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Kim CY, Choi SB, Lee ES. Prevalence and predisposing factors of post-stroke complex regional pain syndrome: Retrospective case-control study. J Stroke Cerebrovasc Dis 2024; 33:107522. [PMID: 38141321 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/05/2023] [Accepted: 11/28/2023] [Indexed: 12/25/2023] Open
Abstract
INTRODUCTION Poststroke complex regional pain syndrome (CRPS) is an important complication in stroke survivors. The identification of factors associated with post-stroke CRPS is important for preventive measures and early diagnosis. METHODS A total of 141 first-ever stroke survivors in the subacute stage were retrospectively analyzed. Demographic data, diagnosis time, duration of hospitalization, location of brain lesion, etiology, comorbidities, and blood test findings were investigated. Clinical data included Medical Research Council (MRC) grade, Fugl-Meyer assessment (FMA), National Institute for Health Stroke Scale (NIHSS), Berg Balance Scale (BBS). RESULTS Among 141 patients with subacute stroke, 22 were diagnosed with CRPS, with a prevalence of 15.6 %. The mean time to diagnosis was 38.6 (±16.5) days. The prevalence according to the degree of paralysis was 33.3 % in MRC grades 0 and 1, 8.6 % in grade 2, and 0 % in grade 3 or higher. The incidence rates within 1 month after stroke were 1.42 % and 22.47 % between 1 and 3 months after stroke, respectively. The independent risk factors for CRPS were hospitalization duration and FMA, NIHSS, and BBS scores. The sensitivity and specificity of the NIHSS score for predicting post-stroke CRPS were 86.4 % and 59.7 %, respectively, with an optimal cutoff value of 7.5. CONCLUSIONS CRPS of the affected upper limb in stroke patients is associated with stroke severity, including paralysis, and the incidence increases over time during the subacute phase. Additionally, having sufficient strength to move through a full range of motion against gravity had a protective effect against CRPS.
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Affiliation(s)
- Chan Yong Kim
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine Hospital, Republic of Korea
| | - Seong Bok Choi
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine Hospital, Republic of Korea
| | - Eun Sun Lee
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine Hospital, Republic of Korea.
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Arcos-Holzinger M, Biebl JT, Storz C, Gutmann M, Azad SC, Holzapfel BM, Kraft E. Virtual reality in managing Complex Regional Pain Syndrome (CRPS): a scoping review. Front Neurol 2023; 14:1069381. [PMID: 37745669 PMCID: PMC10513177 DOI: 10.3389/fneur.2023.1069381] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
Background Complex Regional Pain Syndrome (CRPS) is a severe pain disorder that does not yet have a specific treatment. Patients with CRPS not only suffer from a wide range of symptoms that affect their quality of life but also present psychological affections to the way they see their body and specifically their affected limb. Virtual Reality (VR) modalities have become a targeted treatment for chronic pain and in the case of CRPS, may be a valuable approach to the mechanisms that affect these patients. Objectives Using the PRISMA Scoping Review guidelines, we intend to uncover the key information from the studies available about VR modalities in the treatment of CRPS. We focus on the improvement of pain levels, body perception disturbances (BPD), and limb movement/daily function. Results Our search strategy resulted in 217 articles from PubMed. Twenty were assessed for eligibility and seven were included in the final qualitative synthesis. Of these seven articles, we included a clinical trial, three pilot studies, a blinded randomized controlled trial, a crossover double-blind trial, and a randomized controlled trial. These studies provide important subjective patient findings, along with some statistically significant results in the experiences of VR therapies modulating pain, BPD, and improving limb movement/daily function. However, not all the studies included statistical analysis, and there are contradicting data found from some patients that did not perceive any improvement from VR therapies. Conclusions We describe the results found in 7 articles that focus on the treatment of CRPS with VR modalities. Overall, the articles have various limitations, but the strategies related to immersive virtual reality, cardiac signaling, body switching and limb modulation have shown the most promising results for pain reduction and BPD improvement. These strategies reflect on pathophysiological mechanisms that are hypothesized to be affected in CRPS patients leading to the chronic pain and BPD that they experience. Not much evidence was found for improvement in limb movement and daily function. This review is a pathway for future studies on this topic and a more extensive data synthesis when more information is available.
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Affiliation(s)
- Mauricio Arcos-Holzinger
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
- Facultad de Medicina, Universidad CES, Medellin, Colombia
| | - Johanna Theresia Biebl
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Claudia Storz
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Marcus Gutmann
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Shahnaz Christina Azad
- Department of Anaesthesiology, University Hospital, LMU Munich, Munich, Germany
- Interdisciplinary Pain Unit, University Hospital, LMU Munich, Munich, Germany
| | - Boris Michael Holzapfel
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Eduard Kraft
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
- Interdisciplinary Pain Unit, University Hospital, LMU Munich, Munich, Germany
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Saed A, Neal-Smith G, Fernquest S, Bourget-Murray J, Wood A. Management of complex regional pain syndrome in trauma and orthopaedic surgery-a systematic review. Br Med Bull 2023; 146:27-42. [PMID: 37185896 DOI: 10.1093/bmb/ldac034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2022] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Complex regional pain syndrome (CRPS) is a neurological pain disorder that is challenging to diagnose and manage, resulting in increased morbidity and costs. It most commonly occurs following traumatic injury, such as a fracture, crush injury or surgery. Recent research has evaluated the efficacy of treatments which have contradicted previous hypotheses. This systematic review summarizes these findings to improve clinician's decision-making. SOURCES OF DATA A comprehensive search of PubMed, MEDLINE and Embase databases from inception through January 2021 was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two reviewers independently screened relevant articles discussing the management of CRPS in adult trauma patients. All prospective and retrospective studies, non-randomized comparison studies and case series were considered for inclusion. Data extraction was performed by populating a predefined data abstraction sheet. AREAS OF AGREEMENT There is strong evidence to suggest the efficacy of prompt physiotherapy, lidocaine, ketamine, bisphosphonates, sympathectomy and brachial plexus blocks in the management of CRPS. AREAS OF CONTROVERSY The latest evidence suggests that vitamin C has no significant role to play in the treatment or prevention of CRPS. GROWING POINTS A multidisciplinary team approach and early diagnosis are imperative for successful treatment of CRPS. The Budapest criteria and the British Orthopaedic Association Standards for Trauma and Orthopaedics (BOAST) guidelines should be used when diagnosing CRPS. There is currently no clear evidence of superiority in any treatment. AREAS TIMELY FOR DEVELOPING RESEARCH There are few high-quality studies that inform the best treatment modalities for CRPS. Though emerging treatments show promise, further research is needed.
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Affiliation(s)
- Abdel Saed
- Investigation Performed at the Trauma & Orthopaedic Department, Oxford Trauma Unit, John Radcliffe Hospital, Oxford, UK
| | - Greg Neal-Smith
- Investigation Performed at the Trauma & Orthopaedic Department, Oxford Trauma Unit, John Radcliffe Hospital, Oxford, UK
| | - Scott Fernquest
- Investigation Performed at the Trauma & Orthopaedic Department, Oxford Trauma Unit, John Radcliffe Hospital, Oxford, UK
| | - Jonathan Bourget-Murray
- Investigation Performed at the Trauma & Orthopaedic Department, Oxford Trauma Unit, John Radcliffe Hospital, Oxford, UK
| | - Alexander Wood
- Investigation Performed at the Trauma & Orthopaedic Department, Oxford Trauma Unit, John Radcliffe Hospital, Oxford, UK
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Smart KM, Ferraro MC, Wand BM, O'Connell NE. Physiotherapy for pain and disability in adults with complex regional pain syndrome (CRPS) types I and II. Cochrane Database Syst Rev 2022; 5:CD010853. [PMID: 35579382 PMCID: PMC9112661 DOI: 10.1002/14651858.cd010853.pub3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Complex regional pain syndrome (CRPS) is a painful and disabling condition that usually manifests in response to trauma or surgery and is associated with significant pain and disability. CRPS can be classified into two types: type I (CRPS I) in which a specific nerve lesion has not been identified and type II (CRPS II) where there is an identifiable nerve lesion. Guidelines recommend the inclusion of a variety of physiotherapy interventions as part of the multimodal treatment of people with CRPS. This is the first update of the review originally published in Issue 2, 2016. OBJECTIVES To determine the effectiveness of physiotherapy interventions for treating pain and disability associated with CRPS types I and II in adults. SEARCH METHODS For this update we searched CENTRAL (the Cochrane Library), MEDLINE, Embase, CINAHL, PsycINFO, LILACS, PEDro, Web of Science, DARE and Health Technology Assessments from February 2015 to July 2021 without language restrictions, we searched the reference lists of included studies and we contacted an expert in the field. We also searched additional online sources for unpublished trials and trials in progress. SELECTION CRITERIA We included randomised controlled trials (RCTs) of physiotherapy interventions compared with placebo, no treatment, another intervention or usual care, or other physiotherapy interventions in adults with CRPS I and II. Primary outcomes were pain intensity and disability. Secondary outcomes were composite scores for CRPS symptoms, health-related quality of life (HRQoL), patient global impression of change (PGIC) scales and adverse effects. DATA COLLECTION AND ANALYSIS Two review authors independently screened database searches for eligibility, extracted data, evaluated risk of bias and assessed the certainty of evidence using the GRADE system. MAIN RESULTS We included 16 new trials (600 participants) along with the 18 trials from the original review totalling 34 RCTs (1339 participants). Thirty-three trials included participants with CRPS I and one trial included participants with CRPS II. Included trials compared a diverse range of interventions including physical rehabilitation, electrotherapy modalities, cortically directed rehabilitation, electroacupuncture and exposure-based approaches. Most interventions were tested in small, single trials. Most were at high risk of bias overall (27 trials) and the remainder were at 'unclear' risk of bias (seven trials). For all comparisons and outcomes where we found evidence, we graded the certainty of the evidence as very low, downgraded due to serious study limitations, imprecision and inconsistency. Included trials rarely reported adverse effects. Physiotherapy compared with minimal care for adults with CRPS I One trial (135 participants) of multimodal physiotherapy, for which pain data were unavailable, found no between-group differences in pain intensity at 12-month follow-up. Multimodal physiotherapy demonstrated a small between-group improvement in disability at 12 months follow-up compared to an attention control (Impairment Level Sum score, 5 to 50 scale; mean difference (MD) -3.7, 95% confidence interval (CI) -7.13 to -0.27) (very low-certainty evidence). Equivalent data for pain were not available. Details regarding adverse events were not reported. Physiotherapy compared with minimal care for adults with CRPS II We did not find any trials of physiotherapy compared with minimal care for adults with CRPS II. AUTHORS' CONCLUSIONS The evidence is very uncertain about the effects of physiotherapy interventions on pain and disability in CRPS. This conclusion is similar to our 2016 review. Large-scale, high-quality RCTs with longer-term follow-up are required to test the effectiveness of physiotherapy-based interventions for treating pain and disability in adults with CRPS I and II.
