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Domerchie P, van Kammen K, van Wijk I, Lange M, Van der Sluis CK. Quality of life, functioning and participation of adult patients with an amputation following complex regional pain syndrome I or brachial plexus injury: a scoping review protocol. BMJ Open 2024; 14:e079393. [PMID: 38839383 PMCID: PMC11163622 DOI: 10.1136/bmjopen-2023-079393] [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] [Received: 08/30/2023] [Accepted: 12/11/2023] [Indexed: 06/07/2024] Open
Abstract
INTRODUCTION This planned scoping review aims to provide insight into current literature regarding perceived quality of life (QoL), functioning and participation of patients with upper limb amputations (ULA) because of therapy-resistant debilitating complex regional pain syndrome type I (CRPS-I) or brachial plexus injury (BPI). It is important to gain insight into these outcomes, so we can properly inform and select patients eligible for amputation. METHODS AND ANALYSIS Joanna Briggs Institute methodology for scoping reviews, Systematic Reviews and Meta-Analyses Scoping Reviews guidelines and Arksey and O'Malley's framework will be used. Studies regarding adult patients with either BPI or CRPS-I who underwent ULA will be considered for inclusion. Studies should include one or more of the following topics: QoL, functioning or participation and should be written in English, German or Dutch. Searches will be conducted in the Cochrane database, PubMed, EMBASE and Google Scholar. Search strings will be provided by a licenced librarian. All relevant literatures will be considered for inclusion, regardless of published date, in order to give a full scope of available literature. Studies will be selected first by title, then abstract and finally by full article by two reviewers who will discuss after every round. A third reviewer will make final decisions to reach consensus if needed. Data will be presented as brief summaries and in tables using a modified data extraction table. ETHICS AND DISSEMINATION No ethical approval is required since no original data will be collected. Results will be disseminated through publication in a peer-reviewed journal and presentations at (inter)national conferences.
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Affiliation(s)
- Patrick Domerchie
- Rehabilitation, University Medical Centre Groningen, Groningen, The Netherlands
| | - Klaske van Kammen
- Rehabilitation, University Medical Centre Groningen, Groningen, The Netherlands
| | - Iris van Wijk
- Rehabilitation, Revalidation Centre De Hoogstraat, Utrecht, The Netherlands
| | - Maaike Lange
- Rehabilitation, Revalidation Centre De Hoogstraat, Utrecht, The Netherlands
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Singh S, Saini R, Mathur R, Sarkar S, Sagar R. The prevalence of depression in people following limb amputation: A systematic review and meta-analysis. J Psychosom Res 2024; 181:111677. [PMID: 38657566 DOI: 10.1016/j.jpsychores.2024.111677] [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] [Received: 09/23/2023] [Revised: 04/10/2024] [Accepted: 04/15/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE To estimate the prevalence of depression in people with limb amputation. Additionally, factors affecting the prevalence or pattern of depression following limb amputation were explored. METHODS Systematic literature search to identify all relevant studies assessing prevalence of depression following limb amputations was conducted through following databases: PubMed/ MEDLINE, Scopus, Embase, and Web of Science. Search period was since inception of database till December 2021. Meta-analyses using random-effects model were conducted to estimate pooled prevalence of depression. RESULTS A total of 61 studies comprising 9852 limb amputees were included. Pooled prevalence of depression following limb amputations was 33.85% (95% CI: 27.15% to 40.54%), with significant heterogeneity (I2 = 98.57%; p < 0.001). Sub-group meta-analysis showed that pooled prevalence of depression was significantly higher in studies conducted from middle-income (45.31%, 95% CI: 28.92% to 61.70%) as compared high income countries (28.31%, 95% CI: 23.97% to 32.64%). Greater activity restriction, amputation-related body image disturbances, social discomfort, perceived vulnerability regarding disability, and avoidant coping style were commonly reported factors associated with greater depression symptomatology. Whereas, good perceived social support, and use of more active coping strategies were commonly reported protective factors. CONCLUSION About one-third of all limb amputees suffered from clinically significant depression. This emphasizes need to sensitize health care professionals involved in providing care to people following limb amputation regarding the importance of periodically screening this vulnerable group of patients for depression and liaising with psychiatrists. Further, addressing risk factors identified in this review could help in reducing the rates of depression post-amputation.
