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Dall'Asta A, Volpi L, Morganelli G, Ghi T. Added value of intrapartum recording of the maternal heart rate as an adjunct to fetal monitoring using external ultrasound transducer: not only about artifacts. Am J Obstet Gynecol 2024; 231:e47-e50. [PMID: 38453130 DOI: 10.1016/j.ajog.2024.02.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 02/29/2024] [Indexed: 03/09/2024]
Affiliation(s)
- Andrea Dall'Asta
- Obstetrics and Gynecology Unit, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy.
| | - Lavinia Volpi
- Obstetrics and Gynecology Unit, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Giovanni Morganelli
- Obstetrics and Gynecology Unit, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Tullio Ghi
- Obstetrics and Gynecology Unit, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy
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Hotta J, Saari J, Harno H, Kalso E, Forss N, Hari R. Somatotopic disruption of the functional connectivity of the primary sensorimotor cortex in complex regional pain syndrome type 1. Hum Brain Mapp 2023; 44:6258-6274. [PMID: 37837646 PMCID: PMC10619416 DOI: 10.1002/hbm.26513] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 06/16/2023] [Accepted: 09/17/2023] [Indexed: 10/16/2023] Open
Abstract
In complex regional pain syndrome (CRPS), the representation area of the affected limb in the primary sensorimotor cortex (SM1) reacts abnormally during sensory stimulation and motor actions. We recorded 3T functional magnetic resonance imaging resting-state data from 17 upper-limb CRPS type 1 patients and 19 healthy control subjects to identify alterations of patients' SM1 function during spontaneous pain and to find out how the spatial distribution of these alterations were related to peripheral symptoms. Seed-based correlations and independent component analyses indicated that patients' upper-limb SM1 representation areas display (i) reduced interhemispheric connectivity, associated with the combined effect of intensity and spatial extent of limb pain, (ii) increased connectivity with the right anterior insula that positively correlated with the duration of CRPS, (iii) increased connectivity with periaqueductal gray matter, and (iv) disengagement from the other parts of the SM1 network. These findings, now reported for the first time in CRPS, parallel the alterations found in patients suffering from other chronic pain conditions or from limb denervation; they also agree with findings in healthy persons who are exposed to experimental pain or have used their limbs asymmetrically. Our results suggest that CRPS is associated with a sustained and somatotopically specific alteration of SM1 function, that has correspondence to the spatial distribution of the peripheral manifestations and to the duration of the syndrome.
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Affiliation(s)
- Jaakko Hotta
- Department of Neuroscience and Biomedical EngineeringAalto University School of ScienceEspooFinland
- Aalto NeuroImagingAalto UniversityEspooFinland
- Department of NeurologyHelsinki University Hospital and Clinical Neurosciences, Neurology, University of HelsinkiHelsinkiFinland
| | - Jukka Saari
- Department of Neuroscience and Biomedical EngineeringAalto University School of ScienceEspooFinland
- Aalto NeuroImagingAalto UniversityEspooFinland
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland
| | - Hanna Harno
- Department of NeurologyHelsinki University Hospital and Clinical Neurosciences, Neurology, University of HelsinkiHelsinkiFinland
- Department of Anaesthesiology, Intensive Care and Pain MedicineUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Eija Kalso
- Department of Anaesthesiology, Intensive Care and Pain MedicineUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Nina Forss
- Department of Neuroscience and Biomedical EngineeringAalto University School of ScienceEspooFinland
- Department of NeurologyHelsinki University Hospital and Clinical Neurosciences, Neurology, University of HelsinkiHelsinkiFinland
| | - Riitta Hari
- Department of Neuroscience and Biomedical EngineeringAalto University School of ScienceEspooFinland
- Department of Art and MediaAalto University School of Arts, Design and ArchitectureHelsinkiFinland
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Harden RN, McCabe CS, Goebel A, Massey M, Suvar T, Grieve S, Bruehl S. Complex Regional Pain Syndrome: Practical Diagnostic and Treatment Guidelines, 5th Edition. PAIN MEDICINE (MALDEN, MASS.) 2022; 23:S1-S53. [PMID: 35687369 PMCID: PMC9186375 DOI: 10.1093/pm/pnac046] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 11/23/2022]
Abstract
There have been some modest recent advancements in the research of Complex Regional Pain Syndrome, yet the amount and quality of the work in this complicated multifactorial disease remains low (with some notable exceptions; e.g., the recent work on the dorsal root ganglion stimulation). The semi-systematic (though in some cases narrative) approach to review is necessary so that we might treat our patients while waiting for "better research." This semi-systematic review was conducted by experts in the field, (deliberately) some of whom are promising young researchers supplemented by the experience of "elder statesman" researchers, who all mention the system they have used to examine the literature. What we found is generally low- to medium-quality research with small numbers of subjects; however, there are some recent exceptions to this. The primary reason for this paucity of research is the fact that this is a rare disease, and it is very difficult to acquire a sufficient sample size for statistical significance using traditional statistical approaches. Several larger trials have failed, probably due to using the broad general diagnostic criteria (the "Budapest" criteria) in a multifactorial/multi-mechanism disease. Responsive subsets can often be identified in these larger trials, but not sufficient to achieve statistically significant results in the general diagnostic grouping. This being the case the authors have necessarily included data from less compelling protocols, including trials such as case series and even in some instances case reports/empirical information. In the humanitarian spirit of treating our often desperate patients with this rare syndrome, without great evidence, we must take what data we can find (as in this work) and tailor a treatment regime for each patient.