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Affiliation(s)
- Keith M Smart
- UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- Physiotherapy Department, St Vincent's University Hospital, Dublin, Ireland
| | - Michael C Ferraro
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
- School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Benedict M Wand
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Australia
| | - Neil E O'Connell
- Department of Health Sciences, Centre for Health and Wellbeing Across the Lifecourse, Brunel University London, Uxbridge, UK
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Li Z, Xu C, Fu J, Zulipikaer M, Deng T, Chen J. Scientific Knowledge Graph and Trend Analysis of Central Sensitization: A Bibliometric Analysis. J Pain Res 2022; 15:561-575. [PMID: 35237073 PMCID: PMC8885163 DOI: 10.2147/jpr.s348946] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/28/2022] [Indexed: 12/24/2022] Open
Abstract
Background Central sensitization refers to a state of hypersensitivity in the central nervous system and is associated with the development and maintenance of chronic pain. Central sensitization plays an essential role in various diseases. Nevertheless, there has been no bibliometric analysis before in this field. The purpose of this study was to provide critical themes and trends in the area of central sensitization, to build a network of knowledge, and to facilitate the future development of relevant basic and clinical research. Methods Publications on central sensitization were extracted from the Science Citation Index-Expanded. We used R software to systematically analyze the countries, institutions, authors, journals, references, and keywords of the publications. Besides, conceptual structure, intellectual structure, and social structure were constructed. Results A total of 4466 publications were included. Research in the field of central sensitization generally showed a steady upward trend. The three structural networks showed that the United States is the leading country in this field. Arendt-Nielsen L and Woolf CJ were the most productive and influential authors, respectively. “Pain” was the journal with the most studies. Most journals that published and cited articles about central sensitization were academically influential. Cluster analysis revealed that research in central sensitization contains three main conceptual clusters, and the themes of research evolve frequently. Current research focuses on the pathogenesis of central sensitization in neuropathic pain, the role of central sensitization in different diseases, and related clinical double-blind trials. Conclusion Central sensitization received widespread attention. The United States led the way in academic activity. In this field, the current situation of cooperation and communication between different countries and institutions is positive. The present research hotspots were the pathogenesis of central sensitization in neuropathic pain, the role of central sensitization in different diseases, and related clinical double-blind trials.
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Affiliation(s)
- Zhuo Li
- School of Medicine, Nankai University, Tianjin, People’s Republic of China
- Department of Orthopedic Surgery, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Chi Xu
- Department of Orthopedic Surgery, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Jun Fu
- Department of Orthopedic Surgery, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Maimaiti Zulipikaer
- Department of Orthopedic Surgery, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Tao Deng
- Department of Orthopedic Surgery, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Jiying Chen
- Department of Orthopedic Surgery, Chinese PLA General Hospital, Beijing, People’s Republic of China
- Correspondence: Jiying Chen, Department of Orthopedic Surgery, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, People’s Republic of China, Tel +86 10 66938104, Fax +86 10 68216336, Email
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Antunovich D, Tuck N, Reynolds LM, Bean D. "I Don't Identify with It": A Qualitative Analysis of People's Experiences of Living with Complex Regional Pain Styndrome. PAIN MEDICINE (MALDEN, MASS.) 2021; 22:3008-3020. [PMID: 33693870 DOI: 10.1093/pm/pnab094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 02/14/2021] [Accepted: 03/04/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Complex regional pain syndrome (CRPS) is a painful limb condition known to cause significant disability and distress. However, little previous research has explored CRPS from a patient perspective. The present qualitative study aimed to describe the experiences of people living with CRPS. SUBJECTS Forty-eight people with CRPS participated in this research. METHODS Participants completed a face-to-face or telephone interview about their perceptions and experiences of CRPS and completed three drawings to illustrate their experiences. Data were analyzed through reflexive thematic analysis, and images in drawings were grouped and coded by theme. RESULTS Three overarching themes encapsulated the data, including that 1) people experience CRPS as a source of severe symptoms and emotional difficulties, 2) CRPS undermines personal and social identity, and 3) this results in psychological responses that protect against the emotional and social impact of severe symptoms. Psychological responses include: a) searching for an explanation, b) "nothing is my fault," emphasizing a lack of personal responsibility and personal control, and c) detaching the limb from the self. CONCLUSIONS CRPS is experienced as highly threatening to physical ability, psychological state, and identity. In response to these threats, people may develop their own explanations for CRPS and may mentally detach themselves from responsibility, control, and the painful limb itself. Future research could explore the impact of these factors on psychological well-being and CRPS symptoms and outcomes.
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Affiliation(s)
- Dana Antunovich
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
- Pain Service, Northland District Health Board, Northland, New Zealand
| | - Natalie Tuck
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
- The Auckland Regional Pain Service, Auckland District Health Board, Auckland, New Zealand
- Chronic Pain Service, Department of Anaesthesia and Perioperative Medicine, Waitemata District Health Board, Auckland, New Zealand
| | - Lisa M Reynolds
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Debbie Bean
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
- Chronic Pain Service, Department of Anaesthesia and Perioperative Medicine, Waitemata District Health Board, Auckland, New Zealand
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Varenna M, Crotti C, Ughi N, Zucchi F, Caporali R. Determinants of Diagnostic Delay in Complex Regional Pain Syndrome Type 1: An Observational Study of 180 Consecutive New Cases. J Clin Rheumatol 2021; 27:e491-e495. [PMID: 32897995 DOI: 10.1097/rhu.0000000000001558] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVE Complex regional pain syndrome type 1 (CRPS-1) is a disabling painful disease, with variable outcomes in terms of chronic pain and disability. A long time between onset and diagnosis seems predictive for late recovery and progression toward a chronic disease. This study aims to investigate demographic and clinical variables associated with delayed CRPS-1 diagnosis. METHODS From March 2013 to January 2018, consecutive patients newly diagnosed according to International Association for the Study of Pain diagnostic criteria for CRPS-1 were recruited. Demographic and clinical variables were collected at diagnosis. Student t test and Mann-Whitney U test were used for comparisons; Cox proportional hazards model was applied to evaluate the variables associated with delayed CRPS-1 diagnosis. RESULTS One hundred eighty patients entered the study. At diagnosis, women were older, and foot was more often involved than hand. The triggering event was more commonly a trauma without fracture for foot disease and a fracture for hand localization. No differences between hand and foot disease were found by the International Association for the Study of Pain diagnostic categories (clinical vs research) or pain measures. Variables significantly associated with a longer time between disease onset and diagnosis were foot localization, general practitioner referral, higher number of visits before CRPS diagnosis, and prior physiotherapy prescribed for symptoms later diagnosed as CRPS. An overt clinical manifestation (research CRPS-1) predicted a shorter delay. CONCLUSIONS Foot localization, prior physiotherapy prescribed for symptoms later diagnosed as CRPS, and a disease without overt clinical manifestations were independent predictive factors for a delayed diagnosis. Clinicians should pay attention to these issues to ensure a timely diagnosis and possibly avoid progression toward a chronic disease.
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Affiliation(s)
| | - Chiara Crotti
- From the Department of Rheumatology, Gaetano Pini Institute
| | - Nicola Ughi
- From the Department of Rheumatology, Gaetano Pini Institute
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Frech A, Houle J, Tumin D. Trajectories of unsecured debt and health at midlife. SSM Popul Health 2021; 15:100846. [PMID: 34189245 PMCID: PMC8219895 DOI: 10.1016/j.ssmph.2021.100846] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Unsecured debt - debt not tied to an asset - is a financial stressor that undermines health, but prior research has not investigated relationships between group-based trajectories of unsecured debt and pain and disability at midlife. METHODS US respondents of the National Longitudinal Study of Youth-1979 cohort reported unsecured debt and income between ages 28-40. We used these measures to identify group-based trajectories of unsecured debt and unsecured debt-to-income ratio. We then used trajectory membership to predict three pain and disability-related health outcomes at age 50, adjusting for lagged health and other covariates. RESULTS Group-based trajectory models divided the sample of 7850 respondents into 6 unsecured debt trajectories and 5 unsecured debt-to-income trajectories. In fully adjusted unsecured debt models, compared to people with constant low debt, those who paid down debt over time, carried constant debt, experienced debt cycling, or accumulated debt later in life were more likely to report pain interference with activities or joint pain or stiffness at age 50 (pain interference ORs ranging from 1.33 to 1.76; joint pain or stiffness ORs ranging from 1.27 to 1.45). In fully adjusted unsecured debt-to-income models, compared to those with constant low debt, those with constant high debt or accumulating debt later in life were more likely to report pain interference or joint pain or stiffness (pain interference ORs ranging from 1.30 to 1.91; joint pain or stiffness ORs ranging from 1.19 to 1.33). CONCLUSION The amount, timing, and duration of unsecured debt accumulation and repayment have important health implications and may exacerbate midlife health inequalities.
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Affiliation(s)
- Adrianne Frech
- Department of Health Sciences, University of Missouri, 501 S. Providence Rd, Columbia, MO, USA
| | - Jason Houle
- Department of Sociology, Dartmouth College, 301F Blunt Hall, Hanover, NH, USA
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine at East Carolina University, 600 Moye Blvd, Greenville, NC, USA
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Lewis JS, Newport R, Taylor G, Smith M, McCabe CS. Visual illusions modulate body perception disturbance and pain in Complex Regional Pain Syndrome: A randomized trial. Eur J Pain 2021; 25:1551-1563. [PMID: 33759278 DOI: 10.1002/ejp.1766] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/14/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Effective treatment of longstanding Complex Regional Pain Syndrome (CRPS) is a challenge, as causal mechanisms remain elusive. People with CRPS frequently report distorted subjective perceptions of their affected limb. Evidence of pain reduction when the affected limb is visually altered in size suggests that visual illusions used to target central processing could restore coherence of this disrupted limb representation. We hypothesized that using virtual reality that alters hand image to match the patient's desired hand appearance would improve body perception disturbance and pain. Also, repeated exposure would maintain any therapeutic effect. METHODS A blinded randomized controlled trial of 45 participants with refractory upper-limb CRPS and body perception disturbance (BPD) viewed a digital image of their affected hand for 1 min. The image was digitally altered according to the patient's description of how they desired their hand to look in the experimental group and unaltered in the control group. BPD and pain were measured pre- and post-intervention. A subgroup was followed up 2 weeks after a course of repeated interventions. RESULTS BPD (mean-6, ±SD 7.9, p = 0.036, effect size [ES] = 0.6) and pain intensity (mean-0.43, ±SD 1.3, p = 0.047, ES = 0.5) reduced in 23 participants after single exposure compared to controls (n = 22). At follow-up, the subgroup (experimental n = 21; control n = 18) showed sustained pain reduction only (p = 0.037, ±SD 1.9, ES = 0.7), with an overall 1.2 decrease on an 11-point scale. CONCLUSIONS Visually changing the CRPS hand to a desired appearance modulates BPD and pain suggesting therapeutic potential for those with refractory CRPS. Further research to optimize this therapeutic effect is required. SIGNIFICANCE Visual bodily illusions that change the shape and appearance of the painful CRPS hand to that desired by the patient result in a rapid amelioration of pain and body perception disturbance in people with longstanding CRPS. These findings highlight the future potential of this drug-free approach in the treatment of refractory CRPS.
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Affiliation(s)
- Jennifer S Lewis
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Trust, Bath, UK
- University of the West of England, Bristol, UK
| | - Roger Newport
- University of Nottingham, Nottingham, UK
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | | | - Mike Smith
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Trust, Bath, UK
| | - Candida S McCabe
- University of the West of England, Bristol, UK
- Florence Nightingale Foundation, London, UK
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Bailly F, Cantagrel A, Bertin P, Perrot S, Thomas T, Lansaman T, Grange L, Wendling D, Dovico C, Trouvin AP. Part of pain labelled neuropathic in rheumatic disease might be rather nociplastic. RMD Open 2021; 6:rmdopen-2020-001326. [PMID: 32892169 PMCID: PMC7508212 DOI: 10.1136/rmdopen-2020-001326] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/23/2020] [Accepted: 08/21/2020] [Indexed: 01/08/2023] Open
Abstract
Pain in rheumatic diseases is primarily due to mechanical or inflammatory mechanism, but neuropathic pain (NP) component is also occurring in many conditions and is probably underdiagnosed. The purpose of this article is to provide an overview of prevalence, pathophysiological and currently available treatment of NP in rheumatic diseases. When associated with clinical evaluation assessing neurological clinical signs and neuroanatomical distribution, Douleur Neuropathique 4 Questions, painDETECT, Leeds assessment of neuropathic symptoms and signs and Neuropathic Pain Questionnaire can detect NP component. Inflammatory or connective diseases, osteoarthritis, back pain or persistent pain after surgery are aetiologies that all may have a neuropathic component. Unlike nociceptive pain, NP does not respond to usual analgesics such as paracetamol and non-steroidal anti-inflammatory drugs. Entrapment neuropathy, peripheral neuropathy or small-fibre neuropathy are different aetiologies that can lead to NP. A part of the pain labelled neuropathic is rather nociplastic, secondary to a central sensitisation mechanism. Identifying the right component of pain (nociceptive vs neuropathic or nociplastic) could help to better manage pain in rheumatic diseases with pharmacological and non-pharmacological treatments.
