Neurological findings in complex regional pain syndromes - analysis of 145 cases

Abstract

Early diagnosis is a prerequisite for a successful treatment of complex regional pain syndrome (CRPS). In order to describe neurological symptoms which characterize CRPS, we evaluated 145 patients prospectively. Two-thirds of these were women, the mean age at time of investigation was 50.4 years. CRPS followed limb trauma, surgery and nerve lesion. Employing the current IASP criteria 122 patients were classified as CRPS I and 23 as CRPS II. All patients were assessed clinically pain was quantified using the McGill pain questionnaire, skin temperature was measured by an infrared thermometer and a subgroup of 57 patients was retested in order to determine thermal thresholds (QST). Of our patients 42% reported stressful life events in a close relationship to the onset of CRPS and 41% had a history of chronic pain before CRPS. The latter group of patients gave a higher rating of CRPS pain (P<0.05). The major symptoms were pain at rest in 77% and hyperalgesia in 94%. Typical pain was deep in the limb having a tearing character. Patients getting physical therapy had significantly less pain than those without (P<0.04). Autonomic signs were frequent (98%) and often changed with the duration of CRPS. Skin temperature was warmer in acute and colder in chronic stages (P<0.001). Likewise edema had a higher incidence in acute stages (P<0.001). We found no correlation between pain and autonomic dysfunction. Motor dysfunction (present in 97%) included weakness, tremor, exaggerated tendon reflexes, dystonia or myoclonic jerks. QST revealed increased warm perception thresholds (P<0.02) and decreased cold pain thresholds (P<0.03) of the affected limb. The detailed knowledge of clinical features of CRPS could help physicians early to recognize the disease and thus to improve therapy outcome.

Antagonism of Supraspinal Histamine H3 Receptors Modulates Spinal Neuronal Activity in Neuropathic Rats

“…This heightened level of spontaneous firing may also indicate that there was ongoing or non-evoked discomfort in the animal because higher levels of WDR activity code for increased somatosensory intensity. Non-evoked pain is observed in the majority of patients with chronic pain and is a primary reason for seeking medical care (Birklein et al, 2000;Backonja and Stacey, 2004). There have been recent advances in measuring nonevoked pain in animals, but this is still a difficult endpoint to accurately assess (King et al, 2009;Langford et (2006) have reported that heightened spontaneous discharges of WDR neurons are either reduced or unaltered by drugs that are effective or ineffective, respectively, in treating non-evoked pain in humans.…”

Immunotherapy Prospects for Painful Small-fiber Sensory Neuropathies and Ganglionopathies

“…3) [42][43][44], and epidemiological studies finding no association with psychopathology [45,46]. As CRPS resolves, which it usually does even without treatment [47], the edema, temperature changes, hyperhidrosis, and abnormal hair growth usually resolve before the pain [48,49], so late-stage patients often no longer meet diagnostic criteria for CRPS but only for posttraumatic neuralgia, demonstrating that these are on a continuum (Fig. 4).…”

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