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Affiliation(s)
- R Norman Harden
- Departments of PM&R and Physical Therapy and Human Movement Sciences, Northwestern University
| | - Candida S McCabe
- University of the West of England, Stapleton, Bristol, UK
- Dorothy House Hospice, Bradford-on-Avon, Wilts, UK
| | - Andreas Goebel
- Pain Research Institute, Faculty of Health and Life Science, University of Liverpool, Liverpool, UK
| | - Michael Massey
- CentraCare Neurosciences Pain Center, CentraCare, St. Cloud, Minnesota, USA
| | - Tolga Suvar
- Department of Anesthesiology and Pain Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Sharon Grieve
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Centers, Nashville, Tennessee, USA
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Duenes M, Schoof L, Schwarzkopf R, Meftah M. Complex Regional Pain Syndrome Following Total Knee Arthroplasty. Orthopedics 2020; 43:e486-e491. [PMID: 33002178 DOI: 10.3928/01477447-20200923-05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 09/24/2019] [Indexed: 02/03/2023]
Abstract
Complex regional pain syndrome (CRPS) is an uncommon cause of residual pain after total knee arthroplasty (TKA). The presentation is variable, and there is no gold standard diagnostic test. Diagnosis is more difficult after TKA because some classic signs of CRPS may be unreliable and imaging may be difficult to interpret. Early intervention is the most important factor in predicting improvement, necessitating high suspicion in patients with exaggerated pain and stiffness after excluding more common causes. This article reviews the literature regarding CRPS following TKA, explains the diagnosis, and discusses treatment. [Orthopedics. 2020;43(6):e486-e491.].
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Momoli A, Giarretta S, Modena M, Micheloni GM. The painful knee after total knee arthroplasty: evaluation and management. ACTA BIO-MEDICA : ATENEI PARMENSIS 2017. [PMID: 28657566 PMCID: PMC6179006 DOI: 10.23750/abm.v88i2-s.6515] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Total knee arthroplasty (TKA) is the treatment of choice for end-stage osteoarthritis of the knee. The aging of population and the need to maintain high quality of life have increased the demand for TKA. Although considered a successful procedure, 15-30% of patients presenting persistent pain. The management of these patients requires a clinical, laboratory and radiological assessment in order to address the underlying aetiology. There are several causes of pain, divided in joint and non-joint related, which should be diagnosed and treated promptly. Patients with unexplained pain should be treated conservatively since a plausible reason has been identified. (www.actabiomedica.it)
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Momoli A, Giarretta S, Modena M, Micheloni GM. The painful knee after total knee arthroplasty: evaluation and management. ACTA BIO-MEDICA : ATENEI PARMENSIS 2017; 88:60-67. [PMID: 28657566 DOI: 10.23750/abm.v88i2 -s.6515] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 06/01/2017] [Indexed: 12/27/2022]
Abstract
Total knee arthroplasty (TKA) is the treatment of choice for end-stage osteoarthritis of the knee. The aging of population and the need to maintain high quality of life have increased the demand for TKA. Although considered a successful procedure, 15-30% of patients presenting persistent pain. The management of these patients requires a clinical, laboratory and radiological assessment in order to address the underlying aetiology. There are several causes of pain, divided in joint and non-joint related, which should be diagnosed and treated promptly. Patients with unexplained pain should be treated conservatively since a plausible reason has been identified.
