1
|
Abd-Elsayed A, Stark CW, Topoluk N, Isaamullah M, Uzodinma P, Viswanath O, Gyorfi MJ, Fattouh O, Schlidt KC, Dyara O. A brief review of complex regional pain syndrome and current management. Ann Med 2024; 56:2334398. [PMID: 38569195 PMCID: PMC10993759 DOI: 10.1080/07853890.2024.2334398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/28/2024] [Indexed: 04/05/2024] Open
Abstract
Complex regional pain syndrome (CRPS) is a debilitating chronic pain condition that, although exceedingly rare, carries a significant burden for the affected patient population. The complex and ambiguous pathophysiology of this condition further complicates clinical management and therapeutic interventions. Furthermore, being a diagnosis of exclusion requires a diligent workup to ensure an accurate diagnosis and subsequent targeted management. The development of the Budapest diagnostic criteria helped to consolidate existing definitions of CRPS but extensive work remains in identifying the underlying pathways. Currently, two distinct types are identified by the presence (CRPS type 1) or absence (CRPS type 2) of neuronal injury. Current management directed at this disease is broad and growing, ranging from non-invasive modalities such as physical and psychological therapy to more invasive techniques such as dorsal root ganglion stimulation and potentially amputation. Ideal therapeutic interventions are multimodal in nature to address the likely multifactorial pathological development of CRPS. Regardless, a significant need remains for continued studies to elucidate the pathways involved in developing CRPS as well as more robust clinical trials for various treatment modalities.
Collapse
Affiliation(s)
- Alaa Abd-Elsayed
- Department of Anesthesiology, University of WI School of Medicine and Public Health, Madison, WI, USA
| | - Cain W. Stark
- Department of Anesthesiology, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Natasha Topoluk
- Department of Anesthesiology, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Mir Isaamullah
- Department of Anesthesiology, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Paul Uzodinma
- Department of Anesthesiology, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Omar Viswanath
- Anesthesiology, LSU Health Sciences Center School of Medicine, New Orleans, LA, USA
| | - Michael J. Gyorfi
- Department of Anesthesiology, University of WI School of Medicine and Public Health, Madison, WI, USA
| | - Osama Fattouh
- Department of Neurobiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Kevin C. Schlidt
- Department of Surgery, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Omar Dyara
- Department of Anesthesiology, Medical College of Wisconsin, Wauwatosa, WI, USA
| |
Collapse
|
2
|
David R, Kassam F, Winston P. Finger Manipulation Under Peripheral Nerves Blocks for the Treatment of Stiffness in Refractory Symptoms of Complex Regional Pain Syndrome. Am J Phys Med Rehabil 2024; 103:e58-e59. [PMID: 38112681 DOI: 10.1097/phm.0000000000002380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Affiliation(s)
- Romain David
- From the PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France (RD); Physical and Rehabilitation Medicine Unit, Poitiers University Hospital, University of Poitiers, Poitiers, France (RD); Faculty of Medicine University of British Columbia, Vancouver, BC, CA (FK, PW); Vancouver Island Health Authority, Victoria, Canada (RD, PW); and Canadian Advances in Neuro-Orthopedics for Spasticity Consortium, Kingston, Canada (RD, FK, PW)
| | | | | |
Collapse
|
3
|
Ferraro MC, O'Connell NE, Sommer C, Goebel A, Bultitude JH, Cashin AG, Moseley GL, McAuley JH. Complex regional pain syndrome: advances in epidemiology, pathophysiology, diagnosis, and treatment. Lancet Neurol 2024; 23:522-533. [PMID: 38631768 DOI: 10.1016/s1474-4422(24)00076-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 02/07/2024] [Accepted: 02/12/2024] [Indexed: 04/19/2024]
Abstract
Complex regional pain syndrome (CRPS) is a rare pain disorder that usually occurs in a limb after trauma. The features of this disorder include severe pain and sensory, autonomic, motor, and trophic abnormalities. Research from the past decade has offered new insights into CRPS epidemiology, pathophysiology, diagnosis, and treatment. Early identification of individuals at high risk of CRPS is improving, with several risk factors established and some others identified in prospective studies during the past 5 years. Better understanding of the pathophysiological mechanisms of CRPS has led to its classification as a chronic primary pain disorder, and subtypes of CRPS have been updated. Procedures for diagnosis have also been clarified. Although effective treatment of CRPS remains a challenge, evidence-based integrated management approaches provide new opportunities to improve patient care. Further advances in diagnosis and treatment of CRPS will require coordinated, international multicentre initiatives.
Collapse
Affiliation(s)
- Michael C Ferraro
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia; School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Neil E O'Connell
- Department of Health Sciences, Centre for Health and Wellbeing Across the Lifecourse, Brunel University London, Uxbridge, UK
| | - Claudia Sommer
- University Hospital Würzburg, Department of Neurology, Würzburg, Germany
| | - Andreas Goebel
- Pain Research Institute, Institute of Life Course and Medical Sciences, University of Liverpool, and Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Janet H Bultitude
- Centre for Pain Research, Department of Psychology, University of Bath, Bath, UK
| | - Aidan G Cashin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia; School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - G Lorimer Moseley
- IMPACT in Health, University of South Australia, Kaurna Country, Adelaide, SA, Australia
| | - James H McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia; School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.
| |
Collapse
|
4
|
Vu PD, Hasoon JJ, Chen GH. Pain relief and dermatological changes in complex regional pain syndrome with peripheral nerve stimulation. Pain Med 2024; 25:300-302. [PMID: 38109674 DOI: 10.1093/pm/pnad163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/15/2023] [Accepted: 12/14/2023] [Indexed: 12/20/2023]
Affiliation(s)
- Peter D Vu
- Department of Physical Medicine and Rehabilitation, UTHealth McGovern Medical School, Houston, TX, 77030, United States
| | - Jamal J Hasoon
- Department of Anesthesia and Pain Medicine, UTHealth McGovern Medical School, Houston, TX, United States
| | - Grant H Chen
- Department of Anesthesia and Pain Medicine, UTHealth McGovern Medical School, Houston, TX, United States
| |
Collapse
|
5
|
Foglia SD, Drapeau CC, Rehsi RS, Ramdeo KR, Shanthanna H, Nelson AJ. Repetitive Transcranial Magnetic Stimulation with Sensorimotor Training for the Treatment of Complex Regional Pain Syndrome Type 2 of the Upper Limb Case Report. A A Pract 2024; 18:e01768. [PMID: 38546353 PMCID: PMC11057489 DOI: 10.1213/xaa.0000000000001768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2024] [Indexed: 05/01/2024]
Abstract
This case report describes the use of repetitive transcranial magnetic stimulation (rTMS) combined with sensorimotor training (SMT) to treat an individual with complex regional pain syndrome (CRPS) type 2 with allodynia of the right hand/wrist. After the 9-week intervention, there was a clinically meaningful reduction in pain intensity which continued to 3 months after intervention. Further, clinically meaningful improvements in wrist and hand function and allodynia were observed. Although the use of rTMS for CRPS has been reported, this unique report provides valuable insight into the clinical utility of rTMS plus SMT for the treatment of CRPS and related symptoms.
Collapse
Affiliation(s)
- Stevie D. Foglia
- From the School of Biomedical Engineering, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | - Harsha Shanthanna
- From the School of Biomedical Engineering, McMaster University, Hamilton, Ontario, Canada
- Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Aimee J. Nelson
- From the School of Biomedical Engineering, McMaster University, Hamilton, Ontario, Canada
- Departments of Kinesiology
| |
Collapse
|
6
|
Graca MJ, Lubenow TR. Update to "Efficacy and Safety of Cervical and High-Thoracic Dorsal Root Ganglion Stimulation Therapy for Complex Regional Pain Syndrome of the Upper Extremities". Neuromodulation 2024; 27:593-595. [PMID: 37804280 DOI: 10.1016/j.neurom.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/22/2023] [Accepted: 08/22/2023] [Indexed: 10/09/2023]
Affiliation(s)
- Mateusz J Graca
- Department of Anesthesiology, Rush University Medical Center, Chicago, IL, USA.
| | - Timothy R Lubenow
- Department of Anesthesiology, Rush University Medical Center, Chicago, IL, USA
| |
Collapse
|
7
|
Kochat S, Byers J, Yi PK. Case report: Dorsal root ganglion stimulator lead fracture. Pain Pract 2024; 24:673-676. [PMID: 38102861 DOI: 10.1111/papr.13335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
BACKGROUND One of the unique advances in neuromodulation for chronic pain has been spinal cord stimulators (SCS) and dorsal root ganglion stimulators (DRG-S). These devices have aided in conditions such as neuropathic pain, complex regional pain syndromes, failed back surgery, and peripheral neuropathies. With these benefits, however, complications from implantable stimulators have included lead fractures and migration. The authors reviewed a lead migration, kinking, and subsequent fracture event involving a patient with complex regional pain syndrome (CRPS) II, who was treated with a DRG-S. CASE PRESENTATION The case report follows this patient, from their past medical history to assessment of appropriate qualifications for neuromodulation, to successful surgical placement, to follow-up care. The authors further monitored assessment of inefficacy of pain relief, and identification of lead migration and kinking through imaging. In the process of removal, due to lead stress, lead fracturing occurred. After lead removal, the leads were fully replaced, and the patient was followed up and experienced improved pain relief. CONCLUSION The case report assesses probable mechanisms of lead fracture and considerations for physicians for future assessment and triage of neuromodulation efficacy.
Collapse
Affiliation(s)
- Suhas Kochat
- Department of Anesthesiology, Duke University, Durham, North Carolina, USA
| | - Jacob Byers
- Department of Anesthesiology, Pain Division, Duke University, Durham, North Carolina, USA
| | - Peter K Yi
- Department of Anesthesiology, Pain Division, Duke University, Durham, North Carolina, USA
| |
Collapse
|
8
|
Tay MC, Rider JV. Pediatric Complex Regional Pain Syndrome and Occupational Therapy Intervention: A Scoping Review. OTJR (Thorofare N J) 2024; 44:168-178. [PMID: 37710963 DOI: 10.1177/15394492231197612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
Complex regional pain syndrome (CRPS) is an increasingly recognized pain condition in the pediatric population. Occupational therapy (OT) is a crucial component of a multidisciplinary approach to treating pediatric CRPS. Yet, there is limited evidence detailing these OT interventions. This review aimed to explore the existing literature on OT interventions and delivery methods for pediatric CRPS. We performed a scoping review of peer-reviewed articles that included pediatric participants with CRPS with no limitation on publication date. Most of the 11 included studies described OT interventions that addressed pain, functional disability, motor and sensory function, social participation, and psychological well-being. Interventions included sensory reeducation programs, exercises, functional use of affected extremities, psychoeducation, and client and family education. To facilitate engagement in meaningful occupations, OT practitioners treating pediatric CRPS should provide evidence-based interventions and age-appropriate client education and include caregivers in the care plan.
Collapse
|
9
|
Machač S, Chasáková L, Kakawand S, Kozák J, Štěpánek L, Vejvalka J, Kolář P, Černý R. Mirror visual feedback as therapeutic modality in unilateral upper extremity complex regional pain syndrome type I: randomized controlled trial. Eur J Phys Rehabil Med 2024; 60:280-291. [PMID: 38197628 DOI: 10.23736/s1973-9087.23.07625-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND There is growing evidence for the effectiveness of mirror therapy (MT) on pain reduction in patients with type I complex regional pain syndrome (CRPS I). AIM To evaluate the efficacy of MT on pain reduction and hand function in subjects with unilateral upper extremity CRPS I. DESIGN Randomized controlled trial with control group cross-over (half cross-over design). SETTING Subjects with CRPS I were outpatients of a university hospital and cooperating centers. All patients carried out the daily exercise at home. POPULATION Subjects with unilateral upper extremity CRPS I meeting the Budapest diagnostic criteria. METHODS Subjects were randomly divided into two groups. Group A (N.=13) carried out a ten-minute MT exercise daily, for a total duration of six weeks. Group B (N.=14) acted as a control group for six weeks followed by six weeks of MT with the same characteristics as Group A. Upper extremity active range of motion, strength, dexterity, limb volume, affected-to-unaffected hand temperature difference, and health-related quality of life were evaluated before and after each period. Daily records on the visual analogue scale were used for pain evaluation. Effectiveness was calculated using mixed-effects modelling for between-group comparisons and within-group variability, and identification of significant predictors. RESULTS Twenty-three females and four males with an average age of 56.1±9.6 years completed the study. Except for the affected-to-unaffected hand temperature difference, both groups consistently demonstrated significant or near-significant improvements in measured parameters after MT period. The improvements were evident upon an intergroup comparison of Group A and the control period of Group B as well as longitudinally within Group B. No significant improvement was found during the control period. CONCLUSIONS Principles focused on mirror visual feedback to the central nervous system can sustain promising therapeutic potential as part of the treatment for pain reduction and hand function in CRPS I patients. CLINICAL REHABILITATION IMPACT MT can be considered as part of the therapeutic regimen employed for the treatment of CRPS I.