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Affiliation(s)
- Swarndeep Singh
- Assistant Professor, Department of Psychiatry, Vardhman Mahavir Medical College & Safdarjung Hospital, Delhi, India.
| | - Romil Saini
- Department of Psychiatry, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Rahul Mathur
- Department of Psychiatry, All India Institute of Medical Sciences, Delhi, India
| | - Siddharth Sarkar
- National Drug Dependence Treatment Centre & Department of Psychiatry, All India Institute of Medical Sciences, Delhi, India
| | - Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, Delhi, India
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Yoneda H, Takeda S, Saeki M, Iwatsuki K, Yamamoto M, Tatebe M, Hirata H. Utility of severity scoring systems for mangled upper limb salvage: A systematic review and meta-analysis. Injury 2024; 55:111447. [PMID: 38417237 DOI: 10.1016/j.injury.2024.111447] [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] [Received: 12/16/2023] [Revised: 02/18/2024] [Accepted: 02/20/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND The purpose of scoring systems is to aid in the decision-making process of whether to salvage or amputate mangled extremities, but their efficacy for upper limbs is uncertain. In this study, we examined the predictive potential of scoring systems for upper limb salvage. METHODS Two investigators undertook a systematic search of 3 leading databases for English or Japanese literature from 1985, when the first scoring system to evaluate mangled extremities was proposed, until January 2022. To be eligible, studies must have had upper extremity limb salvage or amputation as an outcome, and identified the scoring system used and treatment outcome in individual cases. RESULTS Ten studies (N = 338) of the Mangled Extremity Scoring System (MESS) were ultimately included in the meta-analysis. The pooled sensitivity and specificity were 0.95 (95 % CI = 0.69-0.99) and 0.81 (0.65-0.91), respectively. The area under the hierarchical summary receiver operating characteristic curve was 0.95 (0.93-0.97). A subgroup analysis showed lower specificity in isolated vascular injuries. Scoring systems other than MESS were ineligible for the quantitative synthesis because none were examined in an adequate number of publications. CONCLUSION The pooled sensitivity and specificity for MESS were comparable to those reported for the lower extremities. The specificity suggests that limb salvage was achieved in at least 20 % of the patients whose MESS was above the threshold beyond which amputation is indicated. Given the likelihood of upper extremity functional limitations following amputation and the drawbacks of prostheses, we conclude that current scoring systems poorly predict salvageability of a mangled upper extremity and should not be used to justify amputation.
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Affiliation(s)
- Hidemasa Yoneda
- Department of Human Enhancement and Hand surgery, Nagoya University, Nagoya, Aichi, Japan.
| | - Shinsuke Takeda
- Orthopedic surgery of Toyohashi Municipal Hospital, Toyohashi, Aichi, Japan
| | - Masaomi Saeki
- Department of Human Enhancement and Hand surgery, Nagoya University, Nagoya, Aichi, Japan
| | - Katsuyuki Iwatsuki
- Department of Human Enhancement and Hand surgery, Nagoya University, Nagoya, Aichi, Japan
| | - Michiro Yamamoto
- Department of Human Enhancement and Hand surgery, Nagoya University, Nagoya, Aichi, Japan
| | - Masahiro Tatebe
- Othopedic surgery of Anjo Kosei Hospital, Anjo, Aichi, Japan
| | - Hitoshi Hirata
- Department of Human Enhancement and Hand surgery, Nagoya University, Nagoya, Aichi, Japan
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Aman MM, Ibrahim YM, Buluk Figueira M, Werhand JM. Combined use of peripheral nerve stimulation and dorsal root ganglion stimulation for refractory complex regional pain syndrome type I to avoid amputation: A case report. Clin Case Rep 2023; 11:e7055. [PMID: 36911638 PMCID: PMC9995816 DOI: 10.1002/ccr3.7055] [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: 02/03/2023] [Revised: 02/16/2023] [Accepted: 02/20/2023] [Indexed: 03/14/2023] Open
Abstract
We describe a case of left foot and ankle complex regional pain syndrome type 1 that necessitated a novel combination of a functioning dorsal root ganglion stimulation and peripheral nerve stimulation. This approach optimized pain relief, functional improvement, and avoided amputation.