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Abstract
Background Persistent idiopathic facial pain (PIFP) is a chronic disorder recurring daily for more than two hours per day over more than three months, in the absence of clinical neurological deficit. PIFP is the current terminology for Atypical Facial Pain and is characterized by daily or near daily pain that is initially confined but may subsequently spread. Pain cannot be attributed to any pathological process, although traumatic neuropathic mechanisms are suspected. When present intraorally, PIFP has been termed ‘Atypical Odontalgia’, and this entity is discussed in a separate article in this special issue. PIFP is often a difficult but important differential diagnosis among chronic facial pain syndromes. Aim To summarize current knowledge on diagnostic criteria, differential diagnosis, pathophysiology and management of PIFP. Methods We present a narrative review reporting current literature and personal experience. Additionally, we discuss and differentiate the common differential diagnoses associated with PIFP including traumatic trigeminal neuropathies, regional myofascial pain, atypical neurovascular pains and atypical trigeminal neuropathic pains. Results and conclusion The underlying pathophysiology in PIFP is still enigmatic, however neuropathic mechanisms may be relevant. PIFP needs interdisciplinary collaboration to rule out and manage secondary causes, psychiatric comorbidities and other facial pain syndromes, particularly trigeminal neuralgia. Burden of disease and psychiatric comorbidity screening is recommended at an early stage of disease, and should be addressed in the management plan. Future research is needed to establish clear diagnostic criteria and treatment strategies based on clinical findings and individual pathophysiology.
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Affiliation(s)
| | - Charly Gaul
- Migraine and Headache Clinic Königstein, Königstein im Taunus, Germany
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Sekino Y, Nakano J, Hamaue Y, Chuganji S, Sakamoto J, Yoshimura T, Origuchi T, Okita M. Sensory hyperinnervation and increase in NGF, TRPV1 and P2X3expression in the epidermis following cast immobilization in rats. Eur J Pain 2013; 18:639-48. [DOI: 10.1002/j.1532-2149.2013.00412.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2013] [Indexed: 12/31/2022]
Affiliation(s)
- Y. Sekino
- Department of Locomotive Rehabilitation Science; Unit of Rehabilitation Sciences; Nagasaki University Graduate School of Biomedical Sciences; Japan
| | - J. Nakano
- Department of Physical Therapy Science; Unit of Physical and Occupational Therapy Sciences; Nagasaki University Graduate School of Biochemical Sciences; Japan
| | - Y. Hamaue
- Department of Locomotive Rehabilitation Science; Unit of Rehabilitation Sciences; Nagasaki University Graduate School of Biomedical Sciences; Japan
| | - S. Chuganji
- Department of Physical Therapy Science; Unit of Physical and Occupational Therapy Sciences; Nagasaki University Graduate School of Biochemical Sciences; Japan
| | - J. Sakamoto
- Department of Rehabilitation; Nagasaki University Hospital; Japan
| | - T. Yoshimura
- Department of Locomotive Rehabilitation Science; Unit of Rehabilitation Sciences; Nagasaki University Graduate School of Biomedical Sciences; Japan
| | - T. Origuchi
- Department of Locomotive Rehabilitation Science; Unit of Rehabilitation Sciences; Nagasaki University Graduate School of Biomedical Sciences; Japan
| | - M. Okita
- Department of Locomotive Rehabilitation Science; Unit of Rehabilitation Sciences; Nagasaki University Graduate School of Biomedical Sciences; Japan
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Harden RN, Oaklander AL, Burton AW, Perez RSGM, Richardson K, Swan M, Barthel J, Costa B, Graciosa JR, Bruehl S. Complex regional pain syndrome: practical diagnostic and treatment guidelines, 4th edition. PAIN MEDICINE 2013; 14:180-229. [PMID: 23331950 DOI: 10.1111/pme.12033] [Citation(s) in RCA: 292] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE This is the fourth edition of diagnostic and treatment guidelines for complex regional pain syndrome (CRPS; aka reflex sympathetic dystrophy). METHODS Expert practitioners in each discipline traditionally utilized in the treatment of CRPS systematically reviewed the available and relevant literature; due to the paucity of levels 1 and 2 studies, less rigorous, preliminary research reports were included. The literature review was supplemented with knowledge gained from extensive empirical clinical experience, particularly in areas where high-quality evidence to guide therapy is lacking. RESULTS The research quality, clinical relevance, and "state of the art" of diagnostic criteria or treatment modalities are discussed, sometimes in considerable detail with an eye to the expert practitioner in each therapeutic area. Levels of evidence are mentioned when available, so that the practitioner can better assess and analyze the modality under discussion, and if desired, to personally consider the citations. Tables provide details on characteristics of studies in different subject domains described in the literature. CONCLUSIONS In the humanitarian spirit of making the most of all current thinking in the area, balanced by a careful case-by-case analysis of the risk/cost vs benefit analysis, the authors offer these "practical" guidelines.
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Affiliation(s)
- R Norman Harden
- Center for Pain Studies, Rehabilitation Institute of Chicago, Illinois 60611, USA.
