Evidence based guidelines for complex regional pain syndrome type 1

Abstract

BackgroundTreatment of complex regional pain syndrome type I (CRPS-I) is subject to discussion. The purpose of this study was to develop multidisciplinary guidelines for treatment of CRPS-I.MethodA multidisciplinary task force graded literature evaluating treatment effects for CRPS-I according to their strength of evidence, published between 1980 to June 2005. Treatment recommendations based on the literature findings were formulated and formally approved by all Dutch professional associations involved in CRPS-I treatment.ResultsFor pain treatment, the WHO analgesic ladder is advised with the exception of strong opioids. For neuropathic pain, anticonvulsants and tricyclic antidepressants may be considered. For inflammatory symptoms, free-radical scavengers (dimethylsulphoxide or acetylcysteine) are advised. To promote peripheral blood flow, vasodilatory medication may be considered. Percutaneous sympathetic blockades may be used to increase blood flow in case vasodilatory medication has insufficient effect. To decrease functional limitations, standardised physiotherapy and occupational therapy are advised. To prevent the occurrence of CRPS-I after wrist fractures, vitamin C is recommended. Adequate perioperative analgesia, limitation of operating time, limited use of tourniquet, and use of regional anaesthetic techniques are recommended for secondary prevention of CRPS-I.ConclusionsBased on the literature identified and the extent of evidence found for therapeutic interventions for CRPS-I, we conclude that further research is needed into each of the therapeutic modalities discussed in the guidelines.

Update on the pathogenesis of complex regional pain syndrome: Role of oxidative stress

“…The clinical picture comprises a characteristic clinical triad of symptoms including autonomic (disturbance of skin temperature, presence of sweating abnormalities in the affected region), sensory (pain, hyperalgesia), and motor (paresis, tremor, dystonia) disturbances. [3][4][5] Impaired microcirculation during the chronic stage of CRPS is related to increased vasoconstriction, tissue hypoxia, and metabolic acidosis of the tissues of the affected limb. 6 Epidemiological studies indicate that there are at least 50,000 new cases of CRPS I annually in the United States.…”

“…1,2 The most common initiating events are surgery, nerve compression, fractures, tissue trauma, ischemia, and sprains. 2,3 Based on previous evidence from clinical trials and animals studies, the general hypothesis is that CRPS is a disease of the central nervous system. The clinical picture comprises a characteristic clinical triad of symptoms including autonomic (disturbance of skin temperature, presence of sweating abnormalities in the affected region), sensory (pain, hyperalgesia), and motor (paresis, tremor, dystonia) disturbances.…”

Patchy Osteoporosis in Complex Regional Pain Syndrome

“…The IASP task force proposed a definition based on four criteria (Harden et al, 2007). (Table 1) In addition, involuntary movements, muscle spasm, paresis, pseudoparalysis, skin, muscle and bone atrophy, hyperhidrosis and changes in hair and nail growth, can also be observed (Perez et al, 2010;Veldman et al, 1993).…”

'Kompleks Bölgesel Ağrı Sendromu' Başlıklı Derleme Hakkında Görüşler

“…Authors stated the used steroid dose as 30 mg/d by referring few of previous trials. Some other reports used higher doses ranging between 40 mg/d and 80 mg/d with various durations (7,8). There is still no certainty of steroid usage regarding the dose and duration in CRPS (7,8).…”