Collapse
Affiliation(s)
- Stanislav Machač
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic -
| | - Ludmila Chasáková
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Soroush Kakawand
- Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Jiří Kozák
- Department of Pain Research and Treatment, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Lubomír Štěpánek
- Institute of Biophysics and Informatics, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Statistics and Probability, Faculty of Informatics and Statistics, Prague University of Economics and Business, Prague, Czech Republic
| | - Jan Vejvalka
- Department of Information Systems, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Pavel Kolář
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Rudolf Černý
- Department of Neurology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| |
Collapse
|
10
|
Sabatowski R, Scharnagel R. [Integrative, complementary medical therapy: is it a useful option in the treatment of CRPS?]. Schmerz 2024; 38:48-50. [PMID: 38079003 DOI: 10.1007/s00482-023-00772-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2023] [Indexed: 02/03/2024]
Affiliation(s)
- R Sabatowski
- UniversitätsSchmerzCentrum, Universitätsklinik und Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinik und Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland.
| | - R Scharnagel
- UniversitätsSchmerzCentrum, Universitätsklinik und Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinik und Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
| |
Collapse
|
11
|
Fatima K, Javed SO, Saleem A, Marsia S, Zafar R, Noorani K, Kumar S, Ali SM, Ismail I, Hashim I, Ganatra FA. Long-term efficacy of spinal cord stimulation for chronic primary neuropathic pain in the contemporary era: a systematic review and meta-analysis. J Neurosurg Sci 2024; 68:128-139. [PMID: 36943763 DOI: 10.23736/s0390-5616.23.05930-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
INTRODUCTION Spinal cord stimulation (SCS) is a modern neuromodulation technique extensively proven to be an effective modality for treatment of chronic neuropathic pain. It has been mainly studied for complex regional pain syndrome (CRPS) and failed back surgery syndrome (FBSS) and recent data almost uniformly establishes its statistically significant positive therapeutic results. It has also been compared with other available treatment modalities across various studies. However, long term data on maintenance of its efficacious potential remains less explored. Few studies have reported data on long follow-up times (>= 12 months) and have compared its efficacy with other treatment options for chronic pain, respectively. Our study pools and analyzes the available data and compares SCS with other treatment options. It also analyzes the efficacy of SCS in long term management of patients with chronic pain. EVIDENCE ACQUISITION We reviewed all the data available on MEDLINE, Embase and Cochrane CENTRAL using a search strategy designed to fit our pre-set inclusion and exclusion criteria. Both single-arm and double-arm studies were included. The primary outcome was defined as decrease of visual analogue scale (VAS) by >50% at 6, 12 and/or 24 months after SCS. EVIDENCE SYNTHESIS According to the pooled data of double-arm studies, SCS has unanimously proven its superiority over other treatment options at 6 months follow-up; however it fails to prove statistically significant difference in results at longer treatment intervals. Dorsal root ganglion stimulation, a relatively recent technique with the same underlying physiologic mechanisms as SCS, showed far more promising results than SCS. Single-arm studies show around 70% patients experiencing greater than 50% reduction in their VAS scores at 6 and 12 months. CONCLUSIONS SCS is a viable option for management of chronic neuropathic pain secondary to FBSS and CRPS. However, data available for its long term efficacy remains scarce and show no further statistically significant results.
Collapse
Affiliation(s)
- Kaneez Fatima
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Syed O Javed
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Aqsa Saleem
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Shayan Marsia
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Ramsha Zafar
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Komal Noorani
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Sahlish Kumar
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan -
| | - Sara M Ali
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Iqra Ismail
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Insiya Hashim
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Fatima A Ganatra
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| |
Collapse
|
12
|
Delon-Martin C, Lefaucheur JP, Hodaj E, Sorel M, Dumolard A, Payen JF, Hodaj H. Neural Correlates of Pain-Autonomic Coupling in Patients With Complex Regional Pain Syndrome Treated by Repetitive Transcranial Magnetic Stimulation of the Motor Cortex. Neuromodulation 2024; 27:188-199. [PMID: 37589642 DOI: 10.1016/j.neurom.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVES Complex regional pain syndrome (CRPS) is a chronic pain condition involving autonomic dysregulation. In this study, we report the results of an ancillary study to a larger clinical trial investigating the treatment of CRPS by neuromodulation. This ancillary study, based on functional magnetic resonance imaging (fMRI), evaluated the neural correlates of pain in patients with CRPS in relation to the sympathetic nervous system and for its potential relief after repetitive transcranial magnetic stimulation of the motor cortex. MATERIALS AND METHODS Eleven patients with CRPS at one limb (six women, five men, aged 52.0 ± 9.6 years) were assessed before and one month after the end of a five-month repetitive transcranial magnetic stimulation (rTMS) therapy targeting the motor cortex contralateral to the painful limb, by means of electrochemical skin conductance (ESC) measurement, daily pain intensity scores on a visual numerical scale (VNS), and fMRI with motor tasks (alternation of finger movements and rest). The fMRI scans were analyzed voxelwise using ESC and VNS pain score as regressors to derive their neural correlates. The criterion of response to rTMS therapy was defined as ≥30% reduction in VNS pain score one month after treatment compared with baseline. RESULTS At baseline, ESC values were reduced in the affected limb vs the nonaffected limb. There was a covariance of VNS with brain activation in a small region of the primary somatosensory cortex (S1) contralateral to the painful side on fMRI investigation. After rTMS therapy on motor cortex related to the painful limb, the VNS pain scores significantly decreased by 22% on average. The criterion of response was met in six of 11 patients (55%). In these responders, at one month after treatment, ESC value increased and returned to normal in the CRPS-affected limb, and overall, the increase in ESC correlated with the decrease in VNS after motor cortex rTMS therapy. At one month after treatment, there also was a covariance of both variables (ESC and VNS) with fMRI activation of the S1 region previously mentioned. The fMRI activation of other brain regions (middle frontal gyrus and temporo-parietal junction) showed correlation with ESC values before and after treatment. Finally, we found a positive correlation at one month after treatment (not at baseline) between VNS pain score and fMRI activation in the temporo-parietal junction contralateral to painful side. CONCLUSIONS This study first shows a functional pain-autonomic coupling in patients with CRPS, which could involve a specific S1 region. However, the modulation of sympathetic sudomotor activities expressed by ESC changes was rather correlated with functional changes in other brain regions. Finally, the pain relief observed at one month after rTMS treatment was associated with a reduced activation of the temporo-parietal junction on the side in which rTMS was performed. These findings open perspectives to define new targets or biomarkers for using rTMS to treat CRPS-associated pain. CLINICAL TRIAL REGISTRATION The Clinicaltrials.gov registration number for the study is NCT02817880.
Collapse
Affiliation(s)
- Chantal Delon-Martin
- University of Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, Grenoble, France.
| | - Jean-Pascal Lefaucheur
- EA University Paris Est Créteil, Health Faculty, Créteil, France; AP-HP, Clinical Neurophysiology Unit, Henri Mondor Hospital, Créteil, France
| | - Enkeledja Hodaj
- CHU Grenoble Alpes, Clinical Investigation Center, Grenoble, France
| | - Marc Sorel
- Sud-Seine-et-Marne Hospital, Center for Pain Evaluation and Treatment, Nemours, France
| | | | - Jean-François Payen
- University of Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, Grenoble, France; CHU Grenoble Alpes, Pain Center, Grenoble, France
| | - Hasan Hodaj
- University of Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, Grenoble, France; CHU Grenoble Alpes, Pain Center, Grenoble, France
| |
Collapse
|
13
|
Graca MJ, Lubenow TR, Landphair WR, McCarthy RJ. Efficacy and Safety of Cervical and High-Thoracic Dorsal Root Ganglion Stimulation Therapy for Complex Regional Pain Syndrome of the Upper Extremities. Neuromodulation 2023; 26:1781-1787. [PMID: 36402657 DOI: 10.1016/j.neurom.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/05/2022] [Accepted: 09/23/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate analgesic and safety considerations for high thoracic and cervical dorsal root ganglion (DRG) neuromodulation for complex regional pain syndrome (CRPS). We hypothesized that DRG neuromodulation would provide sustained analgesia with complications like that of low thoracic or lumbar electrode implantation. MATERIALS AND METHODS A single-center, retrospective study was conducted of patients with CRPS I or II of the upper extremities, refractory to previous therapies, who were treated with DRG neuromodulation in the upper thoracic and cervical spine. The primary outcome was successful DRG therapy, defined as ≥ 50% pain relief on a Numeric Rating Scale (NRS) 0 to 10 pain scale at six months after implantation. A secondary outcome was a reduction in daily opioid use after DRG therapy. RESULTS After a DRG stimulation trial, 17 of 20 patients (85%) had ≥ 50% improvement in NRS pain and underwent a permanent pulse generator implant, with 100% endorsing ≥ 50% pain relief at six months. Mean NRS pain scores before DRG neuromodulation were 9.3 ± 1.1, with a mean reduction of 5.5 (95% CI, 4.5-6.6; p < 0.001) at six months. Ten patients were taking opioids at baseline; the median (interquartile range) dose was 45 mg (23 to 120) morphine equivalents (MME), which was reduced to 20 MME (15 to 40) at six months. The median reduction in daily MME use was -25 (95% CI, -100 to 20; p = 0.099). Six of 20 patients (30%) experienced a complication: three had lead migration; two experienced paresthesias; and one had a reduction in shoulder mobility. One patient had symptoms of a reversible spinal cord compression immediately after implant, requiring emergent electrode removal. CONCLUSIONS DRG neuromodulation for patients with CRPS of the upper extremities produced clinically important analgesia and reduced opioid use for ≥ six months but was associated with one serious complication.
Collapse
Affiliation(s)
- Mateusz J Graca
- Department of Anesthesiology, Rush University Medical Center, Chicago, IL, USA
| | - Timothy R Lubenow
- Department of Anesthesiology, Rush University Medical Center, Chicago, IL, USA.
| | - William R Landphair
- Department of Anesthesiology, Rush University Medical Center, Chicago, IL, USA
| | - Robert J McCarthy
- Department of Anesthesiology, Rush University Medical Center, Chicago, IL, USA
| |
Collapse
|
14
|
Griffiths GS, Thompson BL, Snell DL, Dunn JA. Experiences of diagnosis and treatment for upper limb Complex Regional Pain Syndrome: a qualitative analysis. Pain Med 2023; 24:1355-1363. [PMID: 37584744 PMCID: PMC10690851 DOI: 10.1093/pm/pnad111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/21/2023] [Accepted: 08/10/2023] [Indexed: 08/17/2023]
Abstract
INTRODUCTION Complex Regional Pain Syndrome (CRPS) most frequently affects the upper limb, with high associated disability. Delays to diagnosis and appropriate treatment can adversely impact prognosis and quality of life, but little is known about the healthcare experiences of people with CRPS. This study aimed to explore lived experiences of diagnosis and treatment for people with upper limb CRPS. METHODS Participants were recruited through online support groups and multiple public and private healthcare settings in the Greater Wellington Region, New Zealand. Semi-structured interviews were conducted with participants who had experienced upper limb CRPS for more than three months and less than three years. Interviews were transcribed verbatim and analysed using reflexive thematic analysis. RESULTS Thirteen participants (11 female, 2 male) aged between 43 and 68 years were interviewed. Duration of CRPS ranged from 7 months to 2.5 years. Five themes were identified. Participants initially engaged in healthcare out of a desire to return to being the person they were before having CRPS. Three interacting experiences epitomised the overall healthcare experience: (1) not knowing what is going on, (2) not being taken seriously, and (3) healthcare as adding another layer of load. Meanwhile, participants used multiple approaches in an attempt to not let CRPS stop them from continuing to live their lives. CONCLUSIONS Participants in this study felt that credible information, validation, and simplification from healthcare providers and systems would support their process of navigating towards a meaningful life and self-concept in the presence of CRPS.
