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Hájek M, Chmelař D, Tlapák J, Klugar M. The Effectiveness of Hyperbaric Oxygen Treatment in Patients with Complex Regional Pain Syndrome: A Retrospective Case series. Int J Med Sci 2024; 21:2021-2030. [PMID: 39239556 PMCID: PMC11373553 DOI: 10.7150/ijms.97513] [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: 04/19/2024] [Accepted: 07/12/2024] [Indexed: 09/07/2024] Open
Abstract
Background: Complex regional pain syndrome (CRPS) presents as persistent regional pain, both spontaneous and triggered. The demand persists for innovative treatments that patients can endure with minimal adverse effects. Hyperbaric oxygen therapy (HBOT) emerges as a possible intervention in this regard. Methods: The main objective of this work is to retrospectively analyse a case series of patients diagnosed with CRPS treated in the Centre of Hyperbaric Medicine Ostrava over two years (period 2018-2019). The HBOT was applied at 2.0-2.4 absolute atmosphere (ATA) once a day. Results: A total of 83 patients with CRPS were treated with HBOT. 98% of cases reported pain, 92% reported limitation of movement of the affected limb, 87% had swelling of the limb, 41% had lividity and 70% had sensory problems. The mean number of HBOT exposures was 22.0 ± 7.1. At the end of HBOT treatment, 86% of cases had symptoms relief. The mean VAS value of pain at rest before the start of HBOT was 3.2±3.0, after treatment it was 1.6±1.9 (p<0.001). In a pain at activity it was 6.1±2.4 and 3.7±2.4 (p<0.001), respectively, at the end of HBOT. The value of the functional assessment of the limb was 7.0±2.0 and 4.3±2.4 (p<0.001), respectively, at the end of treatment. 79 cases were included in the end-of-treatment assessment. 23 cases (29%) were evaluated as large clinically significant response, 48 cases (61%) were evaluated as partial response with minimally important difference. The results showed larger clinical HBOT effect in cases of disease duration up to 3 and 6 months (p=0.029). Conclusions: The majority of patients improved pain and functional state of the affected limb. Our data also suggests the sooner after diagnosis of CRPS is HBOT started, the treatment has larger clinical effect. There was no serious HBOT-related complication or injury.
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Affiliation(s)
- Michal Hájek
- Centre of Hyperbaric Medicine, Ostrava City Hospital, Ostrava, Czech Republic
- Institute of Laboratory Medicine, Institute of Microbiology, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
- Centre for Hyperbaric Medicine of Faculty of Medicine University of Ostrava and Ostrava City Hospital, Ostrava, Czech Republic
| | - Dittmar Chmelař
- Institute of Laboratory Medicine, Institute of Microbiology, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
- Centre for Hyperbaric Medicine of Faculty of Medicine University of Ostrava and Ostrava City Hospital, Ostrava, Czech Republic
| | - Jakub Tlapák
- Institute of Aviation Medicine, Prague, Czech Republic
- Faculty of Biomedical Engineering, Czech Technical University in Prague, Czech Republic
| | - Miloslav Klugar
- Cochrane Czech Republic, The Czech Republic: JBI Centre of Excellence, Czech GRADE Network, Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
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Thanaboriboon C, Matos Macêdo MC, Perez J. Complex Regional Pain Syndrome in Cancer Cases: Current Knowledge and Perspectives. Int Med Case Rep J 2024; 17:497-506. [PMID: 38778887 PMCID: PMC11110819 DOI: 10.2147/imcrj.s451291] [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: 12/15/2023] [Accepted: 05/02/2024] [Indexed: 05/25/2024] Open
Abstract
Background Complex regional pain syndrome (CRPS) is a disabling painful disorder caused by many different and poorly understood mechanisms. It often affects the distal limbs and usually happens as consequence of a trauma. Its severity can remarkably affect patients' quality of life. When this painful complication happens in a cancer patient, the impact may be exponential. To date, there is limited knowledge of the surrounding circumstances of CRPS cases in this population. Methods We present two clinical cases of patients diagnosed with cancer-related pain presenting with symptoms and signs compatible with CRPS. In one case, CRPS was attributed to direct tumor nerve compression, and it responded successfully to an interventional pain procedure. The second case was associated with a Zoster infection in an immunocompromised cancer patient. Patient responded to multidisciplinary pain management strategies. Additionally, we conducted a literature review to investigate the coexistence of cancer pain and CRPS and suggest some pathophysiology mechanisms of action. Results and Discussion Literature reviewed and potential pathophysiology mechanisms are simultaneously explored in terms of classification, etiopathology, evidence, challenges, and future scientific directions. Conclusion Comorbid CRPS can impact negatively in cases of cancer pain by affecting their diagnosis and treatment. Further studies are necessary to elucidate how these two conditions present together and how they can be better addressed.