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Affiliation(s)
- Florian Bailly
- Pain Department, Pitie-Salpetriere Hospital, Assistance Publique - Hopitaux De Paris, Paris, France .,Paris 6 University, GRC-UPMC 08, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
| | | | | | - Serge Perrot
- Centre d'Evaluation Et Traitement De La Douleur, Université Paris Descartes, Hopital Cochin, Paris, France.,U987, INSERM, Boulogne Billancourt, France
| | | | - Thibaud Lansaman
- Médecine Physique Et Réadaptation, Hôpital Raymond-Poincaré - Assistance Publique Hôpitaux De Paris, Garches, France
| | | | | | - Calogera Dovico
- Service De Médecine Physique Et Réadaptation, Dispositif IEM APF FRANCE HANDICAP, Belfort, France
| | - Anne-Priscille Trouvin
- U987, INSERM, Boulogne Billancourt, France.,Pain Evaluation and Treatment, Hopital Cochin, Paris, France
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Lee J, Lim YH, Hong SJ, Jeong JH, Choi HR, Park SK, Kim JE, Park EH, Kim JH. Multicenter survey of symptoms, work life, economic status, and quality of life of complex regional pain syndrome patients. Korean J Pain 2021; 34:288-303. [PMID: 34193635 PMCID: PMC8255153 DOI: 10.3344/kjp.2021.34.3.288] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 03/10/2021] [Accepted: 03/23/2021] [Indexed: 11/21/2022] Open
Abstract
Background Complex regional pain syndrome (CRPS) is an intractable pain disease with various symptoms. Here, we investigated the disease status, work life, sleep problems, medical insurance, economic status, psychological problems, and quality of life (QOL) of CRPS patients. Methods CRPS patients from 37 university hospitals in South Korea were surveyed. The survey questionnaire consisted of 24 questions on the following aspects of CRPS patients sex, age, occupation, cause of injury, activities of daily living (ADL), pain severity, sleep disturbance, level of education, economic status, therapeutic effect, and suicidal ideation. Additionally, the abbreviated World Health Organization Quality of Life (WHOQOL-BREF) questionnaire, consisting of 26 questions, was used to identify the status of QOL. Results A total of 251 patients completed the questionnaire. According to the survey, 54.2% patients could not perform ADL on their own. Over the previous week, the mean pain score was 7.15 ± 1.78 (out of a total of 10 points); 92.1% of patients had sleep disorders and 80.5% had suicidal ideation, with most patients suffering from psychological problems. The average for each domain of WHOQOL-BREF was as follows 21.74 ± 14.77 for physical, 25.22 ± 17.66 for psychological, 32.02 ± 22.36 for social relationship, and 30.69 ± 15.83 for environmental (out of a total of 100 points each). Occupation, ADL, sleep time, therapeutic effect, and suicidal ideation were statistically correlated with multiple domains. Conclusions Most patients had moderate to severe pain, economic problems, limitations of their ADL, sleep problems, psychological problems, and a low QOL score.
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Affiliation(s)
- Jaemoon Lee
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Yun Hee Lim
- Department of Anesthesiology and Pain Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Sung Jun Hong
- Department of Anesthesiology and Pain Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Jae Hun Jeong
- Department of Anesthesiology and Pain Medicine, Jeong-clinic, Seoul, Korea
| | - Hey Ran Choi
- Department of Anesthesiology and Pain Medicine, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Sun Kyung Park
- Department of Anesthesiology and Pain Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Jung Eun Kim
- Department of Anesthesiology and Pain Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Eun Hi Park
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Jae Hun Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
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12
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Gryffin PA, Diaz RE. Effects of Tai Chi and running on blood oxygen saturation: a pilot study. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2021; 18:821-825. [PMID: 33793144 DOI: 10.1515/jcim-2020-0306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 10/21/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Large drops in blood oxygen saturation (SpO2) to levels as low as 84% was observed following Tai Chi practice, during a study on the effects of Tai Chi on SpO2. The objectives of the current pilot study were to determine if this was a statistically significant drop, and how SpO2 levels compared to an aerobic activity such as running, in pre, concurrent, and post measurements. METHODS Repeated measures of blood oxygen saturation (SpO2) were taken of a 50-year-old male before, during and for 1 min after TC and running. RESULTS Measurements of SpO2 before, during, and after TC resulted in a statistically significant increase in SpO2 during TC (p=1.69e-06), and a statistically significant (p=1.71e-06) brief momentary drop from resting levels, as low as 87% SpO2. Running showed no significant change in pre and post levels, with a significant change and decrease in SpO2 during running (p=1.1e-08), suggesting increased oxygen use by the large muscle groups during exercise. SpO2 returned to normal resting levels following running with no post drop. Results suggest a higher rate of oxygen metabolism during TC, with a potential effect on hypoxic (oxygen deficient) areas of the body. CONCLUSIONS Findings suggest direct and unique effects on enhanced blood oxygen saturation and oxygen metabolism, which may underlie benefits for conditions complicated by hypoxia, including cardiopulmonary disease, immunity, chronic pain, and arthritis.
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Affiliation(s)
| | - Rafael E Diaz
- California State University Sacramento, Sacramento, CA, USA
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13
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Antunovich DR, Horne JC, Tuck NL, Bean DJ. Are Illness Perceptions Associated with Pain and Disability in Complex Regional Pain Syndrome? A Cross-Sectional Study. PAIN MEDICINE 2020; 22:100-111. [DOI: 10.1093/pm/pnaa320] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Abstract
Objective
Complex regional pain syndrome (CRPS) is a complex and often poorly understood condition, and people with CRPS will have diverse beliefs about their symptoms. According to the self-regulation model, these beliefs (termed “illness perceptions”) influence health behaviors and outcomes. Previous studies have found that psychological factors influence CRPS outcomes, but few studies have investigated CRPS patients’ illness perceptions specifically. The present study examined whether illness perceptions were related to pain intensity and other relevant outcomes in people with CRPS.
Methods
In this cross-sectional study, 53 patients with CRPS (type 1 and type 2) completed questionnaires assessing illness perceptions, pain, disability, and psychological factors. Multiple regression analyses were used to determine whether illness perceptions were associated with pain intensity, disability, depression, and kinesiophobia, after controlling for possible covariates (including clinical and demographic factors, pain catastrophizing, and negative affect).
Results
Negative illness perceptions were associated with greater pain, disability, and kinesiophobia, but not depression. Specifically, attributing more symptoms to CRPS (more negative illness identity perceptions) was associated with greater pain intensity, and reporting a poorer understanding of CRPS (lower illness coherence scores) was associated with greater disability and kinesiophobia.
Conclusions
Patients with CRPS with more negative illness perceptions (particularly perceptions indicating a poor understanding of their condition) also experience greater pain, disability, and kinesiophobia. Future research could investigate whether altering CRPS patients’ illness perceptions influences clinical outcomes.
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Affiliation(s)
- Dana R Antunovich
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Juliette C Horne
- The Auckland Regional Pain Service, Auckland District Health Board, Auckland, New Zealand
| | - Natalie L Tuck
- The Auckland Regional Pain Service, Auckland District Health Board, Auckland, New Zealand
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
- Chronic Pain Service, Department of Anaesthesia and Perioperative Medicine, Waitematā District Health Board, Auckland, New Zealand
| | - Debbie J Bean
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
- The Auckland Regional Pain Service, Auckland District Health Board, Auckland, New Zealand
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
- Chronic Pain Service, Department of Anaesthesia and Perioperative Medicine, Waitematā District Health Board, Auckland, New Zealand
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14
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Lee WJ, Jung CH, Hwang JY, Seong SJ, Han CH, Park JW, Jang JH, Lee D, Kang DH. Prognostic Factors in Complex Regional Pain Syndrome Type 1 Occurring in the Korean Army. PAIN MEDICINE 2020; 20:1989-1996. [PMID: 30986307 DOI: 10.1093/pm/pnz076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES In Korea, patients diagnosed with complex regional pain syndrome (CRPS) in the army are typically discharged from the army; however, the course of the disease after discharge is not known. The purpose of this study was to investigate the course of CRPS that occurred in the army and to identify the influences of various clinical and psychosocial factors immediately before discharge on the disease course. METHODS Clinical profiles and psychosocial status were collected from the medical records of 16 patients with CRPS type 1 who were discharged during the period between March 2017 and April 2018. The degree of improvement after discharge was assessed by follow-up evaluation through telephone contact. Cox proportional hazards regression was performed to identify clinical and psychosocial predictors for the rate of recovery. RESULTS The median time to recovery after discharge was 39 weeks (95% confidence interval [CI] = 8.8-69.2 weeks). The sole predictor for time to recovery after discharge was the time period from the onset of pain to discharge. Each one-week increase in the duration of pain experienced in the military was associated with a 18.2% (95% CI = 5.3%-29.5%) reduction in the rate of recovery after discharge (P = 0.007). CONCLUSIONS Patients who experienced a short period of pain in the military demonstrated a relatively good prognosis after discharge. This may show how prolonged pain in the army could affect the experience of pain from a social point of view, in that it shows the disease course after a change in the social environment.
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Affiliation(s)
- Won Joon Lee
- Department of Psychiatry, Kangdong Sacred Heart Hospital, Seoul, Republic of Korea.,Department of Psychiatry, Armed Forces Capital Hospital, Seongnam, Republic of Korea
| | - Cheol Hee Jung
- Department of Anesthesiology and Pain Medicine, Armed Forces Capital Hospital, Seongnam, Republic of Korea
| | - Jae Yeon Hwang
- Department of Psychiatry, Kangdong Sacred Heart Hospital, Seoul, Republic of Korea
| | - Su-Jeong Seong
- Department of Psychiatry, Kangdong Sacred Heart Hospital, Seoul, Republic of Korea
| | - Chang Hwan Han
- Department of Psychiatry, Kangdong Sacred Heart Hospital, Seoul, Republic of Korea
| | - Jin Woo Park
- Department of Orthopedic Surgery, Kangwon National University College of Medicine, Chuncheon, Republic of Korea
| | - Joon Hwan Jang
- Department of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Dasom Lee
- Emotional Information and Communication Technology Association, Seoul, Republic of Korea
| | - Do-Hyung Kang
- Emotional Information and Communication Technology Association, Seoul, Republic of Korea
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15
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Scholz-Odermatt SM, Luthi F, Wertli MM, Brunner F. Direct Health Care Cost and Work Incapacity Related to Complex Regional Pain Syndrome in Switzerland: A Retrospective Analysis from 2008 to 2015. PAIN MEDICINE 2020; 20:1559-1569. [PMID: 30848817 DOI: 10.1093/pm/pnz030] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE First, to determine the number of accident-related complex regional pain syndrome (CRPS) cases from 2008 to 2015 and to identify factors associated with an increased risk for developing CRPS. Second, to analyze the duration of work incapacity and direct health care costs over follow-up periods of two and five years, respectively. DESIGN Retrospective data analysis. SETTING Database from the Statistical Service for the Swiss National Accident Insurances covering all accidents insured under the compulsory Swiss Accident Insurance Law. SUBJECTS Subjects were registered after an accident between 2008 and 2015. METHODS Cases were retrospectively retrieved from the Statistical Service for the Swiss National Accident Insurances. Cases were identified using the appropriate International Classification of Diseases, 10th Revision, codes. RESULTS CRPS accounted for 0.15% of all accident cases. Age, female gender (odds ratio [OR] = 1.53, 95% confidence interval [CI] = 1.47-1.60), and fracture of the forearm (OR = 38, 95% CI = 35-42) were related to an increased risk of developing CRPS. Over five years, one CRPS case accumulated average insurance costs of $86,900 USD and treatment costs of $23,300 USD. Insurance costs were 19 times and treatment costs 13 times the average costs of accidents without CPRS. Within the first two years after the accident, the number of days lost at work was 20 times higher in patients with CRPS (330 ± 7 days) than in patients without CRPS (16.1 ± 0.1 days). Two-thirds of all CRPS cases developed long-term work incapacity of more than 90 days. CONCLUSION CRPS is a relatively rare condition but is associated with high direct health care costs and work incapacity.