Collapse
Affiliation(s)
- Grace S Griffiths
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch 8011, New Zealand
| | - Bronwyn L Thompson
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch 8011, New Zealand
| | - Deborah L Snell
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch 8011, New Zealand
| | - Jennifer A Dunn
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch 8011, New Zealand
| |
Collapse
|
15
|
Ranker A, Behr-Eggers E. [Electrotherapeutical stellate ganglion block on a patient with complex regional pain syndrome of the upper limb]. Schmerz 2023; 37:468-472. [PMID: 36459205 PMCID: PMC10663199 DOI: 10.1007/s00482-022-00682-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 12/03/2022]
Abstract
The case of a 51-year-old patient with complex regional pain syndrome (CRPS) of the left hand after radius distortion is reported. Anticonvulsant therapy was difficult in this case due to persisting epilepsy with already dual therapy (lamotrigine and brivaracetam) at high dosage. With existing neuropathic pain, pronounced allodynia and hyperhidrosis, repetitive transcutaneous monophasic electrotherapy was applied above the stellate ganglion. A ganglion blockage could not be clinically confirmed in the absence of Horner syndrome, but neuropathic pain and hyperhidrosis could be positively influenced. This case report summarizes the electrode positions used, current parameters, pitfalls and therapy limitations and discusses them in relation to the literature.
Collapse
Affiliation(s)
- Alexander Ranker
- Klinik für Rehabilitationsmedizin, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
- Praxis für Allgemeinmedizin, Amelinghausen, Deutschland.
| | | |
Collapse
|
16
|
Sathiavageesan S, Annamalai I, Karki A, Kamalanathan M, Annadurai A, Chandrasekaran A. Complex regional pain syndrome following vascular access creation for hemodialysis. J Vasc Access 2023; 24:1535-1537. [PMID: 35466797 DOI: 10.1177/11297298221091766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pain and swelling of a limb following creation of arterio-venous fistula (AVF) are often attributable to vascular disorders like venous hypertension or limb ischaemia. Here we report the case of a 70-years old man who developed pain and swelling of upper limb distal to the AVF during second post-operative week due to a complex regional pain syndrome (CRPS). CRPS is characterized by pain that is disproportionate to the invoking injury, autonomic dysfunction, trophic changes and functional impairment of affected limb. Hyperalgesia and allodynia are pain patterns characteristic of CRPS. CRPS has been reported rarely following AVF creation surgery. Prompt diagnosis of CRPS is important to avoid misdiagnosis of vascular disorders and for implementation of right therapeutic strategy.
Collapse
Affiliation(s)
- Subrahmanian Sathiavageesan
- Department of Nephrology, Trichy SRM Medical College Hospital & Research Centre, Trichy, Tamil Nadu, India
- Department of Nephrology, Sundaram Hospital, Puthur, Trichy, Tamil Nadu, India
| | - Ishwarya Annamalai
- Department of Nephrology, Trichy SRM Medical College Hospital & Research Centre, Trichy, Tamil Nadu, India
| | - Arun Karki
- Department of Medicine, Trichy SRM Medical College Hospital & Research Centre, Trichy, Tamil Nadu, India
| | - Melchizedek Kamalanathan
- Department of Nephrology, Trichy SRM Medical College Hospital & Research Centre, Trichy, Tamil Nadu, India
| | - Anjali Annadurai
- Department of Nephrology, Trichy SRM Medical College Hospital & Research Centre, Trichy, Tamil Nadu, India
| | | |
Collapse
|
17
|
Paicius R, White ZS, Smith C, Lightner AL, Ransom JT, Lee DW, Speare S. Safety and Efficacy of Intravenous ExoFlo in the Treatment of Complex Regional Pain Syndrome. Pain Physician 2023; 26:E851-E857. [PMID: 37976492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
BACKGROUND Complex regional pain syndrome (CRPS) is an extremely painful disorder driven primarily by inflammation. OBJECTIVES We hypothesized that the immunomodulatory biologic, ExoFloTM, composed of bone marrow mesenchymal stem cell-derived extracellular vesicles, could be safely administered to CRPS patients and alleviate symptoms. STUDY DESIGN Ten patients received 2 intravenous (IV) infusions, each containing 15 mL ExoFlo, on day one and day 4. A series of tests were performed at baseline (day 0, prior to infusion), week one, and months one, 3, and 6 after the second infusion. SETTING All patients were treated in one of 2 outpatient pain management clinics in Orange County, CA. METHODS Testing for clinical improvement included: visual analog scale of pain, brief pain inventory, 36-item short-form questionnaire, range of motion analysis, and jamar dynamometer testing. RESULTS No serious adverse events related to ExoFlo treatment occurred. Statistically significant improvements in pain and motion assessments occurred across the patient pool. LIMITATIONS This study was limited by its patient number enrolled (10), it lacked a control arm, and one patient who dropped out of the study. CONCLUSIONS IV delivery of ExoFlo appears safe in patients with CRPS. In addition, ExoFlo exhibited efficacy in addressing CRPS symptoms. Given the lack of effective and safe treatments available to CRPS patients, these results suggest that further studies are warranted to explore and validate this potential treatment for CRPS.
Collapse
Affiliation(s)
- Rick Paicius
- SC Spine & Sport, Newport Beach, CA; Newport Coast Surgery Center, Newport Beach, CA
| | - Zeyn S White
- SC Spine & Sport, Newport Beach, CA; Newport Coast Surgery Center, Newport Beach, CA
| | - Cassandra Smith
- SC Spine & Sport, Newport Beach, CA; Newport Coast Surgery Center, Newport Beach, CA
| | | | | | - David W Lee
- Fullerton Orthopedic Surgery Medical Group, Fullerton, California
| | | |
Collapse
|
18
|
Alshehri FS. The complex regional pain syndrome: Diagnosis and management strategies. Neurosciences (Riyadh) 2023; 28:211-219. [PMID: 37844940 PMCID: PMC10827038 DOI: 10.17712/nsj.2023.4.20230034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
Complex regional pain syndrome (CRPS) is a chronic disease that affects a limb following an injury or trauma. The CRPS associated with symptoms, including severe pain, swelling, as well as changes in skin color and temperature. Treatment of CRPS requires a multidisciplinary approach, with a focus on personalized treatment plans and addressing psychological factors. This review provides an overview of updates in the diagnosis and treatment of CRPS. There are clinical criteria for diagnosing CRPS, including persistent pain and swelling. The CRPS can also be diagnosed with imaging and laboratory tests. Novel insights into treatment approaches for CRPS have been gained from advances in understanding its pathophysiology. Treatment of CRPS includes both pharmacological and non-pharmacological interventions. The latest guidelines for CRPS treatment emphasize the importance of early diagnosis and intervention, personalized treatment plans, and addressing psychological factors in managing CRPS.
Collapse
Affiliation(s)
- Fahad S. Alshehri
- From the Department of Pharmacology and Toxicology, College of Pharmacy, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
| |
Collapse
|
19
|
Grinshpun G. Chronic Pain Syndromes: Complex Regional Pain Syndrome. FP Essent 2023; 533:21-26. [PMID: 37812530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
Complex regional pain syndrome (CRPS) is a chronic pain condition characterized by intense pain, usually in a body region that has experienced trauma, and autonomic and inflammatory features. It most commonly develops after an arm or leg injury. Patients typically present with extreme hyperalgesia and/or allodynia. The Budapest Criteria are used to make this clinical diagnosis. Prompt diagnosis and aggressive management are critical because long-term outcomes are improved when treatment is initiated soon after symptom onset. The primary management options are rehabilitation and physical therapy, including such approaches as progressive tactile stimulation, normalization of movement to prevent limited range of motion, and others. No drugs are approved by the Food and Drug Administration (FDA) for CRPS management, but some evidence supports the use of drugs used to manage other types of neuropathic pain (eg, gabapentin, tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors). Nonsteroidal anti-inflammatory drugs also are used, and corticosteroids, bisphosphonates, ketamine, and other drugs can be helpful, particularly for early-stage CRPS. When pain severity prevents patients from participating in rehabilitation, referral to a pain specialist is warranted for consideration of procedural interventions, including sympathetic nerve blockade and spinal cord stimulation.
Collapse
Affiliation(s)
- Ghena Grinshpun
- Interdisciplinary Pain Management Center - Madigan Army Medical Center, Joint Base Lewis-McChord, WA
| |
Collapse
|
20
|
Gabriel T, Klose P. [Complementary methods in the treatment of complex regional pain syndrome]. Schmerz 2023; 37:330-335. [PMID: 37268791 DOI: 10.1007/s00482-023-00724-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/17/2023] [Accepted: 04/04/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND Complex regional pain syndrome (CRPS) affects 10-15% of patients following injuries (fractures, surgery) to the outer extremities and people after a stroke. The affected area hurts, is inflamed and lacks strength, while mobility and sensitivity are restricted. Complementary medicine as part of integrative medicine offers additional effective treatment options. RESEARCH QUESTION Complementary therapies that extend the guideline recommendations, demonstrate clinical evidence and/or are plausible are presented. RESULTS Mind-body medicine procedures (mindfulness, relaxation, yoga, Qi Gong, etc.) support the patient's self-efficacy and stimulate the vagus nerve as well as promoting the reduction of pain, depression and anxiety and improving quality of life. Phytotherapeutics such as turmeric or stinging nettle have an anti-inflammatory effect. Water treatments reduce pain, and acupuncture and neural therapy can be tried. CONCLUSIONS Integrative, complementary medical therapy options support the CRPS patient in coping with their disease and the related pain. These options can play an important role in the multimodal, interdisciplinary treatment of this disease.
