ISSN: 1309 - 3843 E-ISSN: 1307 - 7384
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Kompleks Bölgesel Ağrı Sendromu Tedavisinde Güncel Yaklaşımlar
Up-to-date Approaches in the Treatment of Complex Regional Pain Syndrome
Received Date : 02 Jan 2023
Accepted Date : 02 Jun 2023
Available Online : 08 Jun 2023
Doi: 10.31609/jpmrs.2022-95108 - Makale Dili: TR
J PMR Sci. 2023;26(3):348-59
ÖZET
Kompleks bölgesel ağrı sendromu (KBAS), hastanın yaşam kalitesini önemli şekilde etkileyen kompleks bir bozukluktur. Günümüzde tanı, büyük ölçüde kabul gören Budapeşte tanı kriterleri ile konulur. Tedavide, evrensel etkili bulunmuş tek bir tedavi bulunmamasına rağmen erken teşhis ve tedaviye disiplinlerarası yaklaşım temel gibi görünmektedir. Mevcut tedavi modaliteleri, farmakolojik tedavi, fizik tedavi ve girişimsel teknikler arasında değişmektedir. KBAS için farmakoterapötik tedavi seçenekleri, hedefledikleri mekanizmalara göre 4 gruba ayrılabilir: (1) inflamasyon, (2) periferal ve santral desensitizasyon, (3) vazomotor bozukluklar ve (4) motor bozukluklar. KBAS’de, ilaçlar en belirgin mekanizmalara göre bireysel olarak seçilmelidir. Fiziksel ve mesleki tedaviler, elektroterapi modaliteleri, ayna tedavisi ve aşamalı motor imgelemedir. Girişimsel prosedürler, tetik/hassas nokta enjeksiyonlarını, bölgesel sempatik sinir bloklarını, spinal kord stimülasyonunu, epidural klonidin uygulamasını ve kimyasal veya mekanik sempatektomiyi içerir.
ABSTRACT
Complex regional pain syndrome (CRPS) is a complex disorder that significantly affects the patient’s quality of life. Currently, the diagnosis is made by widely accepted Budapest diagnostic criteria. Despite the absence of a universally effective single treatment, an interdisciplinary approach for early diagnosis and treatment seems to be essential. Treatment modalities available range from pharmacotherapy, physical therapy, and interventional techniques. Pharmaco-therapeutic treatment options for CRPS can be categorised into four groups based on the mechanisms they target: (1) inflammation, (2) peripheral and central sensitization, (3) vasomotor disorders, and (4) motor disorders. In CRPS, medical treatment should be determined individually based on the most prominent mechanisms. Physical and occupational treatments include electrotherapy modalities, mirror therapy, and gradual motor imaging. The selected interventional procedures include trigger/sensitive point injections, regional sympathetic nerve blocks, spinal cord stimulation, epidural clonidine administration, and chemical and mechanical sympathectomy.
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