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Affiliation(s)
- Stefan Markus Scholz-Odermatt
- Department of Statistics, Sammelstelle für die Statistik der Unfallversicherung (SSUV), c/o Swiss Accident Insurance Fund (Suva), Lucerne, Switzerland
| | - François Luthi
- Department for Musculoskeletal Rehabilitation, Clinique Romande de Réadaptation, Sion, Switzerland.,Department of Physical Medicine and Rehabilitation, Orthopedic Hospital, Lausanne University Hospital, Lausanne, Switzerland
| | - Maria Monika Wertli
- Department of General Internal Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Florian Brunner
- Department of Physical Medicine and Rheumatology, Balgrist University Hospital, Zurich, Switzerland
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Altas EU, Onat ŞŞ, Konak HE, Polat CS. Post-stroke complex regional pain syndrome and related factors: Experiences from a tertiary rehabilitation center. J Stroke Cerebrovasc Dis 2020; 29:104995. [PMID: 32807418 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104995] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/23/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE In this study, it is aimed to determine the risk factors associated with CRPS after stroke and the clinical parameters of the patients and the treatment agents used for CPRS METHOD: 213 hemiplegic patients with CRPS diagnosed in Group 1 and 213 hemiplegic patients without CRPS in group 2 (control group) were included in the study designed retrospectively. Demographic data of the patients, Brunnstrom stage, Modified Ashworth scale, Barthel index were recorded from patients files. Associated risk faktors with CRPS such as Shoulder subluxation, adhesive capsulitis, fracture, deep vein thrombosis, spasticity, neglect, visual field defect, heterotopic ossification, entrapment neuropathies, brachial plexus damage, pressure wound, lower respiratory tract infection (LRTI), urinary tract infection, epilepsy, and depression were questioned. In addition, clinical findings, medical treatments, and physical therapy agents used were recorded. RESULTS The average age of the participants was 67.9 ± 10.3 in group 1 and 66.1 ± 9.9 in group 2. According to the multivariate logistic regression analysis, the presence of the duration of hemiplegi, the duration of hospitalization, shoulder subluxation, soft tissue lesion, adhesive capsulitis, spasticity, entrapment neuropathy, brachial plexus ınjury, protein energy malnutrition, LRTI, urinary infection, depression, coronary artery disease were significantly increased the development of CRPS (p<0.05). As a clinical parameter, edema was present in 95.3% of the patients, while trophic change was the lowest in 1.9%. While sensory reeducation was used in all patients in physical therapy, ganglion blockade was the lowest with 0.9% of patients. In medical treatment, the use of oral paracetamol was 28.2%, while the use of gabapentin was the last with 8.9%. CONCLUSIONS In our study, the risk factors of CRPS after hemiplegia, which are as important as its treatment, as well as its diagnosis and prevention, are shown.
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Affiliation(s)
- Elif Umay Altas
- Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Türkocağı street No:3, Sıhhiye, Ankara, Turkey.
| | - Şule Şahin Onat
- Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Türkocağı street No:3, Sıhhiye, Ankara, Turkey
| | - Hatice Ecem Konak
- Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Türkocağı street No:3, Sıhhiye, Ankara, Turkey
| | - Cemile Sevgi Polat
- Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Türkocağı street No:3, Sıhhiye, Ankara, Turkey
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17
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Bang S, Kim YS, Lee S, Park U, Kim TK, Choi Y. Prevalence of common causes of neuropathic pain in Korea: population-based observational study. J Int Med Res 2020; 48:300060519888102. [PMID: 31775560 PMCID: PMC7516997 DOI: 10.1177/0300060519888102] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 10/22/2019] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To investigate the prevalence of complex regional pain syndrome (CRPS), post-herpetic neuralgia (PHN), trigeminal neuralgia (TN), and diabetic neuropathy (DN), common causes of neuropathic pain encountered in pain clinics. METHODS We investigated the period prevalence rate of CRPS, PHN, TN, and DN using data from a Korean national electronic database from 2009 to 2013. RESULTS The prevalence of CRPS decreased slightly throughout the study period, while the prevalence of PHN increased from 2009 to 2013. The prevalence of TN was reduced over the same period. The prevalence of DN increased from 2009 to 2012 but decreased in 2013. All four neuropathic diseases were more prevalent in individuals aged over 70 years. The prevalence of CRPS, PHN, and TN were more common in women than in men, but DN showed no gender difference. CONCLUSION While the prevalence of CRPS and TN has decreased in Korea, that of PHN and DN has increased. With the exception of DN, the neuropathic diseases were more prevalent in women. Further studies are necessary to investigate the risk factors and socioeconomic burden for each disease, and national efforts are essential to limit the development of these preventable neuropathic diseases.
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Affiliation(s)
- Seunguk Bang
- Daejeon St. Mary's Hospital, College
of Medicine, The Catholic University of Korea, Anesthesiology and Pain Medicine,
Daejeon, Republic of Korea
| | - Yee Suk Kim
- Catholic University of Korea Bucheon
Saint Mary's Hospital, Department of Anesthesiology and Pain Medicine, Bucheon,
Republic of Korea
| | - Soyeon Lee
- Catholic University of Korea Bucheon
Saint Mary's Hospital, Department of Anesthesiology and Pain Medicine, Bucheon,
Republic of Korea
| | - Uijin Park
- Catholic University of Korea Bucheon
Saint Mary's Hospital, Department of Anesthesiology and Pain Medicine, Bucheon,
Republic of Korea
| | - Tae-kwan Kim
- Catholic University of Korea Bucheon
Saint Mary's Hospital, Department of Anesthesiology and Pain Medicine, Bucheon,
Republic of Korea
| | - Yuna Choi
- Catholic University of Korea Bucheon
Saint Mary's Hospital, Department of Anesthesiology and Pain Medicine, Bucheon,
Republic of Korea
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18
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Type 1 Complex Regional Pain Syndrome After Subacromial Shoulder Surgery: Incidence and Risk Factor Analysis. Indian J Orthop 2020; 54:210-215. [PMID: 32952932 PMCID: PMC7474010 DOI: 10.1007/s43465-020-00174-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/09/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Complex Regional Pain Syndrome type 1 (CRPS1) is a potential complication, affecting the prognosis of functional joint recovery. Its incidence ranges from 2 to 40% depending on the series and the joints involved. Very few studies have evaluated the incidence of CRPS after shoulder surgery. The objective of our study was to determine the incidence of CRPS1 and to identify any pre-operative risk factors associated with its emergence after extra-articular subacromial space surgery. MATERIAL AND METHODS This is a retrospective single-centre study of patients who underwent surgery for a subacromial extra-articular shoulder pathology from January 2016 to December 2016 and included a follow-up period of at least 6 months. The primary inclusion criterion was developing a CRPS1 as defined by Veldman. A pre- and post-operative clinical assessment was performed based on the Constant (Cst) score. RESULTS Among the 287 patients, with an average follow-up period of 6.5 months, included in the study, 38 (13%) presented with post-operative CRPS1. Treated hypothyroidism (OR = 3.79; 95% CI 1.58;9.07; p = 0.003), open surgery (OR = 2.92; 95% CI 1.35-6.32; p = 0.007) and the level of daily physical activity from the Cst score (OR = 0.088; 95% CI 0.79;0.97; p = 0.015) were found to be significantly associated with the onset of CRPS1. CONCLUSION CRPS1 affected more than 10% of patients who underwent surgery for a subacromial shoulder pathology. The current study identified hypothyroidism, open surgery, and pre-operative clinical status as risk factors for the onset of this complication. These parameters should, therefore, be taken into consideration during the patient's pre-operative consultation.
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19
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Non-coding RNAs in neuropathic pain. Neuronal Signal 2020; 4:NS20190099. [PMID: 32587755 PMCID: PMC7306520 DOI: 10.1042/ns20190099] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/31/2020] [Accepted: 04/02/2020] [Indexed: 02/07/2023] Open
Abstract
Neuro-immune alterations in the peripheral and central nervous system play a role in the pathophysiology of chronic pain in general, and members of the non-coding RNA (ncRNA) family, specifically the short, 22 nucleotide microRNAs (miRNAs) and the long non-coding RNAs (lncRNAs) act as master switches orchestrating both immune as well as neuronal processes. Several chronic disorders reveal unique ncRNA expression signatures, which recently generated big hopes for new perspectives for the development of diagnostic applications. lncRNAs may offer perspectives as candidates indicative of neuropathic pain in liquid biopsies. Numerous studies have provided novel mechanistic insight into the role of miRNAs in the molecular sequelae involved in the pathogenesis of neuropathic pain along the entire pain pathway. Specific processes within neurons, immune cells, and glia as the cellular components of the neuropathic pain triad and the communication paths between them are controlled by specific miRNAs. Therefore, nucleotide sequences mimicking or antagonizing miRNA actions can provide novel therapeutic strategies for pain treatment, provided their human homologues serve the same or similar functions. Increasing evidence also sheds light on the function of lncRNAs, which converge so far mainly on purinergic signalling pathways both in neurons and glia, and possibly even other ncRNA species that have not been explored so far.
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20
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Complex regional pain syndrome following lumbar discectomy: A case report. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2019.100587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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21
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Baerlecken NT, Gaulke R, Pursche N, Witte T, Karst M, Bernateck M. Autoantibodies against P29ING4 are associated with complex regional pain syndrome. Immunol Res 2020; 67:461-468. [PMID: 32008173 DOI: 10.1007/s12026-020-09114-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Complex regional pain syndrome (CRPS) is a complication following trauma or surgery and may be difficult to diagnose since biomarkers are lacking. Using protein array technology, we found antibodies binding to p29ING4, which we further characterized using ELISA. METHODS Thirty-six sera of early-stage type 1 CRPS, 66 sera of rheumatoid arthritis (RA), 53 sera of axial spondyloarthritis (axSpA), 29 sera of psoriatic arthritis (PsA), 22 sera of patients after radial fractures (trauma control), and 100 sera of blood donors (BD) were analyzed for anti-p29ING4. We established ELISAs with 7 different antigens and using different secondary antibodies binding to IgG, IgG1, IgG2, IgG3, IgG4, IgA, and IgM, and 2 different tests to detect immune complexes (IC) of p29ING4 and IgG or IgG1. RESULTS The highest likelihood ratios versus CRPS and trauma control were observed considering the A1-23 (sensitivity 19%, specificity 100%, LR > 19) using IgG as a secondary antibody, the A120-165 (sensitivity 17%, specificity 100%, LR = 17) using IgG as a secondary antibody and the A120-165 (sensitivity 31%, specificity 95%, LR = 6.2) using IgA as a secondary antibody. IC of p29ING4 and IgG were present in 11/36 (31%) CRPS sera, 17/64 (27%) RA sera, 13/53 (25%) SpA sera, 5/29 (17%) PsA sera, 1/22 (5%) trauma control sera, and 4/100 (4%) sera of BD. IC of p29ING4 and IgG1 were present in 14/36 (39%) CRPS sera, 19/64 (30%) RA sera, 13/53 (25%) SpA, 1/29 (3%) PsA, 2/22 (9%) trauma control, and 4/100 (4%) of the BD sera. CONCLUSION Due to the lack of other biomarkers of type 1 CRPS, P29ING4 autoantibodies could be helpful in its diagnostic work-up.