Collapse
Affiliation(s)
- T Gabriel
- Klinik für Naturheilkunde & Integrative Medizin, KEM | Evang. Kliniken Essen-Mitte, Am Deimelsberg 34a, 45276, Essen, Deutschland.
| | - P Klose
- Klinik für Naturheilkunde & Integrative Medizin, KEM | Evang. Kliniken Essen-Mitte, Am Deimelsberg 34a, 45276, Essen, Deutschland
| |
Collapse
|
21
|
Del Piñal F. Diagnosis and Outcomes of 225 Consecutive Cases of Complex Regional Pain Syndrome of the Hand. Plast Reconstr Surg 2023; 152:807-816. [PMID: 36952596 DOI: 10.1097/prs.0000000000010454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
BACKGROUND The lack of specific tests and potential diagnostic inaccuracy may be behind the stunning figures of complex regional pain syndrome (CRPS) cases. The author tested the hypothesis that patients diagnosed with CRPS at referral could be assigned to recognized conditions and treated accordingly. METHODS From January of 2018 to April of 2021, 225 consecutive patients attended the author's office having been diagnosed with and treated for CRPS for an average of 16 ± 26 months. There were 180 women and 45 men; no patient was excluded. RESULTS All patients could be allocated in named conditions: 79 had a wrong diagnosis; seven had a true causalgia; 16 were dystonic-psychogenic hands; 20 presented a flare reaction; and 90 had an "irritative" carpal tunnel syndrome. The remaining 13 patients had a miscellany of symptoms within a substandard management setting. Surgery was offered to 175 with a correctable cause; 50 (20 of whom had a tangible cause responsible for their pain) declined, and their outcome is unknown. The remaining 125 were operated on and tracked for an average of 20 ± 9 months. In the operated group, pain dropped 7.5 ± 2.2 points ( P < 0.0001) on a numerical rating scale of 0 to 10. Disabilities of the Arm, Shoulder, and Hand questionnaire scores fell from 80 to 16 ( P < 0.0001). Patients who were operated on rated their satisfaction on a scale of 0 to 10 as 8.9 ± 1.9. CONCLUSIONS Unlike with CRPS, all patients in this series had a true, diagnosable condition explaining their clinical picture. Most patients who agreed to be operated on had a favorable outcome. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
Collapse
|
22
|
Coggins J, McCabe C, Walsh N, Pearson J, Rolls C, Collins C, Llewellyn A. Optimising management of complex regional pain syndrome to improve clinical outcomes throughout the therapy care pathway in England: Protocol for a qualitative interview and observational study with patients and clinicians. Musculoskeletal Care 2023; 21:871-877. [PMID: 36987399 DOI: 10.1002/msc.1764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/15/2023] [Accepted: 03/18/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION Complex Regional Pain Syndrome (CRPS) is a disabling and distressing chronic pain condition characterised by a range of sensory, motor, autonomic and trophic symptoms. Guidelines recommend early referral for therapies that promote movement of the painful limb. However, evidence suggests a lack of defined therapy pathways for CRPS. AIMS The current study aims to explore CRPS therapy management in centres of excellence in England, and outside of these settings, to understand what facilitates and hinders best practice. The overall aim is to develop a draft stratified package of care to expedite patient access to optimal CRPS therapy across the management pathway. METHODS AND ANALYSIS Semi-structured interviews will be conducted with therapists working in CRPS centres of excellence and with therapists in other settings. Observations of therapy interventions in CRPS centres of excellence and interviews with patients who have received this care, will also help to identify potential key care package components. Interview data will be analysed using thematic analysis, mapped to the Theoretical Domains Framework (TDF), and Intervention Mapping Adapt (IMA) framework. Observations will be described and documented using the TDF headings. CONCLUSION A triangulation protocol for qualitative health research will be used to integrate all data. Online stakeholder events will be held using consensus methods to agree a draft package of care for future implementation following further refinement, testing and evaluation. CLINICAL TRIAL REGISTRATION The trial was registered with ISRCTN registry on 24 February 2022 (ISRCTN16917807).
Collapse
Affiliation(s)
- Jessica Coggins
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
- CRPS Service, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Candida McCabe
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
- Dorothy House Hospice Care, Bradford on Avon, UK
| | - Nicola Walsh
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
- NIHR ARC-West, Bristol, UK
| | - Jennifer Pearson
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
- Therapy Department, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Catherine Rolls
- Hand Rehabilitation Unit, University Hospitals Bristol, Bristol Royal Infirmary, Bristol, UK
| | - Catherine Collins
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Alison Llewellyn
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
- CRPS Service, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- Dorothy House Hospice Care, Bradford on Avon, UK
| |
Collapse
|
23
|
Shafiee E, MacDermid J, Packham T, Grewal R, Farzad M, Bobos P, Walton D. Rehabilitation Interventions for Complex Regional Pain Syndrome: An Overview of Systematic Reviews. Clin J Pain 2023; 39:473-483. [PMID: 37224001 DOI: 10.1097/ajp.0000000000001133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/10/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVES An increasing number of systematic reviews have been conducted on various conservative management of complex regional pain syndrome (CRPS) targeting different rehabilitation interventions and objectives. The intent of this article was to summarize and critically appraise the body of evidence on conservative management of the CRPS and to provide an overall picture of the current state of the literature. METHODS This study was an overview of systematic reviews on conservative treatments for CRPS. We conducted a literature search from inception to January 2023 in the following databases: Embase, Medline, CINAHL, Google Scholar, Cochrane Library, and Physiotherapy Evidence Database (PEDro). Two independent reviewers conducted study screening, data extraction, and methodological quality assessment (using AMSTAR-2). Qualitative synthesis was the preferred method for reporting the findings of our review. We calculated the corrected covered area index to account for the proportion of overlapping primary studies that were included in multiple reviews. RESULT We identified 214 articles, and a total of 9 systematic reviews of randomized controlled trials were eligible for inclusion. Pain and disability were the most common outcomes evaluated in the reviews. There were 6 (6/9; 66%) high-quality, 2 (2/9; 22%) moderate-quality, and 1 critically low-quality systematic review (1/9;11%), with the quality of the included trials ranging from very low to high. There was a large overlap across primary studies that were included in the systematic reviews (corrected covered area=23%). The findings of high-quality reviews support the effectiveness of mirror therapy (MT) and graded motor imagery (GMI) programs on pain and disability improvement in CRPS patients. The large effect size was reported for the effectiveness of MT on pain and disability (SMD:1.88 (95% CI: 0.73-3.02) and 1.30 (95% CI: 0.11-2.49), respectively) and the effectiveness of GMI program (GMIP) on pain and disability improvement (SMD: 1.36 (95% CI: 0.75-1.96) and 1.64 (95% CI: 0.53-2.74), respectively). DISCUSSION The evidence is in favor of adopting movement representation techniques, such as MT and GMI programs, for the treatment of pain and disability in patients with CRPS. However, this is based on a small body of primary evidence, and more research is required to generate conclusions. Overall, the evidence is not comprehensive or of sufficient quality to make definitive recommendations about the effectiveness of other rehabilitation interventions in improving pain and disability.
Collapse
Affiliation(s)
- Erfan Shafiee
- School of Physical Therapy, Department of Health and Rehabilitation Sciences, University of Western Ontario, ON, Canada
| | - Joy MacDermid
- School of Physical Therapy, Department of Health and Rehabilitation Sciences, University of Western Ontario, ON, Canada
- Clinical Research Lab, Hand and Upper Limb Centre, St. Joseph's Health Centre, London, Ontario
| | - Tara Packham
- School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada
| | - Ruby Grewal
- School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada
| | - Maryam Farzad
- School of Physical Therapy, Department of Health and Rehabilitation Sciences, University of Western Ontario, ON, Canada
| | - Pavlos Bobos
- School of Physical Therapy, Department of Health and Rehabilitation Sciences, University of Western Ontario, ON, Canada
| | - David Walton
- School of Physical Therapy, Department of Health and Rehabilitation Sciences, University of Western Ontario, ON, Canada
| |
Collapse
|
24
|
Wang AT, Wang EJ, Smith TJ, Razzak R, Christo PJ. Scrambler Therapy for Patients With Complex Regional Pain Syndrome: A Case Series. J Palliat Med 2023; 26:1302-1306. [PMID: 37477679 DOI: 10.1089/jpm.2022.0539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
Complex regional pain syndrome is a chronic debilitating pain disorder that is difficult to manage, in part due to its heterogeneous clinical presentation and lack of clearly defined pathophysiology. Patients usually require a multidisciplinary approach to treatment, which can entail pharmacotherapy, physical therapy, behavioral therapy, and interventional pain procedures, such as sympathetic nerve blocks, spinal cord stimulation, and dorsal root ganglion stimulation. However, many patients continue to experience pain refractory to these multimodal strategies. Scrambler therapy (ST) is a noninvasive method of neuromodulation that is applied through cutaneous electrodes, and can alleviate chronic neuropathic pain by stimulating C-fibers and replacing endogenous pain signals with synthetic non-nociceptive signals. Although the use of ST has been reported for several types of refractory central and peripheral neuropathic pain, there is a paucity of data regarding the use of ST for complex regional pain syndrome. We present two patients with complex regional pain syndrome of the right lower extremity, who each underwent ST and experienced significant pain relief and improvement in function and quality of life.
Collapse
Affiliation(s)
- Annie T Wang
- Department of Anesthesiology and Pain Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Eric J Wang
- Department of Anesthesiology and Pain Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Thomas J Smith
- Department of Palliative Care, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rab Razzak
- Department of Palliative Care, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Paul J Christo
- Department of Anesthesiology and Pain Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
25
|
Bovaira M, Cañada-Soriano M, García-Vitoria C, Calvo A, De Andrés JA, Moratal D, Priego-Quesada JI. Clinical results of lumbar sympathetic blocks in lower limb complex regional pain syndrome using infrared thermography as a support tool. Pain Pract 2023; 23:713-723. [PMID: 37086044 DOI: 10.1111/papr.13236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Abstract
AIM To describe the clinical outcomes for a group of complex regional pain syndrome patients using infrared thermography as an intraprocedural support tool when undertaking fluoroscopy-guided lumbar sympathetic blocks. SUBJECTS 27 patients with lower limb complex regional pain syndrome accompanied by severe pain and persistent functional impairment. METHODS A series of three fluoroscopic-guided lumbar sympathetic blocks with local anesthetic and corticoids using infrared thermography as an intraprocedural support tool were performed. Clinical variables were collected at baseline, prior to each block, and one, three, and six months after blocks in a standardized checklist assessing each of the clinical categories of complex regional pain syndrome stipulated in the Budapest criteria. RESULTS 23.75% of the blocks required more than one chance to achieve the desired thermal pattern and therefore to be considered as successful. A decrease in pain measured on a visual analogic scale was observed at all time points compared to pre-blockade data, but only 37% of the cases were categorized as responders, representing a ≥ 30% decrease in VAS, with the disappearance of pain at rest. An improvement of most of the clinical variables recorded was observed, such as tingling, edema, perception of thermal asymmetry, difference in coloring and sweating. There was a significant decrease of neuropathic pain and improvement of functional limitation. Logistic regression analysis showed the main variable to explain the probability of being a responder was immobilization time (odds ratio of 0.89). CONCLUSION A series of fluoroscopy-guided lumbar sympathetic blocks controlled by infrared thermography in the treatment of lower limb CRPS showed a responder rate of 37%.
Collapse
Affiliation(s)
- Maite Bovaira
- Anaesthesia Department, Hospital Intermutual de Levante, Sant Antoni de Benaixeve, Spain
| | - Mar Cañada-Soriano
- Applied Thermodynamics Department (DTRA), Universitat Politècnica de València, Valencia, Spain
| | - Carles García-Vitoria
- Anaesthesia Department, Hospital Intermutual de Levante, Sant Antoni de Benaixeve, Spain
| | - Ana Calvo
- Anaesthesia Department, Hospital Intermutual de Levante, Sant Antoni de Benaixeve, Spain
| | - José Antonio De Andrés
- Anesthesia Unit-Surgical specialties Department, Valencia University Medical School, Valencia, Spain
- Multidisciplinary Pain Management Department, Department of Anesthesiology, Critical Care and Pain Management, General University Hospital, Valencia, Spain
| | - David Moratal
- Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain
| | - Jose Ignacio Priego-Quesada
- Research Group in Sports Biomechanics (GIBD), Department of Physical Education and Sports, University of Valencia, Valencia, Spain
- Research Group in Medical Physics (GIFIME), Department of Physiology, University of Valencia, Valencia, Spain
| |
Collapse
|
26
|
Harnik MA, Kesselring P, Ott A, Urman RD, Luedi MM. Complex Regional Pain Syndrome (CRPS) and the Value of Early Detection. Curr Pain Headache Rep 2023; 27:417-427. [PMID: 37410335 PMCID: PMC10462545 DOI: 10.1007/s11916-023-01124-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2023] [Indexed: 07/07/2023]
Abstract
PURPOSE OF REVIEW The goal of this narrative review is to describe the current understanding of the pathology of Complex Regional Pain Syndrome (CRPS), as well as diagnostic standards and therapeutic options. We will then make the case for early recognition and management. RECENT FINDINGS CRPS remains an enigmatic pain syndrome, comprising several subtypes. Recent recommendations clarify diagnostic ambiguities and emphasize the importance of standardized assessment and therapy. Awareness of CRPS should be raised to promote prevention, early detection, and rapid escalation of therapy in refractory cases. Comorbidities and health costs (i.e., the socioeconomic impact) must also be addressed early to prevent negative consequences for patients.
