developing inadequately after trauma or lesions in the peripheral or central nervous system (CNS). However, CRPS may also develop spontaneously. CRPS are clinically characterized by sensory (pain, hyperalgesia, and allodynia), autonomic (disturbances of skin temperature, color change, and presence of sweating abnormalities), and motor (paresis, tremor, and dystonia) disturbances. There has been growing evidence claiming that CRPS is a systemic disease involving the CNS and peripheral nervous system. The diagnosis is mainly based on clinical symptoms and signs, so that it could be under or over diagnosed. However, careful clinical evaluation and additional tests should lead to an adequate diagnosis. The goal of treatment is to improve function, relieve pain, and achieve remission. The clinical management of CRPS involves pharmacotherapy, non pharmacological pain coping skills such as physical, psychological and interventional therapies. Timely diagnosis and validation of clinical presentation for CRPS may result in a better outcome.

Terapia com caixa de espelhos na síndrome dolorosa regional complexa tipo I / Mirror box therapy in the complex regional pain syndrome type I

A Síndrome dolorosa regional complexa (SDRC) tipo I é um quadro de dor neuropática, que afeta, sobretudo as extremidades dos membros após evento traumático e/ou período de imobilização, na ausência de lesão nervosa. Para além da dor, as características clínicas incluem alterações vasomotoras regionais e freqüentemente limitação da mobilidade da extremidade envolvida. Não está totalmente esclarecida a sua causa e existem poucos consensos em relação ao tratamento ideal. A caixa de espelhos é uma modalidade terapêutica baseada no feedback visual, como forma de construção de uma nova imagem mental do membro afetado, promovendo a reorganização cortical. Esta técnica tem sido utilizada na recuperação motora ou no controlo da dor em situações como o acidente vascular cerebral e o SDRC tipo I.

Complex regional pain syndrome (CRPS) type I is a neuropathic pain condition, commonly affecting a limb extremity after a traumatic event and/or a period of immobilization, in the absence of nerve injury. Besides pain, the clinical features include regional vasomotor alterations and usually a decreased range of motion in the affected extremity. Its actual cause remains somewhat obscure and there are few agreements on optimal treatment. The mirror box is a therapeutic approach based on visual feedback as a way to achieve a new mental imagery of the affected limb by promoting cortical reorganization. This approach has been used for the motor recovery or pain relief in conditions such as stroke or type-I CRPS.