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Affiliation(s)
| | - R Gaulke
- Trauma Department, Medical University Hannover, Hannover, Germany
| | - N Pursche
- Department of Clinical Immunology and Rheumatology, Medical University Hannover, Hannover, Germany
| | - T Witte
- Department of Clinical Immunology and Rheumatology, Medical University Hannover, Hannover, Germany
| | - M Karst
- Department of Anesthesiology, Pain Clinic, Medical University Hannover, Hannover, Germany
| | - M Bernateck
- Department of Anesthesiology, Pain Clinic, Medical University Hannover, Hannover, Germany
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22
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Fritz AV, Ferreira-Dos-Santos G, Hurdle MF, Clendenen S. Ultrasound-guided Percutaneous Peripheral Nerve Stimulation for the Treatment of Complex Regional Pain Syndrome Type 1 Following a Crush Injury to the Fifth Digit: A Rare Case Report. Cureus 2019; 11:e6506. [PMID: 32025427 PMCID: PMC6988727 DOI: 10.7759/cureus.6506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
This case report presents an application of percutaneous peripheral nerve stimulation to the left ulnar nerve to treat a patient with complex regional pain syndrome type 1 following a crush injury to the left fifth digit. Conventional treatment had failed to ameliorate the patient's condition. After a successful seven-day trial with an ulnar peripheral nerve catheter, which followed an unsuccessful capsulectomy of the metacarpophalangeal and proximal interphalangeal joints of the left fifth digit with tenolysis of the flexor tendons, the patient underwent an uneventful implantation of a percutaneous peripheral nerve stimulator parallel with the trajectory of the left ulnar nerve just distal to the ulnar tunnel. Two weeks after implantation of the percutaneous peripheral nerve stimulator, the patient reported a reduction in the pain, with the intensity score coming down from 7 out of 10 to 0-1 out of 10 on the numeric rating scale (NRS). The patient was able to initiate pain-free active motion of her left fifth digit. At the 3-month follow-up consultation, the patient reported maintenance of the reduction of pain in her left upper extremity with the implanted percutaneous peripheral nerve stimulator, as well as improved performance in her daily activities. Despite the success achieved in this particular case, further clinical series involving larger numbers of patients are warranted in order to assess the definitive role of percutaneous peripheral nerve stimulation for the treatment of neuropathic pain of the upper and lower extremities, which has been previously unresponsive to medical and/or surgical treatment.
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Affiliation(s)
- Ashley V Fritz
- Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, USA
| | | | | | - Steven Clendenen
- Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, USA
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23
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Rhee SH, Park SH, Ha SH, Ryoo SH, Karm MH, Kim HJ, Seo KS. Treatment of severe pain in a patient with complex regional pain syndrome undergoing dental treatment under general anesthesia: A case report. J Dent Anesth Pain Med 2019; 19:295-300. [PMID: 31723670 PMCID: PMC6834719 DOI: 10.17245/jdapm.2019.19.5.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 10/22/2019] [Accepted: 10/25/2019] [Indexed: 11/15/2022] Open
Abstract
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.
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Affiliation(s)
- Seung-Hyun Rhee
- Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Korea
| | - Sang-Hun Park
- Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Korea
| | - Sung-Ho Ha
- Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital, Seoul, Korea
| | - Seung-Hwa Ryoo
- Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Korea
| | - Myong-Hwan Karm
- Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Korea
| | - Hyun Jeong Kim
- Department of Dental Anesthesiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Kwang-Suk Seo
- Department of Dental Anesthesiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
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Kirby E, Sparrow S. A retrospective analysis of the number of therapy visits after distal radius fractures using a new provider-scored clinical severity scale. J Hand Ther 2019; 31:480-485. [PMID: 28711410 DOI: 10.1016/j.jht.2017.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 05/05/2017] [Accepted: 06/14/2017] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Retrospective study. INTRODUCTION Fractures of the distal radius are common as is a postfracture referral to occupational therapy (OT). This article examines factors that cause greater morbidity and a greater number of OT visits. PURPOSE OF THE STUDY This study aims to analyze which of 5 common sequelae of the distal radius fracture is most significant for increasing the number of therapy visits. METHODS Three-hundred Sixty charts were reviewed, and 89 were selected. Multiple regression was used to determine which of our 5 independent variables had the greatest predictive power for the total number of therapy visits. RESULTS The regression model demonstrated significance at P ≤ .01. Total active motion (TAM) of the digits (P ≤ .01) and TAM of the forearm (P ≤ .01) were the only complications that demonstrated statistical significance and a positive relationship with the number of therapy visits. In addition to this, TAM of the forearm and digits showed a strong correlation with the number of therapy visits. TAM of the wrist, pain, and edema had a weak correlation. Patients with high total group score on the clinical severity scale also had a moderate correlation. DISCUSSION The results of the study illustrate the importance of digital contractures on a patient's morbidity, function, and their need for OT visits. CONCLUSION The information from this study is important for the clinician as it identifies patients at risk for increased morbidity and identifies the complications that the clinician may want to stress early in the rehabilitation of that patient. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Eric Kirby
- MacNeal Hospital Rehabilitation Department, Berwyn, IL, USA.
| | - Sean Sparrow
- MacNeal Hospital Rehabilitation Department, Berwyn, IL, USA
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25
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Mekhail N, Costandi S, Mehanny DS, Armanyous S, Saied O, Taco‐Vasquez E, Saweris Y. The Impact of Tobacco Smoking on Spinal Cord Stimulation Effectiveness in Complex Regional Pain Syndrome Patients. Neuromodulation 2019; 23:133-139. [DOI: 10.1111/ner.13058] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 08/09/2019] [Accepted: 08/10/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Nagy Mekhail
- Evidence‐Based Pain ManagementCleveland Clinic Foundation Cleveland OH USA
| | - Shrif Costandi
- Evidence‐Based Pain ManagementCleveland Clinic Foundation Cleveland OH USA
| | - Diana S. Mehanny
- Evidence‐Based Pain ManagementCleveland Clinic Foundation Cleveland OH USA
| | - Sherif Armanyous
- Evidence‐Based Pain ManagementCleveland Clinic Foundation Cleveland OH USA
| | - Ogena Saied
- Evidence‐Based Pain ManagementCleveland Clinic Foundation Cleveland OH USA
| | - Erika Taco‐Vasquez
- Evidence‐Based Pain ManagementCleveland Clinic Foundation Cleveland OH USA
| | - Youssef Saweris
- Evidence‐Based Pain ManagementCleveland Clinic Foundation Cleveland OH USA
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Modarresi S, Aref-Eshghi E, Walton DM, MacDermid JC. Does a familial subtype of complex regional pain syndrome exist? Results of a systematic review. Can J Pain 2019; 3:157-166. [PMID: 35005404 PMCID: PMC8730611 DOI: 10.1080/24740527.2019.1637249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background and Objective: Complex regional pain syndrome (CRPS) is a chronic condition characterized by severe regional pain, allodynia, hyperalgesia, and functional impairment. The aim of this systematic review is to investigate whether a familial subtype of CRPS (fCRPS) exists and to determine whether people with fCRPS have specific characteristics. Methods: Databases CINAHL, Medline, PsycINFO, and PubMed were searched with no date limitation. Quality of reporting was assessed using the Scottish Intercollegiate Guidelines Network scale and the Joanna Briggs Institute’s checklists. Results: Eight studies were included. Family relationships were defined as any immediate (i.e., parents or siblings) or blood relatives. A combination of participants with known or unknown causes for CRPS was recruited. The studies in this review support the potential for the existence of fCRPS, although this included less than 25% of those affected. People with potential fCRPS showed more severe symptoms, more sites involved, a higher percentage of spontaneous onset, and earlier age at onset. An elevated sibling recurrence risk ratio of 5.6 (95% confidence interval [CI], 3.0 to 9.8) was reported for people under 50. None of the studies established a pattern of heritability. Therefore, the most likely explanation for heritability would be a multifactorial model in which cumulative and interactive Gene × Environment effects may be involved. Conclusions: This systematic review supports the potential for the existence of fCRPS; however, all identified studies used uncontrolled case reports, case series, and case–control designs that cannot provide evidence of causation. Further studies are required to reveal the heritability and genetic structure of fCRPS.
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Affiliation(s)
- S Modarresi
- Health & Rehabilitation Science, Western University, London, Ontario, Canada
| | - E Aref-Eshghi
- Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada
| | - D M Walton
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - J C MacDermid
- School of Physical Therapy, Western University, London, Ontario, Canada.,Department of Surgery, Western University, London, Ontario, Canada.,Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada.,School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
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Trans-styloid, trans-hamate dorsal lunate dislocation: A case report. Int J Surg Case Rep 2019; 61:96-98. [PMID: 31352321 PMCID: PMC6664157 DOI: 10.1016/j.ijscr.2019.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 07/06/2019] [Accepted: 07/11/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Lunate dislocation is a rare and serious injury, frequently due to high-energy trauma such as a fall from height or a motor vehicle accident. Lunate dislocation is usually in the volar direction; however, dorsal dislocation of the lunate is extremely rare. PRESENTATION OF CASE We report a case of 55-year-old male who sustained a high-energy trauma; he was hit by a car while crossing the street. The patient was referred to department of Plastic Surgery for left wrist dorsal dislocation of the lunate and bilateral multiple carpal bone fractures. He was managed by open reduction and internal fixation with scapholunate ligament repair for the left wrist, while the right wrist was treated conservatively. DISCUSSION Such cases must be treated urgently to avoid complications such as avascular necrosis of the lunate, median nerve injury, complex regional pain syndrome, and chronic carpal instability. CONCLUSION This case is one of few cases reported in the literature highlighting the rarity of this injury pattern.
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Gutiérrez-Espinoza H, Tabach-Apraiz A, Oyanadel-Maldonado M. Physical therapy in patients with complex regional pain syndrome type I after distal radius fracture: a case series. J Phys Ther Sci 2019; 31:403-407. [PMID: 31037018 PMCID: PMC6451956 DOI: 10.1589/jpts.31.403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 01/22/2019] [Indexed: 12/01/2022] Open
Abstract
[Purpose] To describe the effect of a physical therapy program in function improvement
and pain reduction in patients older than 60 years with complex regional pain syndrome
(CRPS) type I after distal radius fracture (DRF) treated conservatively. [Participants and
Methods] Fifty-four patients received a 6 weeks physical therapy program that included in
hydrotherapy, manual therapy, and exercises based on motor skill training. Two evaluations
were performed, the wrist/hand function was assessed with Patient-Rated Wrist Evaluation
(PRWE) questionnaire, the upper extremity function with the Disabilities of the Arm,
Shoulder and Hand (DASH) questionnaire, grip strength with Jamar Dynamometer, and pain
intensity with the Visual Analog Scale (VAS). [Results] At the end of the treatment, PRWE
showed a decrease of 30.9 points, DASH 34.7 points, and the VAS, 3.4 cm. The grip strength
showed an increase of 14.4%. [Conclusion] A physical therapy program based on
hydrotherapy, manual therapy, and exercises in a short term improves the function and
reduces the pain in patients older than 60 years with CRPS I after DRF treated
conservatively.
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Affiliation(s)
- Héctor Gutiérrez-Espinoza
- Physical Therapy School, University of the Americas: Echaurren St.140, 3rd floor, Santiago 8320000, Chile.,Physical Therapy Department, Clinical Hospital San Borja Arriaran, Chile
| | - Andrea Tabach-Apraiz
- Physical Medicine and Rehabilitation Department, Hospital San Juan de Dios, Chile
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Goebel A, Jacob A, Frank B, Sacco P, Alexander G, Philips C, Bassett P, Moots R. Mycophenolate for persistent complex regional pain syndrome, a parallel, open, randomised, proof of concept trial. Scand J Pain 2019; 18:29-37. [PMID: 29794285 DOI: 10.1515/sjpain-2017-0154] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 01/10/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS Current therapies for persistent complex regional pain syndrome (CRPS) are grossly inadequate. With accruing evidence to support an underlying immunological process and anecdotal evidence suggesting potential efficacy of mycophenolate, we wished to explore the feasibility and effectiveness of this treatment in patients with CRPS. METHODS A randomised, open, parallel, proof of concept trial was conducted. Patients with Budapest research criteria CRPS of >2-year duration and moderate or high pain intensity (numeric rating scale score ≥5) were enrolled. Eligible patients were randomised 1:1 to openly receive mycophenolate as add-on treatment, or their usual treatment alone, over 5.5 months. They then switched to the other treatment arm for 5.5 months. The main outcome was average the patients' average pain intensity recorded over 14 days, between 5.0 and 5.5 months post randomisation, on 11-point (0-10) numeric rating scales, compared between trial arms. Skin sensitivities and additional outcomes were also assessed. RESULTS Twelve patients were enrolled. Nine provided outcomes and were analysed for the main outcome. Mycophenolate treatment was significantly more effective than control [drug-group mean (SD): pre: 7.4 (1.2)- post: 5.2 (1.3), n=4, control: pre: 7.7 (1.4)- post: 8.1 (0.9), n=5; -2.8 (95% CI: -4.7, -1.0), p=0.01, analysis of covariance]. There were four treatment responders (to mycophenolate treatment either before, or after switch), whose initial exquisite skin hyper-sensitivities, function and quality of life strongly improved. Side effects including itchiness, skin-cryptitis, increased pain, and increased depression caused 45% of the subjects to stop taking mycophenolate. CONCLUSIONS Mycophenolate appears to reduce pain intensity and improve quality of life in a subgroup of patients with persistent CRPS. IMPLICATIONS These results support the feasibility of conducting a definite trial to confirm the efficacy and effect size of mycophenolate treatment for persistent CRPS (EudraCT 2015-000263-14).