Collapse
Affiliation(s)
- Michael Alexander Harnik
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Pascal Kesselring
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alexander Ott
- Department of Anaesthesiology and Pain Medicine, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
| | - Richard D. Urman
- Department of Anaesthesiology, College of Medicine, The Ohio State University, Columbus, OH 43210 USA
| | - Markus M. Luedi
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Anaesthesiology and Pain Medicine, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
| |
Collapse
|
27
|
Limerick G, Christo DK, Tram J, Moheimani R, Manor J, Chakravarthy K, Karri J, Christo PJ. Complex Regional Pain Syndrome: Evidence-Based Advances in Concepts and Treatments. Curr Pain Headache Rep 2023; 27:269-298. [PMID: 37421541 DOI: 10.1007/s11916-023-01130-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 07/10/2023]
Abstract
PURPOSE OF REVIEW This review presents the most current information about the epidemiology of complex regional pain syndrome (CRPS), classification and diagnostic criteria, childhood CRPS, subtypes, pathophysiology, conventional and less conventional treatments, and preventive strategies. RECENT FINDINGS CRPS is a painful disorder with multifactorial pathophysiology. The data describe sensitization of the central and peripheral nervous systems, inflammation, possible genetic factors, sympatho-afferent coupling, autoimmunity, and mental health factors as contributors to the syndrome. In addition to conventional subtypes (type I and type II), cluster analyses have uncovered other proposed subtypes. Prevalence of CRPS is approximately 1.2%, female gender is consistently associated with a higher risk of development, and substantial physical, emotional, and financial costs can result from the syndrome. Children with CRPS seem to benefit from multifaceted physical therapy leading to a high percentage of symptom-free patients. The best available evidence along with standard clinical practice supports pharmacological agents, physical and occupational therapy, sympathetic blocks for engaging physical restoration, steroids for acute CRPS, neuromodulation, ketamine, and intrathecal baclofen as therapeutic approaches. There are many emerging treatments that can be considered as a part of individualized, patient-centered care. Vitamin C may be preventive. CRPS can lead to progressively painful sensory and vascular changes, edema, limb weakness, and trophic disturbances, all of which substantially erode healthy living. Despite some progress in research, more comprehensive basic science investigation is needed to clarify the molecular mechanisms of the disease so that targeted treatments can be developed for better outcomes. Incorporating a variety of standard therapies with different modes of action may offer the most effective analgesia. Introducing less conventional approaches may also be helpful when traditional treatments fail to provide sufficient improvement.
Collapse
Affiliation(s)
- Gerard Limerick
- Division of Pain Medicine, Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
- Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Dana K Christo
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Jennifer Tram
- Department of Anesthesiology, University of California, San Diego, CA, USA
| | | | - John Manor
- Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, USA
| | | | - Jay Karri
- Division of Pain Medicine, Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
- Department of Orthopedic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Paul J Christo
- Division of Pain Medicine, Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA.
| |
Collapse
|
28
|
Kanika, Goyal M, Goyal K. Effectiveness of the physiotherapy interventions on complex regional pain syndrome in patients with stroke: A systematic review and meta-analysis. J Bodyw Mov Ther 2023; 35:175-181. [PMID: 37330766 DOI: 10.1016/j.jbmt.2023.04.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/27/2022] [Accepted: 04/11/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Complex Regional Pain Syndrome (CRPS) is an umbrella term for a variety of clinical presentations characterized by persistent pain usually in the hands or feet that is disproportionate to any preceding injury and characterized by many autonomic, sensory, and motor symptoms. CRPS is among the most common causes of post stroke shoulder pain in approximately 80% of stroke survivors. This study reviewed the available literature of physiotherapy treatment for CRPS following a stroke. METHODS Two electronic databases; PubMed and Google Scholar were searched to screen the articles from 2008 to March 2021 to be included in the study. Meta-analysis was done using the RevMan version 5.4 software. Higgins I2 and Chi-square (Tau2) statistical tests were used to assess heterogeneity. RESULTS Out of all 389 studies, only 4 RCT's were included for systematic review and meta-analysis. Mirror therapy, Laser therapy and Fluidotherapy was found to be effective than control in improving pain intensity (SMD 4.13, 95% CI 3.51 to 4.74, I2 = 99%) and functional independence (SMD 2.07, 95% CI 1.45 to 2.70, I2 = 100%) in patients with CRPS following stroke. CONCLUSION This review concluded that physiotherapy interventions in the form of exercise therapy and electrotherapy has proven to be effective in treating the symptoms of CRPS following stroke. This commonest and devastating condition has not been studied to an extent in clinical settings, there is an utmost need for further studies using the available literature.
Collapse
Affiliation(s)
- Kanika
- Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to Be University), Mullana- Ambala, Haryana, 133207, India.
| | - Manu Goyal
- Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to Be University), Mullana- Ambala, Haryana, 133207, India.
| | - Kanu Goyal
- Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to Be University), Mullana- Ambala, Haryana, 133207, India.
| |
Collapse
|
29
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
30
|
Llewellyn A, Buckle L, Grieve S, Birklein F, Brunner F, Goebel A, Harden RN, Bruehl S, Vaughan-Spickers N, Connett R, McCabe C. Delphi study to define core clinical outcomes for inclusion in a complex regional pain syndrome international research registry and data bank. Pain 2023; 164:543-554. [PMID: 36006075 DOI: 10.1097/j.pain.0000000000002729] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 06/27/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT Complex regional pain syndrome (CRPS) clinical trials have historically captured a diverse range of outcomes. A minimum set of CRPS patient-reported outcomes has been agreed for inclusion in a future CRPS international clinical research registry and data bank. This study aimed to identify a complementary set of core clinical outcomes. Clinicians and researchers from the international CRPS community informed the content of a 2-round electronic Delphi study. Participation was invited from members of the International Association for the Study of Pain CRPS Special Interest Group and the International Research Consortium for CRPS. In round 1, participants rated the relevance of 59 clinical outcomes in relation to the question "What is the clinical presentation and course of CRPS, and what factors influence it?" (1 = not relevant and 9 = highly relevant). In round 2, participants rerated each outcome in the light of the round 1 median scores. The criterion for consensus was median score ≥7, agreed by 75% of respondents. The core study team considered the feasibility of data collection of each identified outcome in agreeing final selections. Sixty respondents completed both survey rounds, with responses broadly consistent across professions. Nine outcomes met the consensus criterion. Final outcomes recommended for inclusion in the core clinical set were record of medications, presence of posttraumatic stress disorder, extent of allodynia, and skin temperature difference between limbs. Study findings provide robust recommendations for core clinical outcome data fields in the future CPRS international clinical research registry. Alongside patient-reported outcomes, these data will enable a better understanding of CRPS.
Collapse
Affiliation(s)
- Alison Llewellyn
- School of Health and Social Wellbeing, University of the West of England, Bristol, United Kingdom
- Research and Education, Dorothy House Hospice, Winsley, Bradford-on-Avon, United Kingdom
| | - Lisa Buckle
- School of Health and Social Wellbeing, University of the West of England, Bristol, United Kingdom
- Research and Development Department, Royal United Hospitals Bath NHS Foundation Trust, Bath, United Kingdom
| | - Sharon Grieve
- School of Health and Social Wellbeing, University of the West of England, Bristol, United Kingdom
- Research and Development Department, Royal United Hospitals Bath NHS Foundation Trust, Bath, United Kingdom
| | - Frank Birklein
- Department of Neurology, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Florian Brunner
- Department of Physical Medicine and Rheumatology, Balgrist University Hospital, Zurich, Switzerland
| | - Andreas Goebel
- Department of Pain Medicine, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - R Norman Harden
- Departments of PM&R and Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, United States
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, United States
| | | | | | - Candida McCabe
- School of Health and Social Wellbeing, University of the West of England, Bristol, United Kingdom
- Research and Education, Dorothy House Hospice, Winsley, Bradford-on-Avon, United Kingdom
| |
Collapse
|
31
|
Reinhold AK, Kindl GK, Dietz C, Scheu N, Mehling K, Brack A, Birklein F, Rittner HL. Molecular and clinical markers of pain relief in complex regional pain syndrome: An observational study. Eur J Pain 2023; 27:278-288. [PMID: 36440973 DOI: 10.1002/ejp.2058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Complex regional pain syndrome (CRPS) is marked by disproportionate pain after trauma. Whilst the long-term outcome is crucial to patients, predictors or biomarkers of the course of pain or CRPS symptoms are still lacking. In particular, microRNAs, such as miR-223, decreased in CRPS, have been described only in cross-sectional studies. METHODS In this study, we characterised CRPS patients over a course of 2.5 years of standard treatment. The patient underwent clinical examination including pain measurement, symptom questionnaires, quantitative sensory testing (QST) and blood sampling. Exosomal microRNA levels were measured via qPCR. After follow-up, patients were stratified into 'pain relief' (mean pain reduced by ≥2 numeric rating scale) or 'persistence' (mean pain unchanged or worsened). The primary outcome was miR-223 and miR-939 expression, secondary outcomes were differences in clinical parameters between groups and time points. RESULTS Thirty-nine patients were included, 33 of whom qualified for stratification. Overall, patients reported lower pain and improved clinical characteristics after 2.5 years, but no significant changes in QST or miR-223 and miR-939 expression levels. 16 patients met the criteria for pain relief. This was associated with stable exosomal miR-223 expression, whilst levels further decreased in pain persistence. Clinically, pain relief was marked by shorter disease duration and correlated positively with high initial pain. CONCLUSION We identified progressively reduced miR-223 as a putative biomarker of chronic CRPS pain. Clinically, this study underlines the importance of early diagnosis and treatment showing that high initial pain does not predict an unfavourable outcome. Finally, pain relief and recovery of sensory disturbances seem independent processes.
Collapse
Affiliation(s)
- Ann Kristin Reinhold
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Center for Interdisciplinary Pain Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Gudrun-Karin Kindl
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Center for Interdisciplinary Pain Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Christopher Dietz
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Center for Interdisciplinary Pain Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Nathalie Scheu
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Center for Interdisciplinary Pain Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Katharina Mehling
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Center for Interdisciplinary Pain Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Alexander Brack
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Center for Interdisciplinary Pain Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Frank Birklein
- Department of Neurology, Mainz University Hospitals, Mainz, Germany
| | - Heike L Rittner
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Center for Interdisciplinary Pain Medicine, University Hospital Würzburg, Würzburg, Germany
| |
Collapse
|
32
|
Ho E, Yazdanpanah N, Ho J, Drukman B, Chang A, Agarwal S. Parameters of Spinal Cord Stimulation in Complex Regional Pain Syndrome: Systematic Review and Meta-analysis of Randomized Controlled Trials. Pain Physician 2022; 25:521-530. [PMID: 36375180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Complex Regional Pain Syndrome (CRPS) is a chronic debilitating neuropathic pain condition characterized by autonomic and inflammatory features that typically occurs after a traumatic event. Spinal cord stimulation (SCS) has been shown to be effective in the treatment of chronic CRPS refractory to conventional treatment modalities. The collective evidence of novel parameters of SCS for treating CRPS has not been characterized extensively. OBJECTIVE To provide evidence for the use of SCS to treat CRPS and characterize the additional benefits of various SCS waveforms. STUDY DESIGN Systematic Review and Meta-analysis. METHODS PubMed, Embase and CINHLA were screened for all randomized controlled trials (RCT) comparing SCS parameters for the treatment of CRPS. RESULTS Four RCTs were identified that included SCS as a treatment arm for CRPS. Of these, one study compared low frequency tonic SCS (LF-SCS) versus conventional physical therapy, 2 studies compared placebo/sham SCS with LF-SCS and a multitude of waveforms, and one study compared LF-SCS with high-frequency SCS (HF-SCS). Two of the studies were rated as having a low risk of bias, one study was rated as having some concerns for bias, while the final study was rated as having a high risk of bias. A meta-analysis of 4 studies comparing conventional therapy/placebo SCS stimulation against LF-SCS revealed increased benefit of LF-SCS in pain reduction up to a month (mean difference [MD] = -1.17 points; 95% CI = -1.61 to -0.73; P < 0.001, I2 = 42%). Another meta-analysis of 2 studies showed that LF-SCS results in higher global perceived effect scores relative to conventional therapy/placebo SCS stimulation (MD = 1.58; 95% CI = 1.00 to 2.15; P < 0.001, I2 = 0%). LIMITATIONS A pooled analysis using different designs for RCTs was conducted. Some studies folded in multiple neuropathic pain pathologies in addition to CRPS. One study was at a high risk for bias in at least one domain. CONCLUSION LF-SCS is superior to conventional therapy/placebo SCS stimulation. However, more evidence is required to demonstrate that novel SCS parameters are superior to LF-SCS in improving pain scores and functional outcomes.