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Affiliation(s)
- Chanon Thanaboriboon
- Cancer Pain Clinic, Departments of Anesthesiology and Supportive and Palliative Care, McGill University Health Center, Montreal, Quebec, Canada
- Department of Anesthesiology, King Chulalongkorn Memorial Hospital and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Márcia C Matos Macêdo
- Cancer Pain Clinic, Departments of Anesthesiology and Supportive and Palliative Care, McGill University Health Center, Montreal, Quebec, Canada
- Department of Medicine, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Jordi Perez
- Cancer Pain Clinic, Departments of Anesthesiology and Supportive and Palliative Care, McGill University Health Center, Montreal, Quebec, Canada
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Cavalcanti Kussmaul A, Kuehlein T, Langer MF, Ayache A, Unglaub F. The Treatment of Closed Finger and Metacarpal Fractures. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:855-862. [PMID: 37963039 PMCID: PMC10840131 DOI: 10.3238/arztebl.m2023.0226] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/11/2023] [Accepted: 10/11/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND Fractures of the fingers and metacarpal bones are the most common fracture type in the upper limb, with an incidence of 114 to 1483 per 100 000 persons per year. The clinical importance of closed finger and metacarpal fractures is often underestimated; inadequate diagnostic and therapeutic measures may result in serious harm. This review concerns the basic elements of the diagnosis and treatment of finger and metacarpal fractures. METHODS This review of the incidence, diagnosis and treatment of finger and metacarpal fractures is based on pertinent publications retrieved by a selective search of the literature. RESULTS The main focus of treatment lies on restoration of hand function in consideration of the requirements of the individual patient. The currently available evidence provides little guidance to optimal treatment (level II evidence). Although most closed fractures can be managed conservatively, individualized surgical treatment is advisable in comminuted fractures and fractures with a relevant degree of torsional malposition, axis deviation, or shortening, as well as in intra-articular fractures. Minimally invasive techniques are, in principle, to be performed wherever possible, yet open surgery is sometimes needed because of fracture morphology. Postsurgical complication rates are in the range of 32-36%, with joint fusion accounting for 67-76% of the complications. 15% involve delayed fracture healing and pseudarthrosis. CONCLUSION Individualized treatment for finger and metacarpal fractures can improve patients' outcomes, with major socioeconomic and societal benefits. Further high-quality studies evaluating the relative merits of the available treatments are needed as a guide to optimized therapy.
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Affiliation(s)
- Adrian Cavalcanti Kussmaul
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich
| | - Titus Kuehlein
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich
| | - Martin F. Langer
- Dept. for Trauma, Hand and Reconstructive Surgery, University Hospital of Muenster, Muenster
| | - Ali Ayache
- Department of Hand Surgery, Vulpius Clinic, Bad Rappenau
| | - Frank Unglaub
- Department of Hand Surgery, Vulpius Clinic, Bad Rappenau
- Mannheim Faculty of Medicine of the Ruprecht-Karls Heidelberg University, Mannheim
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Enax-Krumova E, Tegenthoff M, Enax-Krumova E, Schwarzer A, Tegenthoff M, Maihöfner C, H. Krämer H, Maihöfner C, H. Krämer H, Gierthmühlen J. Confusing and Substantially Overinterpreted. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:486. [PMID: 37661322 PMCID: PMC10487674 DOI: 10.3238/arztebl.m2023.0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Elena Enax-Krumova
- *Neurologische Klinik, BG Universitätsklinikum Bergmannsheil, Ruhr-Universität Bochum
| | - Martin Tegenthoff
- *Neurologische Klinik, BG Universitätsklinikum Bergmannsheil, Ruhr-Universität Bochum
| | - Elena Enax-Krumova
- **Mitglied der Klinischen Kommission „Schmerz“ der Deutschen Gesellschaft für Neurologie
| | - Andreas Schwarzer
- ***Abteilung für Schmerzmedizin, BG Universitätsklinikum Bergmannsheil, Ruhr-Universität Bochum
| | - Martin Tegenthoff
- **** Präsident der Deutschen Gesellschaft für Neurowissenschaftliche Begutachtung
| | - Christian Maihöfner