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Affiliation(s)
- Mansoor M Aman
- Department of Anesthesiology, Division of Pain Medicine Advocate Aurora Health Oshkosh Wisconsin USA
| | - Yussr M Ibrahim
- Anesthesiology Institute Cleveland Clinic Cleveland Ohio USA
| | - Merve Buluk Figueira
- Advocate Aurora Research Institute Advocate Aurora Health Milwaukee Wisconsin USA
| | - Jessica M Werhand
- Department of Anesthesiology, Division of Pain Medicine Advocate Aurora Health Oshkosh Wisconsin USA
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An Algorithm for Elective Amputation Combined with Targeted Muscle Reinnervation in Complex Regional Pain Syndrome—A Perspective. J Pers Med 2022; 12:jpm12071169. [PMID: 35887666 PMCID: PMC9319192 DOI: 10.3390/jpm12071169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/15/2022] [Accepted: 07/16/2022] [Indexed: 11/30/2022] Open
Abstract
Complex regional pain syndrome (CRPS) can result in a devastating condition. For a small number of patients, there is a non-response to any existing multimodal therapies and they ultimately request amputation. Such a drastic and final decision is not easy to take for both the patient and the surgeon and requires careful and interdisciplinary assessments and considerations. Furthermore, new surgical procedures, such as targeted muscle reinnervation (TMR) and hybrid prosthetic fitting, and multidisciplinary board advice should be included when considering amputation. In order to help other therapeutic teams in decision making for such rare but more than demanding cases, we aimed to propose an advanced algorithm for amputation indications in CRPS patients combining all these new factors. This algorithm consists of extensive pre-operative psychiatric assessment, diagnostic hybrid prosthetic fitting including fMRI analyses, multidisciplinary board advice as well as targeted muscle reinnervation and amputation procedures with final prosthetic fitting and rehabilitation. By involving multiple disciplines, this algorithm should provide optimized and individualized patient treatment on the one hand and a reliable base for decision making for therapists on the other.
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de Oliveira Galassi T, Fernandes PF, Salgado ASI, Cidral-Filho FJ, Piovezan AP, Lüdtke DD, Mack JM, Weber KA, Reed WR, Bobinski F, Martins DF. Preventive Supplementation of Omega-3 Reduces Pain and Pro-inflammatory Cytokines in a Mouse Model of Complex Regional Pain Syndrome Type I. Front Integr Neurosci 2022; 16:840249. [PMID: 35431823 PMCID: PMC9005766 DOI: 10.3389/fnint.2022.840249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/04/2022] [Indexed: 01/14/2023] Open
Abstract
Complex regional pain syndrome type I (CRPS-I) is a condition that responds poorly to treatments. The role of omega-3 fatty acids in the treatment of inflammatory disorders is well described in the literature; however, few studies have evaluated its therapeutic benefits in different types of pain. We evaluated the potential antihyperalgesic and anti-inflammatory effects of preventive omega-3 supplementation in an animal model of CRPS-I. In experiment 1, Swiss female mice were supplemented for 30 days with omega-3 before the induction of the CRPS-I model and 14 days after. Mechanical hyperalgesia was evaluated at baseline and from the 4th to the 14th day after CPRS-I induction along with open field locomotor activity after 30 days of supplementation. In experiment 2, Swiss female mice were supplemented for 30 days with omega-3 and then subjected to the CRPS-I model. Twenty-four hours later the animals were euthanized, and tissue samples of the spinal cord and right posterior paw muscle were taken to measure pro-inflammatory cytokine TNF and IL-1β concentrations. Omega-3 supplementation produced antihyperalgesic and anti-inflammatory effects, as well as reducing pro-inflammatory cytokine concentrations, without altering the animals’ locomotion. No open field locomotor changes were found. The 30-day supplementation at the tested dose was effective in the CRPS-I model.