Collapse
Affiliation(s)
- Elver Ho
- Department of Physical Medicine and Rehabilitation, SUNY Downstate Health Sciences University, Brooklyn, NY
| | - Nima Yazdanpanah
- Department of Physical Medicine and Rehabilitation, SUNY Downstate Health Sciences University, Brooklyn, NY
| | - Johnson Ho
- Department of Physical Medicine and Rehabilitation, SUNY Downstate Health Sciences University, Brooklyn, NY
| | - Benjamin Drukman
- Department of Physical Medicine and Rehabilitation, SUNY Downstate Health Sciences University, Brooklyn, NY
| | - Alvin Chang
- Department of Physical Medicine and Rehabilitation, SUNY Downstate Health Sciences University, Brooklyn, NY
| | - Sanjeev Agarwal
- Department of Physical Medicine and Rehabilitation, SUNY Downstate Health Sciences University, Brooklyn, NY
| |
Collapse
|
33
|
Pallotta ML, Lovi A, Luca A, Babbi L, Brayda-Bruno M. Spinal cord stimulator medullary compression-a very rare SCS complication and surgical treatment. Spinal Cord Ser Cases 2022; 8:84. [PMID: 36241621 PMCID: PMC9568500 DOI: 10.1038/s41394-022-00550-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 08/06/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION The risk of spinal cord damage after Spinal Cord Stimulator (SCS) implant is a very rare event. In our case report, the patient was affected by a progressively worsening spinal stenosis due to SCS compression. CASE REPORT The authors describe a progressive paraparesis in a 58-year-old woman with a long history of back pain and multiple spine surgeries. Computed tomography (CT) outlined vertebral canal stenosis corresponding to an electrode array implanted in T9. A posterior T8-T10 spinal cord decompression with explanation of the SCS device was performed and a partial neurological improvement was observed immediately postoperative. DISCUSSION Spinal cord stimulation has been used since 1967 for the treatment of refractory chronic pain, particularly failed back surgery syndrome (FBSS) and complex regional pain syndrome (CRPS). Still, the mechanism underlying its function is not completely clear. Moreover, complications are mainly related to implant dysfunction and the risk of direct and indirect spinal cord compression is described as exceptional in the literature. Our aim is to describe the case SCS device spinal cord direct compression and its surgical treatment.
Collapse
Affiliation(s)
- Maria Ludovica Pallotta
- Spine Surgery in IRCCS Galeazzi Hospital, Orthopedics and Traumatology Residency in Università degli Studi Di Milano, Milan, Italy.
| | - Alessio Lovi
- Spine Surgery in IRCCS Galeazzi Hospital, Milan, Italy
| | - Andrea Luca
- Spine Surgery in IRCCS Galeazzi Hospital, Milan, Italy
| | - Lisa Babbi
- Spine Surgery in IRCCS Galeazzi Hospital, Milan, Italy
| | | |
Collapse
|
34
|
Affiliation(s)
- Nicola Zink
- Springer Medizin Verlag GmbH, Aschauer Str. 30, 81549, München, Germany
| |
Collapse
|
35
|
Aloweidi AS, Halaweh SAA, Al-Mustafa MM, Massad IM, Qudaisat IY, Khanfar AM, Ajlouni JM, Alhadidi ST, El-Share AI, Jarbeh MA, Al-Oweidi AA. Combining Stellate ganglion block and intravenous regional anesthesia to treat complex regional pain syndrome: A 19-years' experience in a tertiary center. Saudi Med J 2022; 43:1168-1172. [PMID: 36261198 PMCID: PMC9994496 DOI: 10.15537/smj.2022.43.10.20220318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/07/2022] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVES To study reduction in pain score after treatment with intravenous regional anesthesia (IVRA) and Stellate ganglion block (SGB) combination on complex regional pain syndrome (CPRS) patients and to quantify patients' satisfaction with treatment and occurrence of complications. METHODS This is a record-based retrospective review carried out in 2020, targeting patients treated in the University of Jordan Hospital, Amman, Jordan, over the years 2002-2020. RESULTS Among 99 patients, a significant drop in pain scores occurred in 88% of the patients' sample. Gender, age, type of CRPS, and duration of symptoms didn't affect statistical results. An average of 8.6 sessions needed to achieve 50% drop in pain score, and 2-3 sessions for first clinical improvement. Patients with previous application of plaster of Paris had increased success rates. CONCLUSION We find it practical, inexpensive, safe, and straightforward to combine SGB with IVRA for CRPS patients.
Collapse
Affiliation(s)
- Abdelkarim S. Aloweidi
- From the Department of Anesthesia and Intensive Care (Aloweidi, Abu Halaweh, Al-Mustafa, Massad, Qudaisat, El-Share, Jarbeh); from the Department of Orthopedics (Khanfar, Ajlouni Alhadidi), School of Medicine; and from the Department of Internal Medicine (Al-Oweidi), Faculty of Medicine, University of Jordan, Amman, Jordan.
| | - Sami A. Abu Halaweh
- From the Department of Anesthesia and Intensive Care (Aloweidi, Abu Halaweh, Al-Mustafa, Massad, Qudaisat, El-Share, Jarbeh); from the Department of Orthopedics (Khanfar, Ajlouni Alhadidi), School of Medicine; and from the Department of Internal Medicine (Al-Oweidi), Faculty of Medicine, University of Jordan, Amman, Jordan.
| | - Mahmoud M. Al-Mustafa
- From the Department of Anesthesia and Intensive Care (Aloweidi, Abu Halaweh, Al-Mustafa, Massad, Qudaisat, El-Share, Jarbeh); from the Department of Orthopedics (Khanfar, Ajlouni Alhadidi), School of Medicine; and from the Department of Internal Medicine (Al-Oweidi), Faculty of Medicine, University of Jordan, Amman, Jordan.
| | - Islam M. Massad
- From the Department of Anesthesia and Intensive Care (Aloweidi, Abu Halaweh, Al-Mustafa, Massad, Qudaisat, El-Share, Jarbeh); from the Department of Orthopedics (Khanfar, Ajlouni Alhadidi), School of Medicine; and from the Department of Internal Medicine (Al-Oweidi), Faculty of Medicine, University of Jordan, Amman, Jordan.
| | - Ibraheem Y. Qudaisat
- From the Department of Anesthesia and Intensive Care (Aloweidi, Abu Halaweh, Al-Mustafa, Massad, Qudaisat, El-Share, Jarbeh); from the Department of Orthopedics (Khanfar, Ajlouni Alhadidi), School of Medicine; and from the Department of Internal Medicine (Al-Oweidi), Faculty of Medicine, University of Jordan, Amman, Jordan.
| | - Aws M. Khanfar
- From the Department of Anesthesia and Intensive Care (Aloweidi, Abu Halaweh, Al-Mustafa, Massad, Qudaisat, El-Share, Jarbeh); from the Department of Orthopedics (Khanfar, Ajlouni Alhadidi), School of Medicine; and from the Department of Internal Medicine (Al-Oweidi), Faculty of Medicine, University of Jordan, Amman, Jordan.
| | - Jihad M. Ajlouni
- From the Department of Anesthesia and Intensive Care (Aloweidi, Abu Halaweh, Al-Mustafa, Massad, Qudaisat, El-Share, Jarbeh); from the Department of Orthopedics (Khanfar, Ajlouni Alhadidi), School of Medicine; and from the Department of Internal Medicine (Al-Oweidi), Faculty of Medicine, University of Jordan, Amman, Jordan.
| | - Shaher T. Alhadidi
- From the Department of Anesthesia and Intensive Care (Aloweidi, Abu Halaweh, Al-Mustafa, Massad, Qudaisat, El-Share, Jarbeh); from the Department of Orthopedics (Khanfar, Ajlouni Alhadidi), School of Medicine; and from the Department of Internal Medicine (Al-Oweidi), Faculty of Medicine, University of Jordan, Amman, Jordan.
| | - Ahmad I. El-Share
- From the Department of Anesthesia and Intensive Care (Aloweidi, Abu Halaweh, Al-Mustafa, Massad, Qudaisat, El-Share, Jarbeh); from the Department of Orthopedics (Khanfar, Ajlouni Alhadidi), School of Medicine; and from the Department of Internal Medicine (Al-Oweidi), Faculty of Medicine, University of Jordan, Amman, Jordan.
| | - Mohammad A. Jarbeh
- From the Department of Anesthesia and Intensive Care (Aloweidi, Abu Halaweh, Al-Mustafa, Massad, Qudaisat, El-Share, Jarbeh); from the Department of Orthopedics (Khanfar, Ajlouni Alhadidi), School of Medicine; and from the Department of Internal Medicine (Al-Oweidi), Faculty of Medicine, University of Jordan, Amman, Jordan.
| | - Anas A. Al-Oweidi
- From the Department of Anesthesia and Intensive Care (Aloweidi, Abu Halaweh, Al-Mustafa, Massad, Qudaisat, El-Share, Jarbeh); from the Department of Orthopedics (Khanfar, Ajlouni Alhadidi), School of Medicine; and from the Department of Internal Medicine (Al-Oweidi), Faculty of Medicine, University of Jordan, Amman, Jordan.
| |
Collapse
|
36
|
Rosales R, Amirianfar E, Appeadu M, Gater D, Price C. Spinal cord stimulation for neuropathic pain following traumatic spinal cord injury: a case report. Spinal Cord Ser Cases 2022; 8:80. [PMID: 36109507 PMCID: PMC9478097 DOI: 10.1038/s41394-022-00546-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 08/23/2022] [Accepted: 08/26/2022] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Neuropathic pain is a common complication of spinal cord injury (SCI), and is notoriously difficult to adequately treat. Gunshot wounds (GSW) near the spinal cord may cause intractable chronic pain through spinal/nerve root transection, or reactive tissue formation resulting in nerve root compression from retained bullet fragments (RBF). CASE PRESENTATION This case report describes a 30-year-old man with a T12 AIS B incomplete spinal cord injury with paraplegia secondary to multiple GSW who presented with severe bilateral lower extremity dysesthesias and muscle spasms. Symptoms failed to improve with oral antispasmodic medications. After being diagnosed with Complex regional pain syndrome (CRPS) type I secondary to an SCI via GSW, he underwent a spinal cord stimulator (SCS) trial, which improved his symptoms by greater than 80%. DISCUSSION Neuropathic pain refractory to conservative treatment may benefit from SCS. Effects of therapy go beyond gate-theory in SCI patients, and may benefit patients at the cellular and molecular level. Our case demonstrates the effectiveness of SCS treatment in a patient who developed CRPS type 1 after GSW resulting in SCI.
