Amputation for Long-Standing, Therapy-Resistant Type-I Complex Regional Pain Syndrome

KransSchreuder, H K; Bodde, Marlies I; Schrier, Ernst; Dijkstra, Pieter U.; Dungen, Jan A van den; Dunnen, Wilfred F. A. den; Geertzen, Jan H. B.

doi:10.2106/jbjs.l.00532

Cited by 36 publications

(49 citation statements)

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“…A systematic review on CRPS-I and amputation could not find enough evidence for or against amputation [8]. Results from our recent study in a group of 21 patients who had an amputation because of longstanding and therapy-resistant CRPS-I did show an overall improvement of life in general and improvements in pain intensity, quality of life, mobility, use of a prosthesis and job or study enrolment [6]. It is unknown why patients from this study have better results than most other patients described in literature [6,8].…”

Section: Introductionmentioning

confidence: 80%

“…The scores range in each domain from 4 to 20; higher scores indicate better quality of life in a certain domain. The results of the WHOQOL-Bref of 21 patients included in this study have been described previously [6].…”

Section: Questionnairesmentioning

confidence: 99%

“…Main results from these interviews have been published [6]. Patients were asked if they still experienced CRPS-I related symptoms, stump pain and phantom pain in the two weeks before the visit.…”

Section: Interview and Physical Examinationmentioning

confidence: 99%

“…However, not all patients respond to these therapies and in some patients CRPS-I may further develop into a dysfunctional limb with uncontrollable pain or life-threatening infection [3][4][5]. Sometimes a patient requests an amputation of the affected limb as a last resort [6,7].…”

Section: Introductionmentioning

confidence: 99%

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Resilience in patients with amputation because of Complex Regional Pain Syndrome type I

Bodde¹,

Schrier²,

Krans³

et al. 2013

Disability and Rehabilitation

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The results confirmed our hypothesis that patients with an amputation because of CRPS-I who have a higher resilience also have a higher quality of life and experience lower psychological distress. The prognostic value of resilience in this patient group requires further research. Implications for Rehabilitation Until characteristics of patients with positive quality of life outcome have been further unraveled, amputation for CRPS-I should only be performed in expertise centers. Resilience, the process of adapting well in the face of adversity, should be further explored in Rehabilitation Medicine research in general. Measurement of resilience should be a standard procedure when patients with CRPS-I request an amputation. Improving resilience of patients in in- and outpatient rehabilitation clinics might be an additional treatment in rehabilitation care.

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Section: Introductionmentioning

confidence: 80%

Section: Questionnairesmentioning

confidence: 99%

Section: Interview and Physical Examinationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Resilience in patients with amputation because of Complex Regional Pain Syndrome type I

Bodde¹,

Schrier²,

Krans³

et al. 2013

Disability and Rehabilitation

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“…Eine insofern alleinstehende Studie berichtete über positive Ergebnisse nach Amputation bei 22 Patienten mit CRPS [ 66 ] . Trotzdem sollte von solchen Therapieoptionen unbedingt abgesehen werden.…”

Section: Amputationenunclassified

Neues aus der Forschung zum Komplexen Regionalen Schmerzsyndrom (CRPS)

2013

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▼ Complex regional pain syndrome (CRPS) typically develops following extremity injuries and is characterised by distally generalised sensory, motor, trophic, vaso-and sudomotor dysfunctions, as well as joint affl iction. CRPS cases without nerve lesions are defi ned as type I -those involving nerve damage as type II. The diagnosis is primarily based on the clinical presentation using the so called 'Budapest criteria'. Important for the diagnosis is the exclusion of other potential conditions which could account for the patient-reported symptoms and demonstrable clinical signs. Triple-phase bone scans are helpful for the early and diff erential diagnosis due to their high specifi city (98 %), although their sensitivity decreases as the disease progresses. In the acute stage of the disease, pro-infl ammatory factors seem to play an important role, allowing for a potential therapeutic approach. As the disease progresses, however, they are unrelated to the clinical severity. Chronic stages are primarily determined by central nervous system changes including a reduced cortical representation of the aff ected limb, changes in body scheme, neglectlike symptoms, as well as dystonic deformities. The most common sensory abnormality is pressure hyperalgesia over muscles, most likely a result of peripheral sensitisation. In addition to the clinically detectable focal autonomic disorders, more generalised autonomic dysfunction is also found. The pathogenesis of dystonic symptoms, however, remains poorly understood, making therapeutic treatment more diffi cult. Treatment of CRPS should be multimodal and take place in a multi-disciplinary setting, adapted to the level of pain. Invasive interventions should be limited to strict indications and specialised centres.

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Patient consultation about a trial of therapeutic plasma exchange for complex regional pain syndrome

Göebel

Callaghan

Jones

et al. 2018

J of Clinical Apheresis

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Background Complex regional pain syndrome (CRPS) is a severe post‐traumatic chronic pain condition affecting distal limbs, for which few effective treatments exist. Complex regional pain syndrome is listed in the 2016 American Society for Apheresis guidelines as an indication for plasma exchange treatment, but patient perspectives are lacking. Study design and methods We convened a “patient and public consultation exercise.” Supervised by a clinical ethicist, the case for using therapeutic plasma exchange (TPE) was presented by a researcher and two TPE experts to five patients with severe, long‐standing CRPS and to one relative. Discussions were recorded and transcribed. Results Participants supported the technology's use but expressed concern that the small trauma of repeat cannulations of CRPS unaffected limbs might theoretically cause a spread of the condition, a risk which requires highlighting when taking consent. For a preliminary trial, the participants proposed to include no less than 10, preferably 20 participants. They suggested that the threshold for a decision to conduct a definite trial based on preliminary trial results should be set no higher than 1/5 patients achieving >30% pain reduction in the preliminary trial, with half of these responders achieving >50%. The use of sham‐TPE and a long trial duration (1 year) of a definite, parallel trial was considered acceptable, provided patients would be offered voluntary swap to the other trial arm at the end of the main trial period. Conclusion These results provide pertinent patient views about TPE treatment which can inform both clinical consultation and consent procedure and the design of future trials.

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Amputation for Long-Standing, Therapy-Resistant Type-I Complex Regional Pain Syndrome

Abstract: Amputation may positively contribute to the lives of patients with long-standing, therapy-resistant type-I complex regional pain syndrome. Patients were likely to use a prosthesis after a lower-limb amputation. The risk of recurrence of the type-I complex regional pain syndrome was 24%.

Cited by 36 publications

References 1 publication

Resilience in patients with amputation because of Complex Regional Pain Syndrome type I

Resilience in patients with amputation because of Complex Regional Pain Syndrome type I

Neues aus der Forschung zum Komplexen Regionalen Schmerzsyndrom (CRPS)

Patient consultation about a trial of therapeutic plasma exchange for complex regional pain syndrome

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