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Heir GM, Nasri-Heir C, Thomas D, Puchimada BP, Khan J, Eliav E, Benoliel R. Complex regional pain syndrome following trigeminal nerve injury: report of 2 cases. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 114:733-9. [DOI: 10.1016/j.oooo.2012.06.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 05/29/2012] [Accepted: 06/01/2012] [Indexed: 11/27/2022]
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Hudson ML, McCormick K, Zalucki N, Moseley GL. Expectation of pain replicates the effect of pain in a hand laterality recognition task: Bias in information processing toward the painful side? Eur J Pain 2012; 10:219-24. [PMID: 16490729 DOI: 10.1016/j.ejpain.2005.03.009] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2004] [Accepted: 03/18/2005] [Indexed: 11/26/2022]
Abstract
BACKGROUND People in pain, or expecting pain, sometimes bias their attention towards pain-relevant cues. Perhaps they also bias their attention towards the body part in question. AIM To determine if experimentally induced pain, and the expectation of pain, involve an information processing bias towards the hand in question. METHODS Seventeen asymptomatic subjects performed a hand laterality recognition task during three conditions: control, during hand pain induced by intramuscular injection of hypertonic saline (pain), and during expectation of hand pain, induced by isotonic saline injection (expectation). Mean response time (RT) was determined for three 45 s epochs within each condition and RT was compared between hands, conditions and epochs using a 2 x 3 x 3 repeated measures multivariate analysis of variance. RESULTS There was a hand x condition interaction and a hand x condition x epoch interaction (p<0.05 for both). RT to recognise the opposite hand was approximately 600 ms longer during epochs when subjects were in pain or expected pain than during control trials. During those epochs, RT to recognise the opposite hand was approximately 600 ms longer than RT to recognise the injected hand, which was consistent across conditions and across epochs. CONCLUSIONS Both pain and the expectation of pain increased RT to recognise the opposite hand. The findings are consistent with a bias in information processing toward the painful or impending painful hand.
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Affiliation(s)
- Megan L Hudson
- Department of Physiotherapy, The University of Queensland & School of Physiotherapy, The University of Sydney, P.O. Box 170, Lidcombe, NSW 1825, Australia
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Finniss DG, Murphy PM, Brooker C, Nicholas MK, Cousins MJ. Complex regional pain syndrome in children and adolescents. Eur J Pain 2012; 10:767-70. [PMID: 16439174 DOI: 10.1016/j.ejpain.2005.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2005] [Revised: 10/29/2005] [Accepted: 12/13/2005] [Indexed: 10/25/2022]
Abstract
Complex regional pain syndrome (CRPS) is a disorder characterised by pain, sensory and motor disturbances and represents a significant medical entity. This report discusses two cases of CRPS in children and adolescents, highlighting several critical issues for clinicians in the diagnosis and management of CRPS in these populations. Early diagnosis, referral and appropriate intervention are essential in decreasing pain, suffering and resorting function for children and adolescents with CRPS.
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Affiliation(s)
- Damien G Finniss
- Pain Management and Research Institute, University of Sydney and Royal North Shore Hospital, Pacific Highway, St Leonards, Sydney, NSW, Australia.
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Ludwig J, Gorodetskaya N, Schattschneider J, Jänig W, Baron R. Behavioral and sensory changes after direct ischemia-reperfusion injury in rats. Eur J Pain 2012; 11:677-84. [PMID: 17174127 DOI: 10.1016/j.ejpain.2006.10.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2006] [Revised: 10/10/2006] [Accepted: 10/22/2006] [Indexed: 11/30/2022]
Abstract
Complex regional pain syndromes (CRPS) are disabling pain syndromes that can develop after trauma or minor tissue injury affecting a limb. Characteristics of CRPS are sensory signs and symptoms, autonomic abnormalities, trophic changes and an impaired motor function. Pathophysiological mechanisms for the development of CRPS are still a matter of investigation. Based on clinical data and investigations of CRPS patients it is hypothesized that tissue hypoxia and inflammation are important for the development of CRPS. The aim of the current study was therefore to examine if direct ischemia-reperfusion injury can induce behavior in rats with symptoms present in patients with CRPS. After baseline behavior measurements the femoral artery of Wistar rats was ligated for 3h with consecutive reperfusion. Sham-operated rats underwent the same preparation except ligation of the artery. Subsequent behavioral testing (observations of spontaneous pain behavior, paw withdrawal to mechanical, noxious mechanical, cold and heat stimuli) was performed up to two months after surgery. Both in rats that underwent ischemia and in sham-operated rats no obvious changes of hindpaw tissue were observed after ischemia-reperfusion injury (trophic changes, edema, differences in skin color or temperature). In behavioral tests only minor changes were observed, these being not different between postischemic rats and sham-operated rats. Using Wistar rats, our data do not support the idea that an ischemia-reperfusion injury can play a major role in the development of CRPS.
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Affiliation(s)
- Janne Ludwig
- Division of Neurological Pain Research and Therapy, Department of Neurology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Schittenhelmstrasse 10, Kiel, Germany.