Collapse
Affiliation(s)
- Richard Rosales
- Department of Physical Medicine and Rehabilitation at University of Miami/Jackson Memorial Hospital, Miami, FL, USA.
| | - Edwin Amirianfar
- Department of Physical Medicine and Rehabilitation at University of Miami/Jackson Memorial Hospital, Miami, FL, USA
| | - Michael Appeadu
- Department of Physical Medicine and Rehabilitation at University of Miami/Jackson Memorial Hospital, Miami, FL, USA
| | - David Gater
- Department of Physical Medicine and Rehabilitation at University of Miami/Jackson Memorial Hospital, Miami, FL, USA
| | - Chane Price
- Department of Physical Medicine and Rehabilitation at University of Miami/Jackson Memorial Hospital, Miami, FL, USA
| |
Collapse
|
37
|
Rochlin DH, Sheckter CC, Satteson ES, Swan CC, Fox PM, Curtin C. Separating Fact From Fiction: A Nationwide Longitudinal Examination of Complex Regional Pain Syndrome Following Treatment of Dupuytren Contracture. Hand (N Y) 2022; 17:825-832. [PMID: 33081519 PMCID: PMC9465785 DOI: 10.1177/1558944720963915] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND One of the most feared complications following treatment of Dupuytren contracture is complex regional pain syndrome (CRPS). This study aims to provide a national perspective on the incidence of CRPS following treatment of Dupuytren contracture and identify patient factors to target for risk reduction. METHODS Using the Truven MarketScan databases from 2007 to 2016, individuals aged ≥18 years who developed CRPS within 1 year of treatment of Dupuytren contracture were identified using the International Classification of Disease diagnosis code for CRPS. Predictor variables included: age, sex, employment status, region, type of procedure, and concurrent carpal tunnel surgery. Multivariable logistic regression was used to analyze outcomes. RESULTS In all, 48 327 patients received treatment for Dupuytren contracture, including collagenase injection (13.6%); percutaneous palmar fasciotomy (10.3%); open palmar fasciotomy (3.9%); palmar fasciectomy with 0 (10.8%), 1 (29.2%), or multiple (19.6%) digit releases; or a combination of these procedures (12.8%). One hundred forty-five patients (0.31%) were diagnosed with CRPS at a mean of 3.4 months (standard deviation, 2.3) following treatment. Significant predictors of CRPS included female sex (odds ratio [OR], 2.02; P < .001), Southern region (OR, 1.80; P = .022), long-term disability status (OR, 4.73; P = .035), palmar fasciectomy with release of 1 (OR, 5.91; P = .003) or >1 digit (OR, 13.32; P < .001), or multiple concurrent procedures for Dupuytren contracture (OR, 8.23; P = .001). CONCLUSIONS Based on national commercial claims data, there is a lower incidence of CRPS following treatment of Dupuytren contracture than previously reported. Risk factors identified should help with preoperative counseling and assist clinicians in targeting risk reduction measures.
Collapse
Affiliation(s)
| | | | | | | | - Paige M. Fox
- Stanford University, Palo Alto, CA,
USA
- VA Palo Alto Health Care System, CA,
USA
| | - Catherine Curtin
- Stanford University, Palo Alto, CA,
USA
- VA Palo Alto Health Care System, CA,
USA
| |
Collapse
|
38
|
Pirri C, Stecco A, Stecco C, Özçakar L. Ultrasound imaging and Fascial Manipulation® for rigid retinacula in two cases of complex regional pain syndrome. Med Ultrason 2022; 24:372-374. [PMID: 34379713 DOI: 10.11152/mu-3182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Complex regional Pain Syndrome (CRPS) is a complex disease with articulate impact on the quality of life and its management is challenging. Ultrasound imaging can identify/assess different musculoskeletal structures that might have role in its pathogenesis. We present two cases of CRSP in whom B-mode ultrasonography and sonoelastography showed rigid retinacula associated with the symptomatology. Both patients were also/successfully treated with Fascial Manipulation®.
Collapse
Affiliation(s)
- Carmelo Pirri
- University of Padova, Department of Neurosciences, Institute of Human Anatomy, Padova, Italy.
| | - Antonio Stecco
- RUSK Rehabilitation, New York University School of Medicine, New York City, New York;.
| | - Carla Stecco
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padova;.
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.
| |
Collapse
|
39
|
Kunwald M, Gulisan HA, Bjarkam CR. Spinal cord stimulation in complex regional pain syndrome type 2. Dan Med J 2022; 69:A06210521. [PMID: 35781126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Spinal cord stimulation (SCS) may be used to treat complex regional pain syndrome (CRPS) when other treatments fail. This study aimed to describe the effects of SCS for CRPS with known nerve injury, i.e. CRPS type 2 (CRPS-2), on pain reduction and opioid use. METHODS Data from the outpatient clinic were retrieved from the Neurizon Neuromodulation Database. The patient records of 16 patients treated with SCS at Aalborg University Hospital, Denmark, who met the Budapest (2003) criteria for CRPS-2 and completed six- and 12+-month follow-up were included. In Excel, paired t-tests comparison was used to identify the effect of SCS in regard to the aspects mentioned above. RESULTS Eight of the 16 patients (50%) enrolled in this study had clinically significant pain reduction when treated with SCS. The average pain reduction for the whole cohort was more than 20%, going from average numerical rating scale 8.0 to 6.2 (p = 0.0006) and 6.0 (p = 0.0011) at the six-month and 12+-month follow-up, respectively. The use of opiods did not change significantly. Seven patients needed revision procedures and the system was explanted in one patient. CONCLUSION SCS may offer clinically relevant pain reduction in CRPS-2. However, in our cohort only half of the patients experienced a clinically significant response, and the costs and complications associated with SCS were considerable. Thus, further knowledge on patient selection and the SCS treatment mechanisms are warranted. FUNDING none. TRIAL REGISTRATION not relevant.
Collapse
Affiliation(s)
- Mikkel Kunwald
- Department of Neurosurgery, Aalborg University Hospital, Denmark
| | | | | |
Collapse
|
40
|
Johnston-Devin C, Oprescu F, Wallis M, Gray M. Educational considerations for health professionals to effectively work with clients with complex regional pain syndrome. PLoS One 2022; 17:e0269337. [PMID: 35696357 PMCID: PMC9191715 DOI: 10.1371/journal.pone.0269337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 05/18/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction
People living with complex regional pain syndrome (CRPS), a rare chronic pain disorder, must become experts in their own self-management. Listening to the voice of the patient is often advocated in the pain literature. However, the patient’s option is rarely asked for or considered by clinicians, even when they live with a condition that health professionals have rarely heard of.
Purpose
To explore what people living with complex regional pain syndrome (CRPS) think health professionals should know about their condition to provide appropriate care.
Design
A heuristic, hermeneutic phenomenological study was conducted asking people about their experiences living with CRPS. This paper reports on the findings of an additional question asked of all participants.
Participants
Seventeen people living with complex regional pain syndrome were interviewed.
Findings
Overwhelmingly, participants felt that health professionals do not know enough about CRPS, or chronic pain and believe their health outcomes are affected by this lack of knowledge. Sub-themes identified were don’t touch unless I say it is okay; be patient with the patient/ it is important to develop a relationship; educate yourself and educate the patient; choose your words carefully and refer to others as needed. An additional theme, it is very hard to describe CRPS was also identified.
Conclusions
Including patients as a member of the healthcare team is recommended to help people take control and self-manage their pain. For true patient centered care to be achieved, health professionals must accept and respect patients’ descriptions of pain and their pain experience. This may require additional health professional education at both undergraduate and post-graduate levels in pain and communication to increase their bedside manner and therapeutic communication to deliver care in partnership with the patient.
Collapse
Affiliation(s)
- Colleen Johnston-Devin
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Brisbane, Queensland, Australia
- * E-mail:
| | - Florin Oprescu
- School of Health and Sport Science, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Marianne Wallis
- Faculty of Health, Southern Cross University, Bilinga, Queensland, Australia
| | - Marion Gray
- School of Health and Wellbeing, University of Southern Queensland, Ipswich, Queensland, Australia
| |
Collapse
|
41
|
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.
Collapse
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
| |
Collapse
|
42
|
Kaplan GO, Menkü Özdemir FD, Gököz Ö, Aksu AE. First case report of Pacinian corpuscle hyperplasia following complex regional pain syndrome. Jt Dis Relat Surg 2022; 33:249-252. [PMID: 35361103 PMCID: PMC9057539 DOI: 10.52312/jdrs.2022.512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/22/2022] [Indexed: 11/14/2022] Open
Abstract
Pacinian disorders are exceedingly rare, and the exact pathogenesis is still unknown. The most common symptoms are pain, sensory changes, and a visible or palpable mass, and diagnosis is usually made by pathological examination after the excision of the painful nodule. In this case report, we present the case of a 49-year-old male with Pacinian corpuscle hyperplasia located on the metacarpophalangeal joint, emerging at the same hand of the patient two years after the treatment due to complex regional pain syndrome (CRPS). To the best of our knowledge, this is the first case report revealing the association of CRPS with hyperplasia of Pacinian corpuscles.
Collapse
Affiliation(s)
| | - Fethiye Damla Menkü Özdemir
- Karabük Eğitim ve Araştırma Hastanesi Plastik, Rekonstrüktif ve Estetik Cerrahi Kliniği, 78200 Karabük, Türkiye.
| | | | | |
Collapse
|
43
|
Abstract
BACKGROUND Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment. One of the most devastating complications is complex regional pain syndrome. OBJECTIVITIES The aim of this study was to systematically analyze available evidence about complex regional pain syndrome after carpal tunnel syndrome surgery (CTSS), its risks, associated factors, and treatments. MATERIAL AND METHODS Research conducted from 1962 through December 31, 2018, in the following databases: PubMed, Web of Science, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials. The quality assessment of the methodology followed the definitions by the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence. The GRADE system (Grades of Recommendation, Assessment, Development, and Evaluation) was applied to evaluate the efficacy of the stellate ganglion block, one of the most cited and recurrent treatments. RESULTS Of the 246 studies retrieved, 44 articles were included. Concerning patients' gender, we identified a ratio of 5 females: 3 males. The mean age for women was 57.79, a standard deviation of 14.96, and for men 60.75, a standard deviation of 9.4. Considering the total of primary publications of CTSS outcomes, the accumulated incidence reached the maximum of 0.15 CRPS after CTSS patients/CTSS patients. The known risk factors for CRPS after CTSS: female gender, from the fifth decade of life, tourniquet time, immobilization and surgery on dominant hand. CONCLUSION CRPS affects 2-5% of people undergoing CTSS. Its diagnosis is still a challenge and its risk factors are unclear, although it seems more likely to affect women, in the dominant hand. The most used treatments include physiotherapy and stellate ganglion block. Most patients show improvement of symptoms within one year. Further clinical trials comparing treatment modalities are required.
Collapse
Affiliation(s)
- Luis Henrique A Sousa
- Division of Neurosurgery, Cajuru University Hospital, Curitiba, Brazil Cajuru University Hospital, Curitiba, Brazil
| | - Caroline de O Costa
- Division of Hand Surgery, Cajuru University Hospital, Curitiba, Brazil Cajuru University Hospital, Curitiba, Brazil
| | - Eduardo M Novak
- Division of Hand Surgery, Cajuru University Hospital, Curitiba, Brazil Cajuru University Hospital, Curitiba, Brazil
| | - Giana S Giostri
- Division of Hand Surgery, Cajuru University Hospital, Curitiba, Brazil Cajuru University Hospital, Curitiba, Brazil
| |
Collapse
|
44
|
Abstract
There have been some modest recent advancements in the research of Complex Regional Pain Syndrome, yet the amount and quality of the work in this complicated multifactorial disease remains low (with some notable exceptions; e.g., the recent work on the dorsal root ganglion stimulation). The semi-systematic (though in some cases narrative) approach to review is necessary so that we might treat our patients while waiting for “better research.” This semi-systematic review was conducted by experts in the field, (deliberately) some of whom are promising young researchers supplemented by the experience of “elder statesman” researchers, who all mention the system they have used to examine the literature. What we found is generally low- to medium-quality research with small numbers of subjects; however, there are some recent exceptions to this. The primary reason for this paucity of research is the fact that this is a rare disease, and it is very difficult to acquire a sufficient sample size for statistical significance using traditional statistical approaches. Several larger trials have failed, probably due to using the broad general diagnostic criteria (the “Budapest” criteria) in a multifactorial/multi-mechanism disease. Responsive subsets can often be identified in these larger trials, but not sufficient to achieve statistically significant results in the general diagnostic grouping. This being the case the authors have necessarily included data from less compelling protocols, including trials such as case series and even in some instances case reports/empirical information. In the humanitarian spirit of treating our often desperate patients with this rare syndrome, without great evidence, we must take what data we can find (as in this work) and tailor a treatment regime for each patient.