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Affiliation(s)
- Taynah de Oliveira Galassi
- Experimental Neuroscience Laboratory (LaNEx), Postgraduate Program in Health Sciences, University of Southern Santa Catarina - UNISUL, Palhoça, Brazil
| | - Paula Franson Fernandes
- Experimental Neuroscience Laboratory (LaNEx), Postgraduate Program in Health Sciences, University of Southern Santa Catarina - UNISUL, Palhoça, Brazil
| | - Afonso Shiguemi Inoue Salgado
- Experimental Neuroscience Laboratory (LaNEx), Postgraduate Program in Health Sciences, University of Southern Santa Catarina - UNISUL, Palhoça, Brazil
- Natural Quanta Wellness Center, Windermere, FL, United States
| | - Francisco José Cidral-Filho
- Experimental Neuroscience Laboratory (LaNEx), Postgraduate Program in Health Sciences, University of Southern Santa Catarina - UNISUL, Palhoça, Brazil
| | - Anna Paula Piovezan
- Experimental Neuroscience Laboratory (LaNEx), Postgraduate Program in Health Sciences, University of Southern Santa Catarina - UNISUL, Palhoça, Brazil
| | - Daniela Dero Lüdtke
- Experimental Neuroscience Laboratory (LaNEx), Postgraduate Program in Health Sciences, University of Southern Santa Catarina - UNISUL, Palhoça, Brazil
| | - Josiel Mileno Mack
- Experimental Neuroscience Laboratory (LaNEx), Postgraduate Program in Health Sciences, University of Southern Santa Catarina - UNISUL, Palhoça, Brazil
- Department of Medical Clinic, Graduate Program in Medical Sciences, Federal University of Santa Catarina - UFSC, Florianopolis, Brazil
| | - Kenneth A. Weber
- Division of Pain Medicine, Stanford School of Medicine, Palo Alto, CA, United States
| | - William R. Reed
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Franciane Bobinski
- Experimental Neuroscience Laboratory (LaNEx), Postgraduate Program in Health Sciences, University of Southern Santa Catarina - UNISUL, Palhoça, Brazil
| | - Daniel F. Martins
- Experimental Neuroscience Laboratory (LaNEx), Postgraduate Program in Health Sciences, University of Southern Santa Catarina - UNISUL, Palhoça, Brazil
- *Correspondence: Daniel F. Martins,
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Hoellwarth JS, Al-Jawazneh SS, Tetsworth K, Lu W, Roberts C, Al Muderis M. Amputation With Osseointegration for Patients With Intractable Complex Regional Pain Syndrome: A Report of 3 Cases. JBJS Case Connect 2021; 11:e20.00267. [PMID: 33448707 DOI: 10.2106/jbjs.cc.20.00267] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASES Three patients with knee-level complex regional pain syndrome type 1 (CRPS1), recalcitrant to conservative interventions, elected for transfemoral amputation and osseointegration. Two patients gained independent ambulation; the third remains on crutches after a disrupted sciatic nerve targeted reinnervation. One uses no pain medication, one is weaning off, and one requires a reduced regimen after revision nerve innervation. CONCLUSION Osseointegration seems suitable to optimize rehabilitation after amputation for CRPS1.
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Affiliation(s)
- Jason Shih Hoellwarth
- Baylor College of Medicine, Department of Pediatric Orthopaedics, Texas Children's Hospital, Houston, Texas.,Department of Orthopaedic Surgery, Macquarie University Hospital, Sydney, New South Wales, Australia
| | - Shakib Sameeh Al-Jawazneh
- Department of Orthopaedic Surgery, Macquarie University Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health Science, The University of Sydney, Sydney, Australia
| | - Kevin Tetsworth
- Department of Orthopaedic Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - William Lu
- Department of Orthopaedic Surgery, Macquarie University Hospital, Sydney, New South Wales, Australia
| | - Claudia Roberts
- Department of Orthopaedic Surgery, Macquarie University Hospital, Sydney, New South Wales, Australia
| | - Munjed Al Muderis
- Department of Orthopaedic Surgery, Macquarie University Hospital, Sydney, New South Wales, Australia
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Stoehr JR, Sood R, Jordan SW, Dumanian GA. Targeted muscle reinnervation at the time of amputation in the management of complex regional pain syndrome of the lower extremity. Microsurgery 2020; 40:852-858. [PMID: 32965061 DOI: 10.1002/micr.30653] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/29/2020] [Accepted: 09/03/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Complex regional pain syndrome (CRPS) is a chronic, posttraumatic condition defined by severe pain and sensorimotor dysfunction. In cases of severe CRPS, patients request amputation, which may cause phantom limb pain (PLP) and residual limb pain (RLP). Targeted muscle reinnervation (TMR) reduces the risk of PLP and RLP. This report describes the use of TMR at the time of amputation in a series of patients with CRPS. PATIENTS AND METHODS Four patients (ages 38-71 years) underwent TMR at the time of amputation for CRPS between April 2018 and January 2019. Three patients had a history of trauma and surgery to the affected limb. All patients attempted pharmacologic and interventional treatments for 1-7 years before requesting amputation. Three patients underwent below-knee amputations (BKA) and one had an above-knee amputation (AKA). Target muscles included the soleus, gastrocnemius, and flexor hallucis longus (BKA), and semitendinosus, biceps femoris, and vastus medialis (AKA). Postoperative phantom and residual limb pain symptoms were collected via a telephone survey adapted from the Patient-Reported Outcomes Measurement Information System (PROMIS). RESULTS There were no complications related to the TMR procedure. Average follow-up time was 12.75 months. Patients reported varied outcomes: two had RLP and PLP, one had RLP only, and one had PLP only. All patients reported successful prosthetic use. CONCLUSION TMR may be performed at the time of amputation for CRPS. Further study is necessary to determine the effect of TMR on pain, pain medication use, prosthesis use, and other domains of function.