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Subedi A, Bhattarai B, Biswas BK, Khatiwada S. Complex Regional Pain Syndrome (CRPS type-1) in an Adolescent Following Extravasation of Dextrose Containing Fluid-an Underdiagnosed Case. Korean J Pain 2011; 24:112-4. [PMID: 21716610 PMCID: PMC3111559 DOI: 10.3344/kjp.2011.24.2.112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 04/18/2011] [Accepted: 04/25/2011] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- Asish Subedi
- Department of Anesthesiology and Critical Care, BPKIHS, Dharan, Nepal
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Walton KD, Dubois M, Llinás RR. Abnormal thalamocortical activity in patients with Complex Regional Pain Syndrome (CRPS) Type I. Pain 2010; 150:41-51. [DOI: 10.1016/j.pain.2010.02.023] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Revised: 01/19/2010] [Accepted: 02/12/2010] [Indexed: 11/26/2022]
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Jänig W. The fascination of complex regional pain syndrome. Exp Neurol 2009; 221:1-4. [PMID: 19799902 DOI: 10.1016/j.expneurol.2009.09.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Revised: 09/21/2009] [Accepted: 09/23/2009] [Indexed: 10/20/2022]
Abstract
Complex regional pain syndrome (CRPS) is a pain disorder involving the somatosensory, the somatomotor and the sympathetic nervous systems. Based on experiments conducted by Bove (2009), it is suggested that changes in impulse activity in small-diameter afferents and postganglionic axons generated by neuritis can contribute to signs of early CRPS. The potential mechanisms involved are discussed. These mechanisms include the possibility that CRPS, a disorder of the central nervous system, may be caused by a nerve inflammation.
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Affiliation(s)
- Wilfrid Jänig
- Physiologisches Institut, Christian-Albrechts-Universität zu Kiel, Kiel, Germany.
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18
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Focal nerve inflammation induces neuronal signs consistent with symptoms of early complex regional pain syndromes. Exp Neurol 2009; 219:223-7. [DOI: 10.1016/j.expneurol.2009.05.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Revised: 05/15/2009] [Accepted: 05/18/2009] [Indexed: 12/25/2022]
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Toms AD, Mandalia V, Haigh R, Hopwood B. The management of patients with painful total knee replacement. ACTA ACUST UNITED AC 2009; 91:143-50. [PMID: 19190044 DOI: 10.1302/0301-620x.91b2.20995] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The management of patients with a painful total knee replacement requires careful assessment and a stepwise approach in order to diagnose the underlying pathology accurately. The management should include a multidisciplinary approach to the patient's pain as well as addressing the underlying aetiology. Pain should be treated with appropriate analgesia, according to the analgesic ladder of the World Health Organisation. Special measures should be taken to identify and to treat any neuropathic pain. There are a number of intrinsic and extrinsic causes of a painful knee replacement which should be identified and treated early. Patients with unexplained pain and without any recognised pathology should be treated conservatively since they may improve over a period of time and rarely do so after a revision operation.
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Affiliation(s)
- A D Toms
- Exeter Knee Reconstruction Unit, Royal Devon & Exeter Hospital, Barrack Road, Exeter EX2 5DW, UK.
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21
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Mogilevsky M, Jänig W, Baron R, Harden RN. Complex Regional Pain Syndrome—A Multifaceted Disorder Requiring Multidimensional Care: Case Study. THE JOURNAL OF PAIN 2007; 8:677-81. [PMID: 17652030 DOI: 10.1016/j.jpain.2007.05.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mila Mogilevsky
- Northwestern University, Rehabilitation Institute of Chicago, Chicago, IL, USA
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22
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Hettne KM, de Mos M, de Bruijn AGJ, Weeber M, Boyer S, van Mulligen EM, Cases M, Mestres J, van der Lei J. Applied information retrieval and multidisciplinary research: new mechanistic hypotheses in complex regional pain syndrome. JOURNAL OF BIOMEDICAL DISCOVERY AND COLLABORATION 2007; 2:2. [PMID: 17480215 PMCID: PMC1871567 DOI: 10.1186/1747-5333-2-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2006] [Accepted: 05/04/2007] [Indexed: 11/30/2022]
Abstract
Background Collaborative efforts of physicians and basic scientists are often necessary in the investigation of complex disorders. Difficulties can arise, however, when large amounts of information need to reviewed. Advanced information retrieval can be beneficial in combining and reviewing data obtained from the various scientific fields. In this paper, a team of investigators with varying backgrounds has applied advanced information retrieval methods, in the form of text mining and entity relationship tools, to review the current literature, with the intention to generate new insights into the molecular mechanisms underlying a complex disorder. As an example of such a disorder the Complex Regional Pain Syndrome (CRPS) was chosen. CRPS is a painful and debilitating syndrome with a complex etiology that is still unraveled for a considerable part, resulting in suboptimal diagnosis and treatment. Results A text mining based approach combined with a simple network analysis identified Nuclear Factor kappa B (NFκB) as a possible central mediator in both the initiation and progression of CRPS. Conclusion The result shows the added value of a multidisciplinary approach combined with information retrieval in hypothesis discovery in biomedical research. The new hypothesis, which was derived in silico, provides a framework for further mechanistic studies into the underlying molecular mechanisms of CRPS and requires evaluation in clinical and epidemiological studies.