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Affiliation(s)
- Andreas Goebel
- Pain Research Institute, Institute of Translational Medicine, University of Liverpool, Liverpool L9 7AL, UK, Phone: +44 151 529 5820, E-mail:
| | - Anu Jacob
- Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool, England, UK
| | - Bernhard Frank
- Department of Pain Medicine, Walton Centre NHS Foundation Trust, Liverpool, England, UK
| | - Paul Sacco
- Pain Research Institute, Institute of Ageing and Chronic Disease, University of Liverpool, England, UK
| | | | - Ceri Philips
- College of Human and Health Sciences, Swansea University, Singelton Park, Swansea, Wales, UK
| | | | - Robert Moots
- Department of Musculoskeletal Biology, Institute of Ageing and Chronic Disease, Aintree University Hospital, Liverpool, England, UK
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Incidence of and Risk Factors for Complex Regional Pain Syndrome Type 1 after Surgery for Distal Radius Fractures: A Population-based Study. Sci Rep 2019; 9:4871. [PMID: 30890732 PMCID: PMC6425010 DOI: 10.1038/s41598-019-41152-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 02/28/2019] [Indexed: 12/14/2022] Open
Abstract
This study aimed to evaluate the incidence rates of and risk factors for complex regional pain syndrome type 1 (CRPS-1) after surgery for distal radius fractures (DRFs). Using data from January 2007 to December 2014, we analysed the data from the Korean Health Insurance Review and Assessment (HIRA) service. After extracting the data of patients aged ≥18 years whose diagnostic and operation codes for DRFs were entered into the HIRA database, we analysed the incidence rates of and risk factors for CRPS-1. From 2007 to 2014, 172,194 DRFs were treated surgically. Within 1 year postoperatively, 1,103 CRPS-1 cases were diagnosed, with an incidence of 0.64%. On univariate and multivariate analyses, the risk factors that significantly correlated with the incidence of CRPS-1 included female sex, rheumatoid arthritis, open reduction, open fracture, and accompanying ulnar fracture, whereas old age, psychiatric disease, and external fixation were not statistically significant. The incidence of CRPS-1 after surgery for DRF was very low (0.64%) in South Korea. Careful monitoring is necessary for patients with complex fractures and rheumatoid arthritis who are at increased risk of developing CRPS-1.
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Goebel A, Callaghan T, Jones S, Bridson J. Patient consultation about a trial of therapeutic plasma exchange for complex regional pain syndrome. J Clin Apher 2018; 33:661-665. [PMID: 30387202 DOI: 10.1002/jca.21662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 07/27/2018] [Accepted: 08/14/2018] [Indexed: 11/07/2022]
Abstract
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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Affiliation(s)
- Andreas Goebel
- Department of Translational Medicine, Faculty of Health and Life Sciences, Pain Research Institute, University of Liverpool, Liverpool, United Kingdom.,Department of Pain Medicine, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | | | - Sandra Jones
- NHS Blood and Transplant, Liverpool, United Kingdom
| | - John Bridson
- Clinical Ethics, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
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32
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Navarro K, Wainwright E, Rodham K, Jordan A. Parenting young people with complex regional pain syndrome: an analysis of the process of parental online communication. Pain Rep 2018; 3:e681. [PMID: 30324173 PMCID: PMC6172825 DOI: 10.1097/pr9.0000000000000681] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 08/01/2018] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Parenting a young person with complex regional pain syndrome (CRPS) is associated with high levels of parental distress and numerous emotional, informational, and practical challenges. To meet these challenges, parents seek others undergoing similar experiences, both in face to face and online forums. OBJECTIVES The objective of this study was to conduct a qualitative analysis of online forum data to explore the process of parental forum communication regarding parenting a young person with CRPS in online spaces. METHODS A total of 107 forum posts relating to parenting a young person with CRPS were collected from 39 users across 2 public forums. Data were analyzed using thematic analysis. RESULTS Findings identified 2 themes: "the informal rules of exchanging and receiving network support" and "parents positioning themselves as experts." The first theme highlighted the varied nature of support sought and provided by parents in addition to social rules associated with the negotiation of this support. The second theme represented an understanding of how parents presented themselves as experts in their young person's pain, both in relation to fellow parents and health care professionals. CONCLUSION This study provided a novel insight into support and communicational exchanges between parents of young people with CRPS on online public forums. Findings identified the perceived usefulness of online spaces in terms of parents of young people with CRPS seeking and providing support. Further research can helpfully investigate how we might implement online peer mentoring to improve support further for parents.
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Affiliation(s)
- Kaedi Navarro
- Department of Psychology, University of Bath, Bath, United Kingdom
| | - Elaine Wainwright
- Department of Psychology, Bath Spa University, Bath, United Kingdom
- Department for Health, University of Bath, Bath, United Kingdom
| | - Karen Rodham
- Department of Psychology, Staffordshire Centre for Psychological Research, Staffordshire University, Stoke on Trent, United Kingdom
| | - Abbie Jordan
- Department of Psychology and Centre for Pain Research, University of Bath, Bath, United Kingdom
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Bar-Shalita T, Livshitz A, Levin-Meltz Y, Rand D, Deutsch L, Vatine JJ. Sensory modulation dysfunction is associated with Complex Regional Pain Syndrome. PLoS One 2018; 13:e0201354. [PMID: 30091986 PMCID: PMC6084887 DOI: 10.1371/journal.pone.0201354] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 07/14/2018] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Complex Regional Pain Syndrome (CRPS), a chronic pain condition, develops mainly after limb trauma and severely inhibits function. While early diagnosis is essential, factors for CRPS onset are elusive. Therefore, identifying those at risk is crucial. Sensory modulation dysfunction (SMD), affects the capacity to regulate responses to sensory input in a graded and adaptive manner and was found associated with hyperalgesia in otherwise healthy individuals, suggestive of altered pain processing. AIM To test SMD as a potential risk factor for CRPS. METHODS In this cross-sectional study, forty-four individuals with CRPS (29.9±11 years, 27 men) and 204 healthy controls (27.4±3.7 years, 105 men) completed the Sensory Responsiveness Questionnaire-Intensity Scale (SRQ-IS). A physician conducted the CRPS Severity Score (CSS), testing individuals with CRPS. RESULTS Thirty-four percent of the individuals with CRPS and twelve percent of the healthy individuals were identified to have SMD (χ2 (1) = 11.95; p<0.001). Logistic regression modeling revealed that the risk of CRPS is 2.68 and 8.21 times higher in individuals with sensory over- and sensory under-responsiveness, respectively, compared to non-SMD individuals (p = 0.03 and p = 0.01, respectively). CONCLUSIONS SMD, particularly sensory under-responsiveness, might serve as a potential risk factor for CRPS and therefore screening for SMD is recommended. This study provides the risk index probability clinical tool a simple evaluation to be applied by clinicians in order to identify those at risk for CRPS immediately after injury. Further research is needed.
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Affiliation(s)
- Tami Bar-Shalita
- Department of Occupational Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Anatoly Livshitz
- Center for Rehabilitation of Pain Syndromes, Reuth Rehabilitation Hospital, Tel Aviv, Israel
| | - Yulia Levin-Meltz
- Center for Rehabilitation of Pain Syndromes, Reuth Rehabilitation Hospital, Tel Aviv, Israel
| | - Debbie Rand
- Department of Occupational Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lisa Deutsch
- BioStats Statistical Consulting Ltd, Modiin, Israel
| | - Jean-Jacques Vatine
- Center for Rehabilitation of Pain Syndromes, Reuth Rehabilitation Hospital, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Bruce RD, Merlin J, Lum PJ, Ahmed E, Alexander C, Corbett AH, Foley K, Leonard K, Treisman GJ, Selwyn P. 2017 HIVMA of IDSA Clinical Practice Guideline for the Management of Chronic Pain in Patients Living With HIV. Clin Infect Dis 2018; 65:e1-e37. [PMID: 29020263 DOI: 10.1093/cid/cix636] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 07/19/2017] [Indexed: 12/27/2022] Open
Abstract
Pain has always been an important part of human immunodeficiency virus (HIV) disease and its experience for patients. In this guideline, we review the types of chronic pain commonly seen among persons living with HIV (PLWH) and review the limited evidence base for treatment of chronic noncancer pain in this population. We also review the management of chronic pain in special populations of PLWH, including persons with substance use and mental health disorders. Finally, a general review of possible pharmacokinetic interactions is included to assist the HIV clinician in the treatment of chronic pain in this population.It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. The Infectious Diseases Society of American considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.
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Affiliation(s)
- R Douglas Bruce
- Department of Medicine, Cornell Scott-Hill Health Center and Yale University, New Haven, Connecticut
| | - Jessica Merlin
- Divisions of Infectious Diseases and Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham
| | - Paula J Lum
- Division of HIV, Infectious Disease, and Global Medicine, University of California San Francisco
| | - Ebtesam Ahmed
- St. Johns University College of Pharmacy and Health Sciences, Metropolitan Jewish Health System Institute for Innovation in Palliative Care, New York
| | - Carla Alexander
- University of Maryland School of Medicine, Institute of Human Virology, Baltimore
| | - Amanda H Corbett
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill
| | - Kathleen Foley
- Attending Neurologist Emeritus, Memorial Sloan Kettering Cancer Center, New York
| | - Kate Leonard
- Division of Neuroscience and Clinical Pharmacology, Cornell University, New York, New York
| | | | - Peter Selwyn
- Department of Family and Social Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
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Kong X, Gozani SN. Effectiveness of fixed-site high-frequency transcutaneous electrical nerve stimulation in chronic pain: a large-scale, observational study. J Pain Res 2018; 11:703-714. [PMID: 29670397 PMCID: PMC5898590 DOI: 10.2147/jpr.s156610] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective The objective of this study was to assess the effectiveness of fixed-site high-frequency transcutaneous electrical nerve stimulation (FS-TENS) in a real-world chronic pain sample. Background There is a need for nonpharmacological treatment options for chronic pain. FS-TENS improved multisite chronic pain in a previous interventional study. Large observational studies are needed to further characterize its effectiveness. Methods This retrospective observational cohort study examined changes in chronic pain measures following 60 days of FS-TENS use. The study data were obtained from FS-TENS users who uploaded their device utilization and clinical data to an online database. The primary outcome measures were changes in pain intensity and pain interference with sleep, activity, and mood on an 11-point numerical rating scale. Dose-response associations were evaluated by stratifying subjects into low (≤30 days), intermediate (31-56 days), and high (≥57 days) utilization subgroups. FS-TENS effectiveness was quantified by baseline to follow-up group differences and a responder analysis (≥30% improvement in pain intensity or ≥2-point improvement in pain interference domains). Results Utilization and clinical data were collected from 11,900 people using FS-TENS for chronic pain, with 713 device users meeting the inclusion and exclusion criteria. Study subjects were generally older, overweight adults. Subjects reported multisite pain with a mean of 4.8 (standard deviation [SD] 2.5) pain sites. A total of 97.2% of subjects identified low back and/or lower extremity pain, and 72.9% of subjects reported upper body pain. All pain measures exhibited statistically significant group differences from baseline to 60-day follow-up. The largest changes were pain interference with activity (-0.99±2.69 points) and mood (-1.02±2.78 points). A total of 48.7% of subjects exhibited a clinically meaningful reduction in pain interference with activity or mood. This proportion increased to 57.1% for the high utilization subgroup. Conclusion FS-TENS is a practical option for treating multisite chronic pain. The greatest impact is on pain interference with activity and mood. FS-TENS utilization and effectiveness exhibit a dose-response association, suggesting that daily use maximizes pain relief.