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Affiliation(s)
- Jenna R Stoehr
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rachita Sood
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sumanas W Jordan
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Gregory A Dumanian
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Martin SC, Macey AR, Raghu A, Edwards T, Watson C, Bojanić S, FitzGerald JJ, Green AL. Dorsal Root Ganglion Stimulation for the Treatment of Chronic Neuropathic Knee Pain. World Neurosurg 2020; 143:e303-e308. [PMID: 32711140 DOI: 10.1016/j.wneu.2020.07.102] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/15/2020] [Accepted: 07/17/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND To elucidate the efficacy of dorsal root ganglion stimulation in the treatment of chronic neuropathic pain confined to the knee. METHODS Retrospective analysis of prospectively collected data of 14 consecutive patients undergoing dorsal root ganglion stimulation for chronic knee pain, in a single center. The primary outcome measure was pain reduction assessed by numeric pain rating scale score preoperatively and postoperatively. Secondary outcomes included quantification of percentage of pain area covered by stimulation, and reduction in usage of opioid medications. Responders were defined as patients that experienced a greater than or equal to 50% improvement in their preoperative pain score. RESULTS Fourteen patients were implanted with dorsal root ganglion stimulator electrodes; 8 had a single L3 lead implanted, 1 patient had a single L4 lead implanted, and 3 patients had 2 leads implanted (L3 and L4). Two patients had their leads explanted: 1 for non-efficacy, and 1 for repeated electrode displacement. The most common indication for surgery was type 2 complex regional pain syndrome, secondary to either trauma or postoperative chronic pain (either knee replacement or arthroscopy). Median preoperative numeric rating scale score was 8.5, median postoperative numeric rating scale score was 2 (P = 0.002, Wilcoxon signed rank test). The median improvement in pain score was 80%. All 12 patients undergoing chronic stimulation were responders. Median coverage of pain area was 85%. All but 1 patient who was on opioid medication prior to surgery had reduced the dosage of regular opioid. CONCLUSIONS In selected patients, dorsal root ganglion stimulation is an extremely efficacious means of treating otherwise refractory chronic knee pain.
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Affiliation(s)
- Sean C Martin
- Department of Neurological Surgery, Oxford University Hospitals, Oxford, UK; Nuffield Department of Surgical Science, University of Oxford, Oxford, UK.