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Affiliation(s)
- Kristina M Hettne
- Safety Assessment, AstraZeneca R&D Mölndal, Sweden
- Department of Medical Informatics, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Marissa de Mos
- Department of Medical Informatics, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Anke GJ de Bruijn
- Department of Anaesthesiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Marc Weeber
- Department of Medical Informatics, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Scott Boyer
- Safety Assessment, AstraZeneca R&D Mölndal, Sweden
| | - Erik M van Mulligen
- Department of Medical Informatics, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Montserrat Cases
- Chemogenomics Laboratory, Research Unit on Biomedical Informatics, Institut Municipal d'Investigació Mèdica and Universitat Pompeu Fabra, Catalonia, Spain
| | - Jordi Mestres
- Chemogenomics Laboratory, Research Unit on Biomedical Informatics, Institut Municipal d'Investigació Mèdica and Universitat Pompeu Fabra, Catalonia, Spain
| | - Johan van der Lei
- Department of Medical Informatics, Erasmus Medical Centre, Rotterdam, The Netherlands
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23
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Management of neuropathic orofacial pain. ACTA ACUST UNITED AC 2007; 103 Suppl:S32.e1-24. [PMID: 17379152 DOI: 10.1016/j.tripleo.2006.10.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2006] [Accepted: 10/16/2006] [Indexed: 12/13/2022]
Abstract
Current management of painful trigeminal neuropathies relies on pharmacological (topical and systemic), surgical, and complementary modalities. There is, however, a lack of quality research relating to the effectiveness of these modalities. In this review we analyze the available data that relates to the therapy of trigeminal neuralgia, postherpetic neuralgia, and posttraumatic neuropathies and provide clinical guidelines. The review focuses on medical management, as well as surgical and other interventions for painful neuropathies.
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24
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Trevino SG, Panchbhavi VK, Castro-Aragon O, Rowell M, Jo J. The "kick-off" position: a new sign for early diagnosis of complex regional pain syndrome in the leg. Foot Ankle Int 2007; 28:92-5. [PMID: 17257546 DOI: 10.3113/fai.2007.0017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Complex regional pain syndrome (CRPS) is a clinical entity that develops after a precipitating injury. It involves dysfunction of the sensory, autonomic, and motor systems and frequently is missed on initial presentation. The purpose of this report was to describe a simple clinical sign that can aid in its diagnosis. METHODS A retrospective review was conducted of 39 consecutive patients with CRPS type I or II seen in a foot and ankle clinic between October, 2001, and May, 2005. The diagnosis was based on clinical findings. RESULTS Twenty-six patients had type I (67%) and 13 patients had type II (33%) CRPS. The most common nerve involved in type II was the superficial peroneal nerve. Each patient, while sitting on the exam table, held the affected extremity with the knee extended against gravity. When the leg was pushed back to a relaxed and suspended position, the patient eventually involuntarily resumed the extended position. This position in which the patients held their legs was termed the "kick-off" position sign. Nine patients were seen at the foot and ankle clinic within 6 weeks of the initial inciting event and had an established "kick-off" position sign within 3 months from the time of injury. The disappearance of this sign correlated with the subsidence of pain. CONCLUSIONS Patients with CRPS have variable clinical presentations. The awareness of this simple observation in the right clinical setting should raise the index of suspicion of CRPS in the differential diagnosis. Early treatment of this syndrome is associated with better outcome.
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Affiliation(s)
- Saul G Trevino
- University of Texas Medical Branch, Department of Orthopaedics, Galveston, TX 77555-0165, USA.