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Schofield JR. Autonomic neuropathy-in its many guises-as the initial manifestation of the antiphospholipid syndrome. Immunol Res 2018; 65:532-542. [PMID: 28116654 DOI: 10.1007/s12026-016-8889-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Autonomic disorders have previously been described in association with the antiphospholipid syndrome. The present study aimed to determine the clinical phenotype of patients in whom autonomic dysfunction was the initial manifestation of the antiphospholipid syndrome and to evaluate for autonomic neuropathy in these patients. This was a retrospective study of 22 patients evaluated at the University of Colorado who were found to have a disorder of the autonomic nervous system as the initial manifestation of antiphospholipid syndrome. All patients had persistent antiphospholipid antibody positivity and all patients who underwent skin biopsy were found to have reduced sweat gland nerve fiber density suggestive of an autonomic neuropathy. All patients underwent an extensive evaluation to rule out other causes for their autonomic dysfunction. Patients presented with multiple different autonomic disorders, including postural tachycardia syndrome, gastrointestinal dysmotility, and complex regional pain syndrome. Despite most having low-titer IgM antiphospholipid antibodies, 13 of the 22 patients (59%) suffered one or more thrombotic event, but pregnancy morbidity was minimal. Prothrombin-associated antibodies were helpful in confirming the diagnosis of antiphospholipid syndrome. We conclude that autonomic neuropathy may occur in association with antiphospholipid antibodies and may be the initial manifestation of the syndrome. Increased awareness of this association is important, because it is associated with a significant thrombotic risk and a high degree of disability. In addition, anecdotal experience has suggested that antithrombotic therapy and intravenous immunoglobulin therapy may result in significant clinical improvement in these patients.
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Affiliation(s)
- Jill R Schofield
- Department of Medicine, University of Colorado, Anschutz Medical Campus 12605 E. 16th Ave. B120, Aurora, CO, 80045, USA.
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37
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Howard BA, Roy L, Kaye AD, Pyati S. Utility of Radionuclide Bone Scintigraphy in Complex Regional Pain Syndrome. Curr Pain Headache Rep 2018; 22:7. [PMID: 29388057 DOI: 10.1007/s11916-018-0659-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW To describe the current understanding of the role of three-phase bone scintigraphy (TPBS) in the diagnosis and management of complex regional pain syndrome (CRPS), discuss its advantages and limitations, and present three examples of TPBS patterns typically seen in CRPS patients. RECENT FINDINGS CRPS is a debilitating disorder frequently presenting with pain to ordinarily non-painful stimuli, redness, swelling, following fractures, stroke, myocardial infarction, surgery, or even minor trauma, and its diagnosis, based on clinical criteria and supportive imaging findings, is difficult. Of the available adjunctive diagnostic imaging modalities, radionuclide bone scintigraphy using a TPBS protocol is the most sensitive and specific for detecting abnormalities commonly seen with this condition-classically, increased periarticular uptake on delayed phase of TPBS, with variable increased uptake on perfusion phases, depending on chronicity. Recent studies have (1) demonstrated a more heterogeneous correlation of TPBS findings with CRPS diagnosis using the current Budapest criteria than in studies using older criteria, (2) pointed to the utility of novel quantitative scintigraphic techniques, and (3) highlighted the value of the early perfusion phases of TPBS in predicting treatment response. TPBS remains a valuable imaging adjunct to clinical diagnosis of CRPS. In combination with a multi-modal analgesic approach, TPBS can be used to follow disease course and potentially treatment response, although prospective trials are needed to further delineate its role.
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Affiliation(s)
- Brandon A Howard
- Division of Nuclear Medicine, Department of Radiology, Duke University Medical Center, Durham, NC, 27710, USA
| | - Lance Roy
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, 27710, USA
| | - Alan David Kaye
- Department of Anesthesiology, Louisiana State University, New Orleans, LA, 70112, USA
| | - Srinivas Pyati
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, 27710, USA. .,Department of Anesthesiology, Durham Veterans Affairs Medical Center, Durham, NC, 27710, USA.
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Case Report of an Acute Complex Perilunate Fracture Dislocation Treated with a Three-Corner Fusion. Case Rep Orthop 2018; 2018:8397638. [PMID: 29951332 PMCID: PMC5989276 DOI: 10.1155/2018/8397638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 04/30/2018] [Accepted: 05/08/2018] [Indexed: 11/17/2022] Open
Abstract
Perilunate fracture dislocations are a rare but devastating injury, which is often missed on initial presentation leading to significant delays in treatment. With the delay in treatment and a high energy mechanism of injury, patients are at increased risk of developing complex regional pain syndrome following trauma. In this report, we review the case of a 57-year-old left-hand dominant female who presented to a clinic with a five-and-a-half-week-old transtriquetral, perilunate fracture dislocation with comminution of the scaphoid facet. Due to the increased likelihood of a secondary procedure and low probability of a satisfactory outcome with open reduction internal fixation secondary to the loss of the scaphoid articulation, a salvage procedure was deemed her best option. To our knowledge, this is the first case reported in the literature in which a scaphoidectomy, triquetromy, and midcarpal fusion (three-corner fusion) was performed in the acute setting for a perilunate fracture dislocation.
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Llewellyn A, McCabe C, Hibberd Y, White P, Davies L, Marinus J, Perez R, Thomassen I, Brunner F, Sontheim C, Birklein F, Schlereth T, Goebel A, Haigh R, Connett R, Maihöfner C, Knudsen L, Harden R, Zyluk A, Shulman D, Small H, Gobeil F, Moskovitz P. Are you better? A multi-centre study of patient-defined recovery from Complex Regional Pain Syndrome. Eur J Pain 2017; 22:551-564. [PMID: 29194871 DOI: 10.1002/ejp.1138] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2017] [Indexed: 11/07/2022]
Affiliation(s)
- A. Llewellyn
- Royal United Hospitals; Bath UK
- University of the West of England; Bristol UK
| | - C.S. McCabe
- Royal United Hospitals; Bath UK
- University of the West of England; Bristol UK
| | | | - P. White
- University of the West of England; Bristol UK
| | | | - J. Marinus
- Leiden University Medical Centre; Leiden The Netherlands
| | | | - I. Thomassen
- Dutch National CRPS Patient Organization; Nijmegen The Netherlands
| | - F. Brunner
- Balgrist University Hospital; Zurich Switzerland
| | - C. Sontheim
- Balgrist University Hospital; Zurich Switzerland
| | - F. Birklein
- University Medical Centre Mainz; Mainz Germany
| | - T. Schlereth
- University Medical Centre Mainz; Mainz Germany
- DKD HELIOS Klinik; Wiesbaden Germany
| | - A. Goebel
- Walton Centre NHS Foundation Trust and Pain Research Institute; University of Liverpool; Liverpool UK
| | - R. Haigh
- Royal Devon & Exeter Hospital; Exeter UK
| | - R. Connett
- Royal Devon & Exeter Hospital; Exeter UK
| | - C. Maihöfner
- Department of Neurology; General Hospital Fürth; Fürth Germany
| | - L. Knudsen
- The Spinal Cord Injury Centre of Western Denmark; Viborg Regional Hospital; Viborg Denmark
- Danish Pain Research Centre; Aarhus University Hospital; Aarhus Denmark
| | - R.N. Harden
- Rehabilitation Institute of Chicago; Chicago IL USA
| | - A. Zyluk
- Pomeranian Medical University; Szczecin Poland
| | - D. Shulman
- Markham-Stouffville Hospital; Markham ON Canada
| | - H. Small
- PARC (Promoting Awareness of RSD and CRPS in Canada); St. Catharines Canada
| | - F. Gobeil
- CSSS Pierre Boucher; Longueuil QC Canada
| | - P. Moskovitz
- The George Washington University Hospital; Washington DC USA
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Migraine and Complex Regional Pain Syndrome: A Case-Referent Clinical Study. BIOMED RESEARCH INTERNATIONAL 2017; 2017:5714673. [PMID: 29214172 PMCID: PMC5682894 DOI: 10.1155/2017/5714673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 09/25/2017] [Accepted: 10/01/2017] [Indexed: 01/03/2023]
Abstract
We studied clinical phenotype differences between migraineurs with CRPS (Mig + CRPS) and those without (Mig − CRPS). Mig + CRPS cases and Mig − CRPS referents aged ≥18 years were enrolled. Diagnosis was made in accordance with International Classification of Headache Disorders-3 beta (ICHD-3 beta) for migraine and Budapest Criteria for CRPS. Migraines both with and without aura were included. A total of 70 Mig + CRPS cases (13% males, mean age 48 years) and 80 Mig − CRPS referents (17% males, mean age 51 years) were included. 33% of Mig + CRPS and 38% of Mig − CRPS exhibited episodic migraine (EM) while 66% of Mig + CRPS and 62% of Mig − CRPS had chronic migraine (CM) (OR = 0.98, CI 0.36, 2.67). Median duration of CRPS was 3 years among EM + CRPS and 6 years among CM + CRPS cohort (p < 0.02). Mig + CRPS (57%) carried higher psychological and medical comorbidities compared to Mig − CRPS (6%) (OR 16.7, CI 10.2, 23.6). Higher migraine frequency was associated with longer CRPS duration. Migraineurs who developed CRPS had higher prevalence of psychological and medical disorders. Alleviating migraineurs' psychological and medical comorbidities may help lower CRPS occurrence.
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Effects of Glutathione on Mechanical Allodynia and Central Sensitization in Chronic Postischemic Pain Rats. Pain Res Manag 2017; 2017:7394626. [PMID: 29209138 PMCID: PMC5676478 DOI: 10.1155/2017/7394626] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/08/2017] [Accepted: 09/18/2017] [Indexed: 01/08/2023]
Abstract
Background The chronic postischemia pain (CPIP) model is an animal model using ischemia/reperfusion injury that mimics the symptoms of complex regional pain syndrome type I. Glutathione (GSH) prevents ischemia/reperfusion injury by scavenging free radicals. We conducted this study to investigate the protective effect of GSH in CPIP rats via changes of mechanical allodynia and phospholyration of the N-methyl-D-aspartate receptor subunit GluN1. Methods We divided 45 rats into 5 groups: sham, CPIP, CPIP + GSH 100 mg/kg, CPIP + GSH 200 mg/kg, and CPIP + GSH 500 mg/kg. Rats in the sham and CPIP groups received normal saline and rats in the other groups received GSH at the designated doses thirty minutes prior to reperfusion. Withdrawal thresholds were evaluated before sugery as well as 1, 3, and 7 days after surgery. pGluN1 level in the spinal cord was also measured. Results GSH treated rats show a significant increase in the withdrawal thresholds of both hind paws as compared with the CPIP group dose-dependently. The expression of pGluN1 in the GSH treated rats significantly decreased as compared to the CPIP group (all P < 0.05). Conclusion These findings suggest that GSH inhibited the development of mechanical allodynia and central sensitization in CPIP rats.
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Arjmand P, Azizi B, Bal M, O'Connor M, Zackon D. Periorbital complex regional pain syndrome. Can J Ophthalmol 2017; 52:e49-e52. [PMID: 28457301 DOI: 10.1016/j.jcjo.2016.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 10/08/2016] [Accepted: 10/20/2016] [Indexed: 11/17/2022]
Affiliation(s)
| | | | | | - Michael O'Connor
- University of Ottawa Eye Institute, Ottawa, Ont; The Children's Hospital of Southern Ontario, Ottawa, Ont
| | - David Zackon
- University of Ottawa Eye Institute, Ottawa, Ont.
