What Is Complex Regional Pain Syndrome?

Complex local pain syndrome (CRPS) refers to a clinical syndrome that is characterized by severe refractory, polypathic pain, malnutrition, and dysfunction secondary to accidental injury, iatrogenic injury, or systemic disease.

Complex local pain syndrome

This entry lacks an overview map . Supplementing related content makes the entry more complete and can be upgraded quickly. Come on!

Complex local pain syndrome (CRPS) refers to a clinical syndrome that is characterized by severe refractory, polypathic pain, malnutrition, and dysfunction secondary to accidental injury, iatrogenic injury, or systemic disease.

Chinese name

Complex local pain syndrome

Foreign name

CRPS

Features

Severe refractory, polymorphic pain

Object

Mostly female

The incidence of complex local pain syndrome (CRPS) in the normal population is extremely small; patients with complex local pain syndrome (CRPS) after trauma have different reports, generally ranging from 4% to 8%. Burn injury (CRPS type II) is more likely to occur after nerve injury than other tissue injuries (CRPS type II), with an incidence rate of 1% to 15%, depending on the degree of nerve injury; observations have shown that 20% of patients with nerve injury experience transient burning symptoms After 12 days, 2% of the symptoms persisted; there were also reports of brachial plexus, median, ulnar, sciatic, and tibial nerve injuries, and 8.2% of patients had persistent type 2 symptoms.

In terms of distribution, adults tend to have upper limbs, and 2/3 of type II lesions are located in the upper limbs; children are less likely to develop complex local pain syndrome (CRPS); they are mostly between the ages of 40 and 60 years; It is generally believed that the majority of women are related to their mental state.

Complex local pain syndrome (CRPS) includes two types of typical sympathetic pain disorders, namely reflex sympathetic atrophy and burning neuralgia, namely CRPS type I and CRPS type II.

Type I is a symptom group that is consistent with the traditional description of RSD symptoms, that is, abnormal neuroregulation (vasomotor contraction and sweating dysfunction), hypersensitivity or insensitivity, and poor tissue nutrition.

Type is especially burning pain. This type is specifically sympathetic persistent pain (SMP) and should be distinguished from sympathetic independent persistent pain, that is, independent pain (SIP). Because the latter is the pain of the nerve injury itself, it does not fall into the category of complex local pain syndrome (CRPS).

1. Pain: Most patients are induced by mechanical, warm, mental, and emotional stimuli. Such pain includes neurogenic pain such as spontaneous pain, hyperalgesia, and hyperalgesia. In some cases, 3 to 6 months or more after the injury, they can still show refractory pain and spread to the surroundings.

2. Nutritional Disorders: At the injury site and surrounding tissues, vascular motor nerve function disorders are often accompanied by edema. Sometimes although swelling is not obvious, it is often complained of swelling. The skin started to sweat, and it was mostly moist and flushed. The skin temperature can be high or low, and the skin temperature will decrease in the later stage, showing ischemic changes. With the progressive development of the disease, the growth rate of hair and nails changed from accelerating to slowing down, and gradually the skin became thin and the curls of the nails became tarnished.

3. Motor function: decline in grip strength and reduction of delicate motor function can occur early. Due to the reduced range of motion, the muscles become atrophic and the joints become stiff. Patients often after 6 months of disease, due to subcutaneous tissue atrophy, skin thinner and brighter, affected skin sweating increased or decreased. If the myofascial hypertrophy, it can also lead to joint contracture and osteoporosis. X-ray examination may show osteoporosis.

Have a long or recent history of injury and disease.

Persistent burning-like pain with neurogenic pain.

There are vascular and sweating dysfunction, nutritional changes such as muscle atrophy, limb edema or dehydration, and excessive sensitivity to stimuli such as cold.

The diagnostic sympathetic nerve block test is mostly positive.

Once the treatment of complex local pain syndrome (CRPS) is diagnosed, it is necessary to find as early as possible ways to reduce pain, and at the same time, actively carry out rehabilitation treatment.

1. Preventive treatment: It is important to complete the treatment of wounds and adequate analgesia early in the injury. That is to control the pain in the acute phase and prevent it from becoming chronic. At the same time, it is generally considered that a good effect can be achieved in combination with mental treatment.

2. Transcutaneous electrical stimulation (TENS): Transcutaneous electrical stimulation is analgesic by activating endogenous opioid peptides. It can also stimulate the crude fiber nerves in the painful area and change the sensory impulses of the central nervous system. purpose.

3. Drug treatment:

Antidepressants: Three (four) ring antidepressants such as amitriptyline, imipramine, doxepin, and meptylline are commonly used.

Anticonvulsants: Representative drugs are carbamazepine, phenytoin, and valproate, which are effective for nerve-shock-like pain. Gabapentin, which is widely used abroad, can obviously relieve neuralgia caused by diabetes or shingles.

non-steroidal anti-inflammatory analgesics, neurotorpine, prostaglandin preparations, hormones, morphine drugs, etc.

4. Nerve block treatment: mainly sympathetic block. Commonly used nerve blocks are: SGB, thoracic sympathetic nerve block, lumbar sympathetic nerve block, intravenous local nerve block, epidural block, and subarachnoid block. The sympathetic nerve block clinically performed mainly works by blocking the pain mediated by it and dilating the blood vessels in its inner area.

5. After the anesthetic blockade of the authorities, the pain symptoms have not improved or are only temporarily improved, it is necessary to consider the use of neurodestructive drugs for nerve destruction or sympathectomy.

6. When the above treatments are not effective, analgesic pacemaker or subarachnoid analgesia pump implantation can be considered.