Collapse
Affiliation(s)
| | - Candida S McCabe
- University of the West of England, Stapleton, Bristol, UK
- Dorothy House Hospice, Bradford-on-Avon, Wilts, UK
| | - Andreas Goebel
- Pain Research Institute, Faculty of Health and Life Science, University of Liverpool, Liverpool, UK
| | - Michael Massey
- CentraCare Neurosciences Pain Center, CentraCare, St. Cloud, Minnesota, USA
| | - Tolga Suvar
- Department of Anesthesiology and Pain Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Sharon Grieve
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Centers, Nashville, Tennessee, USA
| |
Collapse
|
45
|
D'Souza RS, Kubrova E, Her YF, Barman RA, Smith BJ, Alvarez GM, West TE, Abd-Elsayed A. Dorsal Root Ganglion Stimulation for Lower Extremity Neuropathic Pain Syndromes: An Evidence-Based Literature Review. Adv Ther 2022; 39:4440-4473. [PMID: 35994195 PMCID: PMC9464732 DOI: 10.1007/s12325-022-02244-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 06/23/2022] [Indexed: 01/30/2023]
Abstract
Dorsal root ganglion stimulation (DRG-S) is a form of selective neuromodulation therapy that targets the dorsal root ganglion. DRG-S offers analgesia in a variety of chronic pain conditions and is approved for treatment of complex regional pain syndrome (CRPS) by the US Food and Drug Administration (FDA). There has been increasing utilization of DRG-S to treat various neuropathic pain syndromes of the lower extremity, although evidence remains limited to one randomized controlled trial and 39 observational studies. In this review, we appraised the current evidence for DRG-S in the treatment of lower extremity neuropathic pain using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) criteria. The primary outcome was change in pain intensity after DRG-S compared to baseline. We stratified presentation of results based of type of neuropathy (CRPS, painful diabetic neuropathy, mononeuropathy, polyneuropathy) as well as location of neuropathy (hip, knee, foot). Future powered randomized controlled trials with homogeneous participants are warranted.
Collapse
Affiliation(s)
- Ryan S D'Souza
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Eva Kubrova
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Yeng F Her
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ross A Barman
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Brandon J Smith
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Gabriel M Alvarez
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Tyler E West
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA.
| |
Collapse
|
46
|
Abstract
The treatment of patients with complex regional pain syndrome (CRPS) takes place in an interdisciplinary and multimodal setting. Physical therapies represent a major treatment focus along with physiotherapy, occupational therapy, and analgetic treatments. This review explains their importance in current clinical practice and gives an impression of the evidence on different treatments including electrotherapy, neuromodulating procedures, manual lymphatic drainage, CO2 applications and paraffin wax baths. As far as ascertainable from clinical experience and the scientific literature, treatment recommendations are presented in accordance with current guidelines.
Collapse
Affiliation(s)
- Eduard Kraft
- Muskuloskelettales Universitätszentrum München, LMU Klinikum, München, Deutschland.
- Interdisziplinäre Schmerzambulanz, Campus Großhadern, LMU Klinikum, München, Deutschland.
| | - Claudia Storz
- Muskuloskelettales Universitätszentrum München, LMU Klinikum, München, Deutschland
| | - Alexander Ranker
- Muskuloskelettales Universitätszentrum München, LMU Klinikum, München, Deutschland
- Klinik für Rehabilitationsmedizin, MHH Hannover, Hannover, Deutschland
| |
Collapse
|
47
|
Wallace C, Coulter JL, Sebes N, Seeley M. Novel Presentation of Pediatric Complex Regional Pain Syndrome with Concurrent Chromhidrosis: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00078. [PMID: 35102013 DOI: 10.2106/jbjs.cc.21.00194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
CASE An 11-year-old female patient presented to our clinic with a low-grade lateral ankle sprain that was subsequently treated with a lace-up ankle brace. On the reintroduction of weight bearing, the patient developed recurrent ankle pain and symptoms consistent with complex regional pain syndrome (CRPS) Type 1. On physical examination, the patient was found to have a concurrent chromhidrosis in the injured area, which is a novel presentation of CRPS. CONCLUSION Patients with CRPS found to have superficial skin discoloration should be evaluated further to investigate for chromhidrosis. Early diagnosis can improve the treatment of CRPS and allow for appropriate management of varying manifestations, such as chromhidrosis.
Collapse
Affiliation(s)
- Calum Wallace
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania
| | - John L Coulter
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania
| | - Nick Sebes
- Department of Dermatology, Geisinger Medical Center, Danville, Pennsylvania
| | - Mark Seeley
- Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, Pennsylvania
| |
Collapse
|
48
|
Abstract
ABSTRACT Complex regional pain syndrome remains a debated syndrome characterized by symptoms and signs, including pain, sensory disturbances, thermal asymmetry, edema, and motor impairments. Thermography is a tool that assesses skin surface temperature distribution. Current literature focuses on the role of thermography for diagnostic purposes; however, its role in monitoring the response to treatment in complex regional pain syndrome is unclear. We present a case series of four patients with complex regional pain syndrome where a FLIR ONE thermal imaging camera (FLIR Systems, Inc, Wilsonville, OR) was used to assist in the diagnosis of complex regional pain syndrome, capture the effects of diagnostic nerve blocks to evaluate a peripheral nerve contribution to complex regional pain syndrome, as well as monitor and assess treatment efficacy with prednisone and surgery. Four patients were screened by clinical assessment to meet the Budapest Criteria. The thermal images revealed improvement in the temperature distribution after therapeutic intervention. We also noted temporary but immediate changes on thermal imaging with diagnostic nerve blocks. Our cases suggest that the FLIR ONE thermal imaging camera has the potential to be an accessible monitoring tool to assist in diagnosis and assess treatment efficacy in complex regional pain syndrome over time.
Collapse
Affiliation(s)
- Saroop Dhatt
- From the University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada (SD); Division of Plastic Surgery, University of British Columbia, Victoria, British Columbia, Canada (EMK); and Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Victoria, British Columbia, Canada (PW)
| | | | | |
Collapse
|
49
|
Halicka M, Vittersø AD, McCullough H, Goebel A, Heelas L, Proulx MJ, Bultitude JH. Prism adaptation treatment for upper-limb complex regional pain syndrome: a double-blind randomized controlled trial. Pain 2021; 162:471-489. [PMID: 32833791 PMCID: PMC7808368 DOI: 10.1097/j.pain.0000000000002053] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 07/14/2020] [Accepted: 08/03/2020] [Indexed: 12/17/2022]
Abstract
ABSTRACT Initial evidence suggested that people with complex regional pain syndrome (CRPS) have reduced attention to the affected side of their body and the surrounding space, which might be related to pain and other clinical symptoms. Three previous unblinded, uncontrolled studies showed pain relief after treatment with prism adaptation, an intervention that has been used to counter lateralised attention bias in brain-lesioned patients. To provide a robust test of its effectiveness for CRPS, we conducted a double-blind randomized controlled trial of prism adaptation for unilateral upper-limb CRPS-I. Forty-nine eligible adults with CRPS were randomized to undergo 2 weeks of twice-daily home-based prism adaptation treatment (n = 23) or sham treatment (n = 26). Outcomes were assessed in person 4 weeks before and immediately before treatment, and immediately after and 4 weeks after treatment. Long-term postal follow-ups were conducted 3 and 6 months after treatment. We examined the effects of prism adaptation vs sham treatment on current pain intensity and the CRPS symptom severity score (primary outcomes), as well as sensory, motor, and autonomic functions, self-reported psychological functioning, and experimentally tested neuropsychological functions (secondary outcomes). We found no evidence that primary or secondary outcomes differed between the prism adaptation and sham treatment groups when tested at either time point after treatment. Overall, CRPS severity significantly decreased over time for both groups, but we found no benefits of prism adaptation beyond sham treatment. Our findings do not support the efficacy of prism adaptation treatment for relieving upper-limb CRPS-I. This trial was prospectively registered (ISRCTN46828292).
Collapse
Affiliation(s)
- Monika Halicka
- Centre for Pain Research, University of Bath, Bath, United Kingdom
- Department of Psychology, University of Bath, Bath, United Kingdom
| | - Axel D. Vittersø
- Centre for Pain Research, University of Bath, Bath, United Kingdom
- Department of Psychology, University of Bath, Bath, United Kingdom
- Department of Sport and Health Sciences, University of Exeter, Exeter, United Kingdom
| | - Hayley McCullough
- Department of Translational Medicine, Pain Research Institute, University of Liverpool, Liverpool, United Kingdom
| | - Andreas Goebel
- Department of Translational Medicine, Pain Research Institute, University of Liverpool, Liverpool, United Kingdom
- Department of Pain Medicine, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Leila Heelas
- Optimise Pain Rehabilitation Unit, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Michael J. Proulx
- Department of Psychology, University of Bath, Bath, United Kingdom
- Department of Computer Science, Centre for Real & Virtual Environments Augmentation Labs, University of Bath, Bath, United Kingdom
| | - Janet H. Bultitude
- Centre for Pain Research, University of Bath, Bath, United Kingdom
- Department of Psychology, University of Bath, Bath, United Kingdom
| |
Collapse
|
50
|
Canós-Verdecho A, Abejón D, Robledo R, Izquierdo R, Bermejo A, Gallach E, Argente P, Peraita-Costa I, Morales-Suárez-Varela M. Randomized Prospective Study in Patients With Complex Regional Pain Syndrome of the Upper Limb With High-Frequency Spinal Cord Stimulation (10-kHz) and Low-Frequency Spinal Cord Stimulation. Neuromodulation 2021; 24:448-458. [PMID: 33462918 DOI: 10.1111/ner.13358] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The objective of this prospective randomized study of cases and controls was to evaluate the efficacy of treatment with low-frequency spinal cord stimulation (LF-SCS) and 10 kHz spinal cord stimulation (10-kHz SCS) in patients diagnosed with complex regional pain syndrome type I (CRPS) with upper limb involvement. MATERIALS AND METHODS Fifty patients were randomized to receive conventional treatment or SCS with a commercially available low-frequency or 10-kHz system. Patients were assessed at 1, 3, 6, and 12 months. The primary endpoint was at 12-months post permanent implantation of the SCS devices. Outcome measures assessed included: Numerical Rating Scale (NRS), 12-Item Short-Format Health Survey (SF-12), Oswestry Disability Index (ODI), Study Sleep Scale medical outcomes (MOS-SS), Douleur Neuropathique 4 questions pain questionnaire (DN4), Patient Global Impression Scale on the impact of treatment improvement (PGI-I), Clinician Global Impression Scale on the impact of improving the patient (CGI-I). RESULTS Forty-one patients were finally included in the analysis, 19 patients in the conventional treatment group, 12 in the LF-SCS group, and 10 in the 10-kHz SCS group. At the primary endpoint, patients treated with LF-SCS presented improvements in the NRS and DN4 outcomes around 2.4 and 1.5 times above the minimal clinically important difference (MCID) thresholds. At the primary endpoint, patients treated with 10-kHz SCS presented improvements in the NRS and DN4 outcomes around 2 and 1.4 times above the MCID thresholds. CONCLUSIONS Patients experienced considerable improvement after SCS. The results show that LF-SCS has very good results when compared with conventional treatment. The results obtained with 10-kHz SCS are encouraging, with the advantages of the absence of paresthesia making it an alternative in the treatment of CRPS.
Collapse
Affiliation(s)
- Angeles Canós-Verdecho
- Multidisciplinary Pain Management Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Anaesthesiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - David Abejón
- Multidisciplinary Pain Management Unit, Hospital Universitario Quirónsalud, Madrid, Spain
| | - Ruth Robledo
- Multidisciplinary Pain Management Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Anaesthesiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Rosa Izquierdo
- Multidisciplinary Pain Management Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Anaesthesiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Ara Bermejo
- Multidisciplinary Pain Management Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Elisa Gallach
- Multidisciplinary Pain Management Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Psychiatry Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Pilar Argente
- Anaesthesiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Surgical Specialities Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Isabel Peraita-Costa
- Unit of Preventive Medicine and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, Universitat de València, Valencia, Spain
- CIBER Epidemiology and Public Health (CIBERESP). The Institute of Health Carlos III (ISCIII), Madrid, Spain
| | - María Morales-Suárez-Varela
- Unit of Preventive Medicine and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, Universitat de València, Valencia, Spain
- CIBER Epidemiology and Public Health (CIBERESP). The Institute of Health Carlos III (ISCIII), Madrid, Spain
| |
Collapse
|