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25
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Kim HK, Schattschneider J, Lee I, Chung K, Baron R, Chung JM. Prolonged maintenance of capsaicin-induced hyperalgesia by brief daily vibration stimuli. Pain 2006; 129:93-101. [PMID: 17134833 PMCID: PMC1952238 DOI: 10.1016/j.pain.2006.09.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2006] [Accepted: 09/28/2006] [Indexed: 11/30/2022]
Abstract
This study tests the hypothesis that central sensitization initiated by nociceptive input can be maintained by repeated brief innocuous peripheral inputs. Capsaicin was injected intradermally into the hind paw of adult rats. Three different types of daily cutaneous mechanical stimulations (vibration, soft brush, or pressure) were applied to the capsaicin-injected paw for a period of 2 weeks. Daily stimulation consisted of a 10-s stimulation repeated every 30s for 30 min. Foot withdrawal thresholds to von Frey stimuli applied to the paw were measured once a day for 4 weeks. The capsaicin-only group (control rats without daily stimulation) showed hyperalgesia lasting for 3 days. In contrast, hyperalgesia persisted for 2 weeks in the group that received vibration stimulation. Neither the soft brush nor the pressure group showed a significant difference in mechanical threshold from the control group (capsaicin only). The vibration-induced prolonged hyperalgesia was significantly reduced by systemic injection of ifenprodil, an NMDA-receptor antagonist, but it was not influenced by either an AMPA-receptor blocker or a reactive oxygen species (ROS) scavenger. Furthermore, a dorsal column lesion did not interfere with the prolongation of hyperalgesia. Data suggest that vibration-induced prolongation of hyperalgesia is mediated by spinal NMDA-receptors, and a similar mechanism may underlie some forms of chronic pain with no obvious causes, such as complex regional pain syndrome type 1 (CRPS-1).
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Affiliation(s)
- Hee Kee Kim
- Department of Neuroscience and Cell Biology, University of Texas Medical Branch, Galveston, TX 77555-1069, USA
| | - Jörn Schattschneider
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Inhyung Lee
- Department of Neuroscience and Cell Biology, University of Texas Medical Branch, Galveston, TX 77555-1069, USA
| | - Kyungsoon Chung
- Department of Neuroscience and Cell Biology, University of Texas Medical Branch, Galveston, TX 77555-1069, USA
| | - Ralf Baron
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Jin Mo Chung
- Department of Neuroscience and Cell Biology, University of Texas Medical Branch, Galveston, TX 77555-1069, USA
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26
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de Mos M, de Bruijn AGJ, Huygen FJPM, Dieleman JP, Stricker BHC, Sturkenboom MCJM. The incidence of complex regional pain syndrome: a population-based study. Pain 2006; 129:12-20. [PMID: 17084977 DOI: 10.1016/j.pain.2006.09.008] [Citation(s) in RCA: 543] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2006] [Revised: 08/24/2006] [Accepted: 09/06/2006] [Indexed: 02/08/2023]
Abstract
The complex regional pain syndrome (CRPS) is a painful disorder that can occur in an extremity after any type of injury, or even spontaneously. Data on the incidence of CRPS are scarce and mostly hospital based. Therefore the size of the problem and its burden on health care and society are unknown. The objective of the present study was to estimate the incidence of CRPS in the general population. A retrospective cohort study was conducted during 1996-2005 in the Integrated Primary Care Information (IPCI) project, a general practice research database with electronic patient record data from 600,000 patients throughout The Netherlands. Potential CRPS cases were identified by a sensitive search algorithm including synonyms and abbreviations for CRPS. Subsequently, cases were validated by electronic record review, supplemented with original specialist letters and information from an enquiry of general practitioners. The estimated overall incidence rate of CRPS was 26.2 per 100,000 person years (95% CI: 23.0-29.7). Females were affected at least three times more often than males (ratio: 3.4). The highest incidence occurred in females in the age category of 61-70 years. The upper extremity was affected more frequently than the lower extremity and a fracture was the most common precipitating event (44%). The observed incidence rate of CRPS is more as four times higher than the incidence rate observed in the only other population-based study, performed in Olmsted County, USA. Postmenopausal woman appeared to be at the highest risk for the development of CRPS.
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Affiliation(s)
- M de Mos
- Erasmus Medical Center, Pharmaco-epidemiology Unit, Department of Medical Informatics, PO BOX 2040, 3000 CA Rotterdam, The Netherlands.
