ISSN: 1309 - 3843 E-ISSN: 1307 - 7384
FÄ°ZÄ°KSEL TIP VE REHABÄ°LÄ°TASYON
BÄ°LÄ°MLERÄ° DERGÄ°SÄ°
www.jpmrs.com
Kayıtlı İndexler


DERLEMELER

Kompleks Bölgesel AÄŸrı 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.
REFERENCES
  1. Harden RN, Bruehl S, Stanton-Hicks M, et al. Proposed new diagnostic criteria for complex regional pain syndrome. Pain Med. 2007;8:326-31. [Crossref]  [PubMed] 
  2. Saltık S, Sözen HG, Basgul S, et al. Pregabalin treatment of a patient with complex regional pain syndrome. Pediatr Neurol. 2016;54:88-90. [Crossref]  [PubMed] 
  3. Farzad M, MacDermid JC, Packham T, et al. Factors associated with disability and pain intensity in patients with complex regional pain syndrome. Disabil Rehabil. 2022;44:8243-51. [Crossref]  [PubMed] 
  4. Stanton-Hicks M, Jänig W, Hassenbusch S, et al. Reflex sympathetic dystrophy: changing concepts and taxonomy. Pain. 1995;63:127-33. [Crossref]  [PubMed] 
  5. Bruehl S, Maihöfner C, Stanton-Hicks M, et al. Complex regional pain syndrome: evidence for warm and cold subtypes in a large prospective clinical sample. Pain. 2016;157:1674-81. [Crossref]  [PubMed] 
  6. Taylor SS, Noor N, Urits I, et al. Complex regional pain syndrome: a comprehensive review. Pain Ther. 2021;10:875-92. Erratum in: Pain Ther. 2021. [Crossref]  [PubMed]  [PMC] 
  7. Kessler A, Yoo M, Calisoff R. Complex regional pain syndrome: an updated comprehensive review. NeuroRehabilitation. 2020;47:253-64. [Crossref]  [PubMed] 
  8. Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011;152:S2-S15. [Crossref]  [PubMed]  [PMC] 
  9. Mangnus TJP, Bharwani KD, Dirckx M, et al. From a symptom-based to a mechanism-based pharmacotherapeutic treatment in complex regional pain syndrome. Drugs. 2022;82:511-31. [Crossref]  [PubMed]  [PMC] 
  10. Smart KM, Ferraro MC, Wand BM, et al. Physiotherapy for pain and disability in adults with complex regional pain syndrome (CRPS) types I and II. Cochrane Database Syst Rev. 2022;5:CD010853. [Crossref]  [PubMed]  [PMC] 
  11. Saha S, Sur M, Ray Chaudhuri G, et al. Effects of mirror therapy on oedema, pain and functional activities in patients with poststroke shoulder-hand syndrome: a randomized controlled trial. Physiother Res Int. 2021;26:e1902. [Crossref]  [PubMed] 
  12. Pervane Vural S, Nakipoglu Yuzer GF, Sezgin Ozcan D, et al. Effects of mirror therapy in stroke patients with complex regional pain syndrome type 1: a randomized controlled study. Arch Phys Med Rehabil. 2016;97:575-81. [Crossref]  [PubMed] 
  13. Shafiee E, MacDermid J, Packham T, et al. The effectiveness of rehabilitation interventions on pain and disability for complex regional pain syndrome: a systematic review and meta-analysis. Clin J Pain. 2023;39:91-105. [Crossref]  [PubMed] 
  14. Hwang H, Cho S, Lee JH. The effect of virtual body swapping with mental rehearsal on pain intensity and body perception disturbance in complex regional pain syndrome. Int J Rehabil Res. 2014;37:167-72. [Crossref]  [PubMed] 
  15. Lewis JS, Newport R, Taylor G, et al. Visual illusions modulate body perception disturbance and pain in Complex Regional Pain Syndrome: a randomized trial. Eur J Pain. 2021;25:1551-63. [Crossref]  [PubMed] 
  16. Rauck RL, Eisenach JC, Jackson K, et al. Epidural clonidine treatment for refractory reflex sympathetic dystrophy. Anesthesiology. 1993;79:1163-9; discussion 27A. [Crossref]  [PubMed] 
  17. Durmus A, Cakmak A, Disci R, et al. The efficiency of electromagnetic field treatment in Complex Regional Pain Syndrome Type I. Disabil Rehabil. 2004;26:537-45. [Crossref]  [PubMed] 
  18. Benedetti MG, Cavazzuti L, Mosca M, et al. Bio-Electro-Magnetic-Energy-Regulation (BEMER) for the treatment of type I complex regional pain syndrome: a pilot study. Physiother Theory Pract. 2020;36:498-506. [Crossref]  [PubMed] 
  19. Dimitrijevic IM, Lazovic MP, Kocic MN, et al. Effects of low-level laser therapy and interferential current therapy in the treatment of complex regional pain syndrome. Turkish Journal of Physical Medicine and Rehabilitation. 2014;60:98-105. [Crossref] 
  20. Devrimsel G, Turkyilmaz AK, Yildirim M, et al. The effects of whirlpool bath and neuromuscular electrical stimulation on complex regional pain syndrome. J Phys Ther Sci. 2015;27:27-30. [Crossref]  [PubMed]  [PMC] 