| | - Alistair R Macey
- Department of Trauma and Orthopaedics, Queen Elizabeth University Hospital, Glasgow, UK
| | - Ashley Raghu
- Nuffield Department of Surgical Science, University of Oxford, Oxford, UK
| | - Tamara Edwards
- Department of Neurological Surgery, Oxford University Hospitals, Oxford, UK
| | - Clare Watson
- Department of Neurological Surgery, Oxford University Hospitals, Oxford, UK
| | - Stana Bojanić
- Department of Neurological Surgery, Oxford University Hospitals, Oxford, UK
| | - James J FitzGerald
- Department of Neurological Surgery, Oxford University Hospitals, Oxford, UK; Nuffield Department of Surgical Science, University of Oxford, Oxford, UK
| | - Alexander L Green
- Department of Neurological Surgery, Oxford University Hospitals, Oxford, UK; Nuffield Department of Surgical Science, University of Oxford, Oxford, UK
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Ayyaswamy B, Saeed B, Anand A, Chan L, Shetty V. Quality of life after amputation in patients with advanced complex regional pain syndrome: a systematic review. EFORT Open Rev 2019; 4:533-540. [PMID: 31598331 PMCID: PMC6771076 DOI: 10.1302/2058-5241.4.190008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The majority of included studies (8 out of 11, n = 54) supported the concept of considering amputation for selected, unresponsive cases of complex regional pain syndrome (CRPS) as a justifiable alternative to an unsuccessful multimodality nonoperative option.Of patients who underwent amputation, 66% experienced improvement in quality of life (QOL) and 37% were able to use a prosthesis, 16% had an obvious decline in QOL and for 12% of patients, no clear details were given, although it was suggested by authors that these patients also encountered deterioration after amputation.Complications of phantom limb pain, recurrence of CRPS and stump pain were predominant risks and were noticed in 65%, 45% and 30% of cases after amputation, respectively and two-thirds of patients were satisfied.Amputation can be considered by clinicians and patients as an option to improve QOL and to relieve agonizing, excruciating pain of severe, resistant CRPS at a specialized centre after multidisclipinary involvement but it must be acknowledged that evidence is limited, and the there are risks of aggravating or recurrence of CRPS, phantom pain and unpredictable consequences of rehabilitation.Amputation, if considered for resistant CRPS, should be carried out at specialist centres and after MDT involvement before and after surgery. It should only be considered if requested by patients with poor quality of life who have failed to improve after multiple treatment modalities.Further high quality and comprehensive research is needed to understand the severe form of CRPS which behaves differently form less severe stages. Cite this article: EFORT Open Rev 2019;4:533-540. DOI: 10.1302/2058-5241.4.190008.
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Affiliation(s)
- Brijesh Ayyaswamy
- Department of Orthopaedics, Blackpool Teaching Hospitals NHS Trust, Blackpool, UK
| | - Bilal Saeed
- Department of Orthopaedics, Blackpool Teaching Hospitals NHS Trust, Blackpool, UK
| | - Anoop Anand
- Department of Orthopaedics, Blackpool Teaching Hospitals NHS Trust, Blackpool, UK
| | - Lai Chan
- Edge Hill University, Ormskirk, UK
| | - Vishwanath Shetty
- Department of Orthopaedics, Blackpool Teaching Hospitals NHS Trust, Blackpool, UK
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Henderson J. Response to "Reply to: Updated guidelines on complex regional pain syndrome in adults". J Plast Reconstr Aesthet Surg 2018; 72:335-354. [PMID: 30581116 DOI: 10.1016/j.bjps.2018.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 12/06/2018] [Indexed: 11/28/2022]
Affiliation(s)
- James Henderson
- Department of PLastic Surgery, North Bristol NHS Trust, BS10 5DN, United KIngdom.
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Schrier E, Dijkstra P, Zeebregts C, Wolff A, Geertzen J. Decision making process for amputation in case of therapy resistant complex regional pain syndrome type-I in a Dutch specialist centre. Med Hypotheses 2018; 121:15-20. [DOI: 10.1016/j.mehy.2018.08.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 08/28/2018] [Indexed: 12/13/2022]
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Mazzardo-Martins L, Salm DC, Winkelmann-Duarte EC, Ferreira JK, Lüdtke DD, Frech KP, Belmonte LAO, Horewicz VV, Piovezan AP, Cidral-Filho FJ, Moré AOO, Martins DF. Electroacupuncture induces antihyperalgesic effect through endothelin-B receptor in the chronic phase of a mouse model of complex regional pain syndrome type I. Pflugers Arch 2018; 470:1815-1827. [DOI: 10.1007/s00424-018-2192-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/12/2018] [Accepted: 08/02/2018] [Indexed: 01/13/2023]
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Yvon A, Faroni A, Reid AJ, Lees VC. Selective Fiber Degeneration in the Peripheral Nerve of a Patient With Severe Complex Regional Pain Syndrome. Front Neurosci 2018; 12:207. [PMID: 29670505 PMCID: PMC5893835 DOI: 10.3389/fnins.2018.00207] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 03/15/2018] [Indexed: 02/04/2023] Open
Abstract