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Pasek TA, Crowley K, Campese C, Lauer R, Yang C. Case Study of High-Dose Ketamine for Treatment of Complex Regional Pain Syndrome in the Pediatric Intensive Care Unit. Crit Care Nurs Clin North Am 2017; 29:177-186. [PMID: 28460699 DOI: 10.1016/j.cnc.2017.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Complex regional pain syndrome (CRPS) is a life-altering and debilitating chronic pain condition. The authors are presenting a case study of a female who received high-dose ketamine for the management of her CRPS. The innovative treatment lies not only within the pharmacologic management of her pain, but also in the fact that she was the first patient to be admitted to our pediatric intensive care unit solely for pain control. The primary component of the pharmacotherapy treatment strategy plan was escalating-dose ketamine infusion via patient-controlled-analgesia approved by the pharmacy and therapeutics committee guided therapy for this patient. The expertise of advanced practice nurses blended exquisitely to ensure patient and family-centered care and the coordination of care across the illness trajectory. The patient experienced positive outcomes.
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Affiliation(s)
- Tracy Ann Pasek
- Pain, Pediatric Intensive Care Unit, Evidence-Based Practice and Research, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Kelli Crowley
- Department of Pharmacy, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Catherine Campese
- Department of Anesthesiology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Rachel Lauer
- Department of Anesthesiology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Charles Yang
- Department of Anesthesiology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Adult Complex Regional Pain Syndrome Type I: A Narrative Review. PM R 2016; 9:707-719. [PMID: 27890578 DOI: 10.1016/j.pmrj.2016.11.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 11/06/2016] [Accepted: 11/15/2016] [Indexed: 12/19/2022]
Abstract
Complex regional pain syndrome type I (CRPS I) is a multifactorial painful disorder with a complex pathogenesis. Both peripheral and central mechanisms are involved. Acute CRPS I is considered to be an exaggerated inflammatory disorder; however, over time, because of altered function of the sympathetic nervous system and maladaptive neuroplasticity, CRPS I evolves into a neurological disorder. This review thoroughly describes the pathophysiological aspects of CRPS I and summarizes the potential therapeutic options. The mechanisms and targets of the treatment are different in the early and late stages of the disease. This current review builds on a previous review by this author group by deepening the role of the peripheral classic and neuronal inflammatory component in the acute stage of this painful disorder. LEVEL OF EVIDENCE Not applicable.
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Senkowski D, Heinz A. Chronic pain and distorted body image: Implications for multisensory feedback interventions. Neurosci Biobehav Rev 2016; 69:252-9. [DOI: 10.1016/j.neubiorev.2016.08.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 08/01/2016] [Accepted: 08/06/2016] [Indexed: 12/14/2022]
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Midbari A, Suzan E, Adler T, Melamed E, Norman D, Vulfsons S, Eisenberg E. Amputation in patients with complex regional pain syndrome: a comparative study between amputees and non-amputees with intractable disease. Bone Joint J 2016; 98-B:548-54. [PMID: 27037439 DOI: 10.1302/0301-620x.98b4.36422] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 10/05/2015] [Indexed: 11/05/2022]
Abstract
AIMS Amputation in intractable cases of complex regional pain syndrome (CRPS) remains controversial. The likelihood of recurrent Complex Regional Pain Syndrome (CRPS), residual and phantom limb pain and persistent disability after amputation is poorly described in the literature. The aims of this study were to compare pain, function, depression and quality of life between patients with intractable CRPS who underwent amputation and those in whom amputation was considered but not performed. PATIENTS AND METHODS There were 19 patients in each group, with comparable demographic details. The amputated group included 14 men and five women with a mean age of 31 years (sd 12) at the time of CRPS diagnosis. The non-amputated group consisted of 12 men and seven women and their mean age of 36.8 years (sd 8) at CRPS diagnosis. The mean time from CRPS diagnosis to (first) amputation was 5.2 years (sd 4.3) and the mean time from amputation to data collection was 6.6 years (sd 5.8). All participants completed the following questionnaires: Short-Form (SF) 36, Short Form McGill Pain questionnaire (SF-MPQ), Pain Disability Index (PDI), the Beck Depression Inventory (BDI) and a clinical demographic questionnaire. RESULTS The amputation group showed consistently better results compared to the non-amputation group in the following parameters: median pain intensity (VAS): 80 (inter-quartile range (IQR) 13 to 92) vs 91 (IQR 85 to 100); p = 0.007; median SF-MPQ score 28 (IQR 9 to 35) vs 35 (IQR 31 to 38), p = 0.025; median PDI: 42 (IQR 11 to 64) vs 58 (IQR 50 to 62), p = 0.031; median BDI: 19 (IQR 5 to 28) vs 27 (IQR 21 to 32), p = 0.061 (borderline significant) and in six of the eight SF-36 domains. TAKE HOME MESSAGE Amputation should be considered as a form of treatment for patients with intractable CRPS.
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Affiliation(s)
- A Midbari
- Institute of Pain Medicine, Pain Research Unit, Rambam Health Care Campus, P.O. Box 9602, Haifa 3109601, Israel
| | - E Suzan
- Institute of Pain Medicine, Pain Research Unit, Rambam Health Care Campus, P.O. Box 9602, Haifa 3109601, Israel
| | - T Adler
- Institute of Pain Medicine, Rambam Health Care Campus, Haifa, Israel
| | - E Melamed
- Rambam Health Care Campus, Department of Orthopedics Haifa, Israel
| | - D Norman
- Rambam Health Care Campus, Department of Orthopedics, Haifa, Israel
| | - S Vulfsons
- Institute of Pain Medicine, Rambam Health Care Campus, Haifa, Israel
| | - E Eisenberg
- Institute of Pain Medicine, Pain Research Unit, Rambam Health Care Campus, P.O. Box 9602, Haifa 3109601, Israel
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Ferrillo MG. Treatment of complex regional pain syndrome with stellate ganglion local anesthetic blockade: a case report of one patient's experiences with traditional bupivacaine HCl and liposome bupivacaine. Clin Case Rep 2016; 4:861-5. [PMID: 27648263 PMCID: PMC5018589 DOI: 10.1002/ccr3.614] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 05/18/2016] [Accepted: 06/07/2016] [Indexed: 11/30/2022] Open
Abstract
Complex regional pain syndrome (CRPS) is a poorly understood, debilitating disorder characterized by severe chronic pain in an affected limb or region of the body. This case presentation is the first to describe the effectiveness and prolonged duration of the effect of liposome bupivacaine in stellate ganglion block for CRPS.
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Affiliation(s)
- Martin G Ferrillo
- The Saratoga Center for Pain Management 3 Care Lane Saratoga Springs New York 12866 USA
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Raucci U, Tomasello C, Marri M, Salzano M, Gasparini A, Conicella E. Scrambler Therapy®MC-5A for Complex Regional Pain Syndrome: Case Reports. Pain Pract 2016; 16:E103-9. [DOI: 10.1111/papr.12474] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 05/05/2016] [Accepted: 05/10/2016] [Indexed: 01/03/2023]
Affiliation(s)
- Umberto Raucci
- Emergency Department; Bambino Gesù Children's Hospital; IRCCS; Rome Italy
| | - Caterina Tomasello
- Anaesthesia and Intensive Care Department; Pain Center; Bambino Gesù Children's Hospital; IRCCS; Rome Italy
| | - Marcello Marri
- Anaesthesia and Intensive Care Department; Pain Center; Bambino Gesù Children's Hospital; IRCCS; Rome Italy
| | - Marco Salzano
- Anaesthesia and Intensive Care Department; Pain Center; Bambino Gesù Children's Hospital; IRCCS; Rome Italy
| | - Augusto Gasparini
- Anaesthesia and Intensive Care Department; Pain Center; Bambino Gesù Children's Hospital; IRCCS; Rome Italy
| | - Elena Conicella
- Emergency Department; Bambino Gesù Children's Hospital; IRCCS; Rome Italy
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Gillick JL, Cooper JB, Babu S, Das K, Murali R. Successful Treatment of Complex Regional Pain Syndrome with Pseudoaneurysm Excision and Median Nerve Neurolysis. World Neurosurg 2016; 92:582.e5-582.e8. [PMID: 27318309 DOI: 10.1016/j.wneu.2016.06.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 06/06/2016] [Accepted: 06/07/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Complex regional pain syndrome (CRPS), formerly referred to as reflex sympathetic dystrophy, is a pain syndrome characterized by severe pain, altered autonomic and motor function, and trophic changes. CRPS is usually associated with soft tissue injury or trauma. It has also been described as a rare complication of arterial access for angiography secondary to pseudoaneurysm formation. CASE DESCRIPTION A 73-year-old woman underwent catheterization of the left brachial artery for angiography of the celiac artery. The following day, the patient noticed numbness and severe pain in the median nerve distribution of the left upper extremity. Over the next 6 months, the patient developed CRPS in the left hand with pain and signs of autonomic dysfunction. Further work-up revealed the formation of a left brachial artery pseudoaneurysm with impingement on the median nerve. She underwent excision of the pseudoaneurysm with decompression and neurolysis of the left median nerve. Approximately 6 weeks after surgery, the patient had noticed significant improvement in autonomic symptoms. CONCLUSIONS This case involves a unique presentation of CRPS caused by brachial artery angiography and pseudoaneurysm formation. In addition, the case demonstrates the efficacy of pseudoaneurysm excision and median nerve neurolysis in the treatment of CRPS as a rare complication of arterial angiography.
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Affiliation(s)
- John L Gillick
- Department of Neurosurgery, New York Medical College, Valhalla, New York, USA.
| | - Jared B Cooper
- Department of Neurosurgery, New York Medical College, Valhalla, New York, USA
| | - Sateesh Babu
- Department of Neurosurgery, New York Medical College, Valhalla, New York, USA
| | - Kaushik Das
- Department of Neurosurgery, New York Medical College, Valhalla, New York, USA
| | - Raj Murali
- Department of Neurosurgery, New York Medical College, Valhalla, New York, USA
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50
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Cutaneous tissue damage induces long-lasting nociceptive sensitization and regulation of cellular stress- and nerve injury-associated genes in sensory neurons. Exp Neurol 2016; 283:413-27. [PMID: 27264359 DOI: 10.1016/j.expneurol.2016.06.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 05/10/2016] [Accepted: 06/01/2016] [Indexed: 12/15/2022]
Abstract
Tissue damage is one of the major etiological factors in the emergence of chronic/persistent pain, although mechanisms remain enigmatic. Using incision of the back skin of adult rats as a model for tissue damage, we observed sensitization in a nociceptive reflex enduring to 28days post-incision (DPI). To determine if the enduring behavioral changes corresponded with a long-term impact of tissue damage on sensory neurons, we examined the temporal expression profile of injury-regulated genes and the electrophysiological properties of traced dorsal root ganglion (DRG) sensory neurons. The mRNA for the injury/stress-hub gene Activating Transcription Factor 3 (ATF3) was upregulated and peaked within 4 DPI, after which levels declined but remained significantly elevated out to 28 DPI, a time when the initial incision appears healed and tissue-inflammation largely resolved. Accordingly, stereological image analysis indicated that some neurons expressed ATF3 only transiently (mostly medium-large neurons), while in others it was sustained (mostly small neurons), suggesting cell-type-specific responses. In retrogradely-traced ATF3-expressing neurons, Calcium/calmodulin-dependent protein kinase type IV (CAMK4) protein levels and isolectin-B4 (IB4)-binding were suppressed whereas Growth Associated Protein-43 (GAP-43) and Neuropeptide Y (NPY) protein levels were enhanced. Electrophysiological recordings from DiI-traced sensory neurons 28 DPI showed a significant sensitization limited to ATF3-expressing neurons. Thus, ATF3 expression is revealed as a strong predictor of single cells displaying enduring pain-related electrophysiological properties. The cellular injury/stress response induced in sensory neurons by tissue damage and indicated by ATF3 expression is positioned to contribute to pain which can occur after tissue damage.
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