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27
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Jänig W, Baron R. Is CRPS I a neuropathic pain syndrome? Pain 2006; 120:227-229. [PMID: 16426757 DOI: 10.1016/j.pain.2005.11.015] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2005] [Accepted: 11/30/2005] [Indexed: 11/23/2022]
Affiliation(s)
- Wilfrid Jänig
- Department of Physiology, Christian-Albrechts-Universität zu Kiel, Kiel, Germany Division of Neurological Pain Research and Therapy, Department of Neurology, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
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28
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Moseley GL, McCormick K, Hudson M, Zalucki N. Disrupted cortical proprioceptive representation evokes symptoms of peculiarity, foreignness and swelling, but not pain. Rheumatology (Oxford) 2005; 45:196-200. [PMID: 16377731 DOI: 10.1093/rheumatology/kei119] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES It has been proposed that disruption of the internal proprioceptive representation, via incongruent sensory input, may underpin pathological pain states, but experimental evidence relies on conflicting visual input, which is not clinically relevant. We aimed to determine the symptomatic effect of incongruent proprioceptive input, imparted by vibration of the wrist tendons, which evokes the illusion of perpetual wrist flexion and disrupts cortical proprioceptive representation. METHODS Twenty-nine healthy and naive volunteers reported symptoms during five conditions: control, active and passive wrist flexion, extensor carpi radialis tendon vibration to evoke illusion of perpetual wrist flexion, and ulnar styloid (sham) vibration. No advice was given about possible illusions. RESULTS Twenty-one subjects reported the illusion of perpetual wrist flexion during tendon vibration. There was no effect of condition or of whether or not subjects reported an illusion on discomfort/pain (P>0.28). Peculiarity, swelling and foreignness were greater during tendon vibration than during the other conditions, and greater during tendon vibration in those who reported an illusion of wrist flexion than in those who did not (P<0.05 for all). Symptoms were reported by at least two subjects in each condition and four subjects reported systemic symptoms (e.g. nausea). CONCLUSIONS In healthy volunteers, incongruent proprioceptive input does not cause discomfort or pain but does evoke feelings of peculiarity, swelling and foreignness in the limb.
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Affiliation(s)
- G L Moseley
- Department of Human Anatomy and Genetics, University of Oxford, South Parks Road, Oxford OX1 3QX, UK.
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29
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Harke H, Gretenkort P, Ladleif HU, Rahman S. Spinal cord stimulation in sympathetically maintained complex regional pain syndrome type I with severe disability. A prospective clinical study. Eur J Pain 2005; 9:363-73. [PMID: 15979016 DOI: 10.1016/j.ejpain.2004.09.003] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2004] [Accepted: 09/09/2004] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE In this prospective trial we assessed the long-term effect of spinal cord stimulation (SCS) on the improvement of functional status in complex regional pain syndrome type I (CRPS I). METHODS A prerequisite for eligibility to SCS treatment was the responsiveness of patients to sympathetic nerve block. In 29 patients with chronic sympathetically maintained CRPS I, the efficacy of SCS on deep pain, allodynia and functional disability was determined. Pain intensity was estimated during SCS free intervals of 45 min (inactivation test) every 3 months and compared with that under SCS treatment. RESULTS On SCS treatment, both deep pain and allodynia could be permanently reduced from 10 to 0-2 on a 10 cm visual analogue scale (VAS) (p<0.01). During the inactivation tests, reoccurrence of pain up to 8 VAS (quartiles 6-8) was measured. Considerable impairments in daily living activities, objectified by the pain disability index, were also restored (p<0.01). After a follow-up period of 35.6+/-21 months, 12 of 16 patients with affected upper limb showed significant increase of the fist grip strength from 0 to 0.35 (quartiles 0.1-0.5) kg compared with 0.9 (quartiles 0.7-1.1) kg on the unaffected side (p<0.01). Eight of ten patients with lower limb disability resumed walking without crutches. Previous pain medication could be significantly reduced (p<0.01). CONCLUSIONS As a result of permanent pain relief under long-term SCS combined with physiotherapy, the functional status and the quality of life could be significantly improved in sympathetically maintained CRPS I.
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Affiliation(s)
- Henning Harke
- Department of Anesthesia and Pain Therapy, Klinikum Krefeld, Lutherplatz 40, D-47805 Krefeld, Germany.
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30
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Straub RH, Baerwald CG, Wahle M, Jänig W. Autonomic dysfunction in rheumatic diseases. Rheum Dis Clin North Am 2005; 31:61-75, viii. [PMID: 15639056 DOI: 10.1016/j.rdc.2004.09.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Patients who have rheumatic diseases often present with dysfunctions that are related to the autonomic nervous system (ANS) and are due to peripheral autonomic neuropathy or central changes. This article describes the prevalence of autonomic dysfunctions in patients who have rheumatic diseases. In the second part of this article, another form of ANS dysfunction-complex regional pain syndromes-is demonstrated. Clinically, these syndromes are characterized by pain (spontaneous, hyperalgesia, allodynia); active movement disorders, including an increased physiologic tremor, abnormal regulation of blood flow and sweating, edema of skin and subcutaneous tissues; and trophic changes of skin, appendages of skin, and subcutaneous tissues. In conclusion, this discussion shows that alterations of the ANS occur in rheumatic and related diseases, that these alterations may be involved in the pathogenesis of these diseases, and that we need more refined methods to study the changes that are related to the ANS.
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Affiliation(s)
- Rainer H Straub
- Laboratory of Neuroendocrinoimmunology, Department of Internal Medicine I, University Hospital Regensburg, 93042 Regensburg, Germany.
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31
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Berger P. Can complex regional pain syndrome type 1 be circumvented? A case report. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2004. [DOI: 10.1080/22201173.2004.10872378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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