Aims: Complex regional pain syndrome (CRPS) is characterized by chronic debilitating pain disproportional to the inciting event and accompanied by motor, sensory, and autonomic disturbances. The pathophysiology of CRPS remains elusive. An exceptional case of severe CRPS leading to forearm amputation provided the opportunity to examine nerve histopathological features of the peripheral nerves. Methods: A 35-year-old female developed CRPS secondary to low voltage electrical injury. The CRPS was refractory to medical therapy and led to functional loss of the forelimb, repeated cutaneous wound infections leading to hospitalization. Specifically, the patient had exhausted a targeted conservative pain management programme prior to forearm amputation. Radial, median, and ulnar nerve specimens were obtained from the amputated limb and analyzed by light and transmission electron microscopy (TEM). Results: All samples showed features of selective myelinated nerve fiber degeneration (47–58% of fibers) on electron microscopy. Degenerating myelinated fibers were significantly larger than healthy fibers (p < 0.05), and corresponded to the larger Aα fibers (motor/proprioception) whilst smaller Aδ (pain/temperature) fibers were spared. Groups of small unmyelinated C fibers (Remak bundles) also showed evidence of degeneration in all samples. Conclusions: We are the first to show large fiber degeneration in CRPS using TEM. Degeneration of Aα fibers may lead to an imbalance in nerve signaling, inappropriately triggering the smaller healthy Aδ fibers, which transmit pain and temperature. These findings suggest peripheral nerve degeneration may play a key role in CRPS. Improved knowledge of pathogenesis will help develop more targeted treatments.
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Affiliation(s)
- Adrien Yvon
- Nottingham University Hospitals, Nottingham, United Kingdom.,Blond McIndoe Laboratories, Division of Cell Matrix Biology and Regenerative Medicine, Faculty of Biology Medicine and Health, Manchester Academic Health Science Centre, School of Biological Sciences, University of Manchester, Manchester, United Kingdom
| | - Alessandro Faroni
- Blond McIndoe Laboratories, Division of Cell Matrix Biology and Regenerative Medicine, Faculty of Biology Medicine and Health, Manchester Academic Health Science Centre, School of Biological Sciences, University of Manchester, Manchester, United Kingdom
| | - Adam J Reid
- Blond McIndoe Laboratories, Division of Cell Matrix Biology and Regenerative Medicine, Faculty of Biology Medicine and Health, Manchester Academic Health Science Centre, School of Biological Sciences, University of Manchester, Manchester, United Kingdom.,Department of Plastic Surgery & Burns, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Vivien C Lees
- Department of Plastic Surgery & Burns, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
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16
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Urits I, Shen AH, Jones MR, Viswanath O, Kaye AD. Complex Regional Pain Syndrome, Current Concepts and Treatment Options. Curr Pain Headache Rep 2018; 22:10. [PMID: 29404787 DOI: 10.1007/s11916-018-0667-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW Complex regional pain syndrome (CRPS) refers to a chronic pain condition that is characterized by progressively worsening spontaneous regional pain without dermatomal distribution. The symptomatology includes pain out of proportion in time and severity to the inciting event. The purpose of this review is to present the most current information concerning epidemiology, diagnosis, pathophysiology, and therapy for CRPS. RECENT FINDINGS In recent years, discovery of pathophysiologic mechanisms of CRPS has led to significant strides in the understanding of the disease process. Continued elucidation of the underlying pathophysiological mechanisms will allow for the development of more targeted and effective evidence-based therapy protocols. Further large clinical trials are needed to investigate mechanisms and treatment of the disorder.
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Affiliation(s)
- Ivan Urits
- Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Mark R Jones
- Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Omar Viswanath
- Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Alan D Kaye
- Department of Anesthesiology, Lousiana State University Health Science Center, 1542 Tulane Avenue Suite 659, New Orleans, LA, 70112, USA.
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17
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Carpenter DP, Draeger RW. Neurogenic Edema from Complex Regional Pain Syndrome Resulting in Fulminant Infection Necessitating Below Elbow Amputation. J Hand Microsurg 2018; 9:159-162. [PMID: 29302140 DOI: 10.1055/s-0037-1608694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 08/28/2017] [Indexed: 10/18/2022] Open
Abstract
We report a case of severe upper extremity complex regional pain syndrome type 1 (CRPS-1) and neurogenic edema that ultimately led to a medically necessary below-elbow amputation. The patient presented with a history of remote bilateral carpal tunnel release complicated by debilitating and recalcitrant bilateral CRPS-1. Following years of severe neurogenic edema of the left upper extremity, the patient had full-thickness skin sloughing on the dorsum of her hand due to massive edema. This subsequently led to maggot infestation of the soft tissues of the left hand ultimately necessitating amputation. We present the case as an illustration of an extreme case of neurogenic edema, a potential physical manifestation of CRPS-1. The case presented discusses upper extremity amputation as an end treatment option for CRPS-1, though in this case amputation was primarily indicated secondary to medical necessity.
