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      Síndrome doloroso regional complejo, a propósito de un caso. La importancia del diagnóstico precoz Translated title: Complex regional pain syndrome. The importance of early diagnosis

      case-report

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          Abstract

          Resumen El síndrome de dolor regional complejo es una enfermedad de etiopatogenia poco conocida que se desarrolla tras un fenómeno nocivo desencadenante y que se manifiesta por dolor espontáneo o alodinia/hiperalgesia no limitado a la distribución territorial de un nervio periférico y desproporcionado al episodio desencadenante. Se presenta un caso que evoluciona con dolor mantenido en el tiempo, cambios tróficos e impotencia funcional pese al uso de múltiples técnicas terapéuticas. El diagnóstico precoz y el tratamiento temprano son fundamentales para conseguir una evolución favorable y evitar complicaciones discapacitantes.

          Translated abstract

          Abstract Complex regional pain syndrome is a disease of uncertain pathogenesis that develops after a harmful triggering phenomenon and manifests itself by spontaneous pain or allodynia / hyperalgesia, not limited to the territorial distribution of a peripheral nerve and disproportionate to the triggering episode. We present a case that evolves with pain maintained over time, trophic changes and functional impotence despite the use of multiple therapeutic techniques. Early diagnosis and early treatment are essential to achieve a favorable outcome and avoid disabling complications

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          Epidemiology of complex regional pain syndrome: a retrospective chart review of 134 patients.

          Joseph Allen, Jana Schwartz, Bradley S Galer (1999)
          Complex regional pain syndrome (CRPS) remains a poorly understood chronic pain disorder. Little data has been published assessing the epidemiology of CRPS (and reflex sympathetic dystrophy, RSD). This study assessed epidemiological variables in 134 CRPS patients evaluated at a tertiary chronic pain clinic in the US, including demographic, health care utilization and legal/workman's compensation measures. In addition, the frequency of physician-imposed immobilization of the CRPS limb was assessed, as was physical examination evidence of myofascial dysfunction. This study found that these patients had seen on average 4.8 different physicians before referral to the pain center and had received an average of five different kinds of treatments both prior to and during pain clinic treatment. The mean duration of CRPS symptoms prior to pain center evaluation was 30 months. Seventeen percent had a lawsuit and 54% had a worker compensation claim related to the CRPS. Fifty-one patients received a bone scan, but only 53% of which were interpreted as consistent with the diagnosis of RSD/CRPS. Forty-seven percent had a history of physician-imposed immobilization, and 56% had a myofascial component present at evaluation. The duration of CRPS symptoms and the involvement of the upper extremity was significantly associated with the presence of myofascial dysfunction. Thus, this study found that most CRPS patients are referred to a pain specialty clinic after several years of symptoms and many failed therapies. The data also suggest the lack of utility of a diagnostic bone scan and highlight the prominence of myofascial dysfunction in a majority of CRPS patients.
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            Complex regional pain syndrome: An optimistic perspective.

            Frank Birklein, Darragh O’Neill, Tanja Schlereth (2015)
            Complex regional pain syndrome (CRPS) presents with clinical symptoms that can no longer be explained by the initial trauma, including pain, sensory, motor, and trophic symptoms, and impairment of autonomic control of the limb. These symptoms spread distally and go beyond single nerve innervation territories. Typically, the symptoms change through the course of CRPS as a result of the varying pathophysiology. Diagnosis is made clinically after the rigorous elimination of other possible causes, and 3-phase bone scintigraphy can be a useful tool for confirming CRPS. In acute stages, inflammatory symptoms prevail and should be treated with anti-inflammatory agents (steroids), bisphosphonates, or topical application of dimethyl sulfoxide. In chronic stages, many symptoms are related to so-called central neuroplasticity; these include hyperalgesia, sensory loss, motor symptoms, body perception disturbance, autonomic symptoms, and learned incorrect behavior such as nonuse. At this stage, the only medical treatment that is effective against pain without improving the function is ketamine infusions, but this has side effects. Physical therapy, graded motor imagery, and pain exposure/graded exposure in vivo therapy can help to overcome central reorganization. If a relevant mental comorbidity is present, the patient should be referred for psychotherapeutic treatment. Invasive treatment should be restricted to special cases and only offered after psychosomatic assessment. If these recommendations are followed, CRPS prognosis is not as poor as commonly assumed. Whether the patients can return to their previous life depends on particular individual factors.
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              Complex regional pain syndromes: new pathophysiological concepts and therapies.

              C Maihöfner, K Markovic, F. Seifert (2010)
              Complex regional pain syndrome (CRPS), formerly known as Sudeck's dystrophy and causalgia, is a disabling and distressing pain syndrome. We here provide a review based on the current literature concerning the epidemiology, etiology, pathophysiology, diagnosis, and therapy of CRPS. CRPS may develop following fractures, limb trauma or lesions of the peripheral or CNS. The clinical picture comprises a characteristic clinical triad of symptoms including autonomic (disturbances of skin temperature, color, presence of sweating abnormalities), sensory (pain and hyperalgesia), and motor (paresis, tremor, dystonia) disturbances. Diagnosis is mainly based on clinical signs. Several pathophysiological concepts have been proposed to explain the complex symptoms of CRPS: (i) facilitated neurogenic inflammation; (ii) pathological sympatho-afferent coupling; and (iii) neuroplastic changes within the CNS. Furthermore, there is accumulating evidence that genetic factors may predispose for CRPS. Therapy is based on a multidisciplinary approach. Non-pharmacological approaches include physiotherapy and occupational therapy. Pharmacotherapy is based on individual symptoms and includes steroids, free radical scavengers, treatment of neuropathic pain, and finally agents interfering with bone metabolism (calcitonin, biphosphonates). Invasive therapeutic concepts include implantation of spinal cord stimulators. This review covers new aspects of pathophysiology and therapy of CRPS.
              Article 0 comments Cited 37 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (publisher-id): mesetra
                Title: Medicina y Seguridad del Trabajo
                Abbreviated Title: Med. segur. trab.
                Publisher: Escuela Nacional de Medicina del Trabajo. Instituto de Salud Carlos III (Madrid, Madrid, Spain )
                ISSN (Print): 0465-546X
                ISSN (Electronic): 1989-7790
                Publication date (Print and electronic): December 2021
                Volume: 67
                Issue: 265
                Pages: 298-303
                Affiliations
                [1] Madrid orgnameInstituto Nacional de la Seguridad Social orgdiv1Dirección Provincial orgdiv2Unidad Médica del Equipo de Valoración de Incapacidades España
                Article
                Publisher ID: S0465-546X2021000400298 Publisher ID: S0465-546X(21)06726500298
                DOI: 10.4321/s0465-546x2021000400005
                SO-VID: 77217cd1-8264-4932-8e4e-bae6e9a4c834
                License:

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                Date received : 23 November 2021
                Date accepted : 29 December 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 10, Pages: 6
                Product

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                Categories
                Subject: A propósito de un caso

                Keywords: Diagnóstico precoz,Causalgia,Distrofia Simpática Refleja,Síndrome de dolor regional complejo,Early diagnosis,Reflex Sympathetic Dystrophy,Complex regional pain syndrome
                Data availability:
                Keywords: Diagnóstico precoz, Causalgia, Distrofia Simpática Refleja, Síndrome de dolor regional complejo, Early diagnosis, Reflex Sympathetic Dystrophy, Complex regional pain syndrome

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