- *****Sprecher und Sprecherin der Klinischen Kommission „Schmerz“ der Deutschen Gesellschaft für Neurologie
| | - Heidrun H. Krämer
- *****Sprecher und Sprecherin der Klinischen Kommission „Schmerz“ der Deutschen Gesellschaft für Neurologie
| | - Christian Maihöfner
- ******Klinik für Neurologie, Klinikum Fürth Mitglied im Ständigen Beirat der Deutschen Schmerzgesellschaft
| | | | - Janne Gierthmühlen
- ********Interdisziplinäre Schmerz- und Palliativambulanz, Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Kiel Präsidentin der CRPS-Special Interest Group der Internationalen Schmerzgesellschaft (IASP)
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Hausteiner-Wiehle C, Böhringer B, Wiehle M, Melf-Marzi A. In Reply. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:486-487. [PMID: 37661323 PMCID: PMC10487671 DOI: 10.3238/arztebl.m2023.0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Constanze Hausteiner-Wiehle
- *Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie; Klinikum rechts der Isar der Technischen Universität München Abteilung für Neurologie, Klinische Neurophysiologie und Stroke Unit; BG Unfallklinik Murnau
| | | | - Matthias Wiehle
- ***Abteilung für Neurologie, Klinische Neurophysiologie und Stroke Unit; BG Unfallklinik Murnau
| | - Alexandra Melf-Marzi
- ****Abteilung für BG-Rehabilitation; CRPS-Ambulanz; BG Unfallklinik Murnau, Abteilung für Anästhesie, Intensiv- und Schmerzmedizin; Multimodale Schmerztherapie
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Geber C, Casser HR, Birklein F. Complex Pathophysiology and Differentiated Therapy. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:485. [PMID: 37661321 PMCID: PMC10487672 DOI: 10.3238/arztebl.m2023.0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Christian Geber
- *DRK-Schmerz-Zentrum Mainz; Klinik und Poliklinik für Neurologie, Universitätsmedizin Mainz,
| | | | - Frank Birklein
- ***Klinik und Poliklinik für Neurologie, Universitätsmedizin Mainz
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Bahm J. Additions Required. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:485. [PMID: 37661320 PMCID: PMC10487678 DOI: 10.3238/arztebl.m2023.0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Jörg Bahm
- *Klinik für Plastische, Hand- und Verbrennungschirurgie am Universitätsklinikum Aachen
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Li TS, Wang R, Su X, Wang XQ. Effect and mechanisms of exercise for complex regional pain syndrome. Front Mol Neurosci 2023; 16:1167166. [PMID: 37206984 PMCID: PMC10188984 DOI: 10.3389/fnmol.2023.1167166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/17/2023] [Indexed: 05/21/2023] Open
Abstract
Complex regional pain syndrome characterized by severe pain and dysfunction seriously affects patients' quality of life. Exercise therapy is gaining attention because it can effectively relieve pain and improve physical function. Based on the previous studies, this article summarized the effectiveness and underlying mechanisms of exercise interventions for complex regional pain syndrome, and described the gradual multistage exercise program. Exercises suitable for patients with complex regional pain syndrome mainly include graded motor imagery, mirror therapy, progressive stress loading training, and progressive aerobic training. In general, exercise training for patients with complex regional pain syndrome not only alleviates pain but also improves physical function and positive mental status. The underlying mechanisms of exercise interventions for complex regional pain syndrome include the remodeling of abnormal central and peripheral nervous system, the regulation of vasodilation and adrenaline levels, the release of endogenous opioids, and the increased anti-inflammatory cytokines. This article provided a clear explanation and summary of the research on exercise for complex regional pain syndrome. In the future, more high-quality studies with sufficient sample sizes may provide more exercise regimens and better evidence of efficacy.
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Affiliation(s)
- Tian-Shu Li
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Rui Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Xuan Su
- Department of Rehabilitation Medicine, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Xuan Su,
| | - Xue-Qiang Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
- Shanghai Shangti Orthopaedic Hospital, Department of Rehabilitation Medicine, Shanghai, China
- *Correspondence: Xue-Qiang Wang,
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