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Affiliation(s)
- Daniel P Carpenter
- Department of Orthopaedics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States
| | - Reid W Draeger
- Department of Orthopaedics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States
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18
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Elsamadicy AA, Yang S, Sergesketter AR, Ashraf B, Charalambous L, Kemeny H, Ejikeme T, Ren X, Pagadala P, Parente B, Xie J, Lad SP. Prevalence and Cost Analysis of Complex Regional Pain Syndrome (CRPS): A Role for Neuromodulation. Neuromodulation 2017; 21:423-430. [PMID: 28961359 DOI: 10.1111/ner.12691] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/14/2017] [Accepted: 07/31/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The diagnosis and treatment of complex regional pain syndrome (CRPS) is challenging and there is a paucity of data describing its overall cost burden and quantifying its impact on the US healthcare system. The aim of this study was to assess the prevalence and healthcare utilization costs associated with CRPS. MATERIALS AND METHODS A retrospective longitudinal study was performed using the Truven MarketScan® database to identify patients with a new indexed diagnosis of CRPS (Type I, II, or both) from 2001 to 2012. We collected total, outpatient, and pain prescription costs three years prior to CRPS diagnosis (baseline), at year of CRPS diagnosis, and eight-year post-CRPS diagnosis. A longitudinal multivariate analysis was used to model the estimated total and pain prescription cost ratios comparing patients diagnosed before and after CRPS. RESULTS We included 35,316 patients with a newly indexed diagnosis of CRPS (Type I: n = 18,703, Type II: n = 14,599, Unspecified: n = 2014). Baseline characteristics were similar between the CRPS cohorts. Compared to two- and three-year baseline costs, one-year prior to diagnosis for all CRPS patients yielded the highest interquartile median [IQR] costs: total costs $7904[$3469, $16,084]; outpatient costs $6706[$3119, $12,715]; and pain prescription costs $1862[$147, $7649]. At the year of CRPS diagnosis, the median [IQR] costs were significantly higher than baseline costs: total costs $8508[$3943, $16,666]; outpatient costs $7251[$3527, $13,568]; and pain prescription costs $2077[$140, $8856]. Over the eight-year period after CRPS diagnosis, costs between all the years were similar, ranging from the highest (one-year) to lowest (seven-years), $4845 to $3888. The median total cumulative cost 8-years after CRPS diagnosis was $43,026 and $12,037 for pain prescription costs. [Correction added on 06 November 2017 after first online publication: the preceding sentence has been updated to demonstrate the median cumulative cost in replacement of the additive cumulative mean costs.]. During the CRPS diagnosis period, patients are expected to have a total cost 2.17-fold and prescription cost 2.56-fold of their baseline cost annually. CONCLUSIONS Our study demonstrates that there is a significant increase in cost and healthcare resource utilization one-year prior to and around the time of CRPS diagnosis. Furthermore, there is an increased annual cost post-diagnosis compared to baseline costs prior to CRPS diagnosis.
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Affiliation(s)
| | - Siyun Yang
- Department of Biostatistics, Duke University Medical Center, Durham, NC, USA
| | | | - Bilal Ashraf
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Lefko Charalambous
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Hanna Kemeny
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Tiffany Ejikeme
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Xinru Ren
- Department of Biostatistics, Duke University Medical Center, Durham, NC, USA
| | - Promila Pagadala
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Beth Parente
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Jichun Xie
- Department of Biostatistics, Duke University Medical Center, Durham, NC, USA
| | - Shivanand P Lad
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
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Midbari A, Eisenberg E. Is the Pain Medicine Community Reluctant to Discuss Limb Amputation in Patients with Intractable Complex Regional Pain Syndrome? PAIN MEDICINE 2017; 18:1406-1407. [PMID: 28082526 DOI: 10.1093/pm/pnw289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | - Elon Eisenberg
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Rambam Health Care Campus, Institute of Pain Medicine, Haifa, Israel
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