  21. Sezgin Ozcan D, Tatli HU, Polat CS, et al. The effectiveness of fluidotherapy in poststroke complex regional pain syndrome: a randomized controlled study. J Stroke Cerebrovasc Dis. 2019;28:1578-85. [Crossref]  [PubMed] 
  22. Duman I, Ozdemir A, Tan AK, et al. The efficacy of manual lymphatic drainage therapy in the management of limb edema secondary to reflex sympathetic dystrophy. Rheumatol Int. 2009;29:759-63. [Crossref]  [PubMed] 
  23. Li N, Tian F, Wang C, et al. Therapeutic effect of acupuncture and massage for shoulder-hand syndrome in hemiplegia patients: a clinical two-center randomized controlled trial. J Tradit Chin Med. 2012;32:343-9. [Crossref]  [PubMed] 
  24. Harden RN, McCabe CS, Goebel A, et al. Complex regional pain syndrome: practical diagnostic and treatment guidelines, 5th edition. Pain Med. 2022;23:S1-S53. [Crossref]  [PubMed]  [PMC] 
  25. Harden RN, Oaklander AL, Burton AW, et al; Reflex Sympathetic Dystrophy Syndrome Association. Complex regional pain syndrome: practical diagnostic and treatment guidelines, 4th edition. Pain Med. 2013;14:180-229. [Crossref]  [PubMed] 
  26. Hanlan AK, Mah-Jones D, Mills PB. Early adjunct treatment with topical lidocaine results in improved pain and function in a patient with complex regional pain syndrome. Pain Physician. 2014;17:E629-35. [Crossref]  [PubMed] 
  27. Kwak SG, Choo YJ, Chang MC. Effectiveness of prednisolone in complex regional pain syndrome treatment: a systematic narrative review. Pain Pract. 2022;22:381-90. [Crossref]  [PubMed] 
  28. Kalita J, Vajpayee A, Misra UK. Comparison of prednisolone with piroxicam in complex regional pain syndrome following stroke: a randomized controlled trial. QJM. 2006;99:89-95. [Crossref]  [PubMed] 
  29. Park S, Kim HJ, Kim DK, et al. Use of oral prednisolone and a 3-phase bone scintigraphy in patients with complex regional pain syndrome type I. Healthcare (Basel). 2020;8:16. [Crossref]  [PubMed]  [PMC] 
  30. van den Berg C, de Bree PN, Huygen FJPM, et al. Glucocorticoid treatment in patients with complex regional pain syndrome: a systematic review. Eur J Pain. 2022;26:2009-35. [Crossref]  [PubMed]  [PMC] 
  31. Wertli MM, Kessels AG, Perez RS, et al. Rational pain management in complex regional pain syndrome 1 (CRPS 1)--a network meta-analysis. Pain Med. 2014;15:1575-89. [Crossref]  [PubMed] 
  32. Eun Young H, Hyeyun K, Sang Hee I. Pamidronate effect compared with a steroid on complex regional pain syndrome type I: Pilot randomised trial. Neth J Med. 2016;74:30-5. [PubMed] 
  33. Faggiani M, Piccato A, Baroni C, et al. Intravenous treatment with biphosphates in complex regional pain syndrome. Acta Biomed. 2021;92:e2021190. [PubMed]  [PMC] 
  34. Manicourt DH, Brasseur JP, Boutsen Y, et al. Role of alendronate in therapy for posttraumatic complex regional pain syndrome type I of the lower extremity. Arthritis Rheum. 2004;50:3690-7. [Crossref]  [PubMed] 
  35. Chevreau M, Romand X, Gaudin P, et al. Bisphosphonates for treatment of Complex Regional Pain Syndrome type 1: a systematic literature review and meta-analysis of randomized controlled trials versus placebo. Joint Bone Spine. 2017;84:393-9. [Crossref]  [PubMed] 
  36. Fassio A, Mantovani A, Gatti D, et al. Pharmacological treatment in adult patients with CRPS-I: a systematic review and meta-analysis of randomized controlled trials. Rheumatology (Oxford). 2022;61:3534-46. [Crossref]  [PubMed] 
  37. Goebel A, Baranowski A, Maurer K, et al. Intravenous immunoglobulin treatment of the complex regional pain syndrome: a randomized trial. Ann Intern Med. 2010;152:152-8. [Crossref]  [PubMed] 
  38. Huygen FJ, Niehof S, Zijlstra FJ, et al. Successful treatment of CRPS 1 with anti-TNF. J Pain Symptom Manage. 2004;27:101-3. [Crossref]  [PubMed] 
  39. Dirckx M, Groeneweg G, Wesseldijk F, et al. Report of a preliminary discontinued double-blind, randomized, placebo-controlled trial of the anti-TNF-α chimeric monoclonal antibody infliximab in complex regional pain syndrome. Pain Pract. 2013;13:633-40. [Crossref]  [PubMed] 
  40. Eisenberg E, Sandler I, Treister R, et al. Anti tumor necrosis factor - alpha adalimumab for complex regional pain syndrome type 1 (CRPS-I): a case series. Pain Pract. 2013;13:649-56. [Crossref]  [PubMed] 
  41. Perez RS, Zollinger PE, Dijkstra PU, et al; CRPS I task force. Evidence based guidelines for complex regional pain syndrome type 1. BMC Neurol. 2010;10:20. [Crossref]  [PubMed]  [PMC] 
  42. Javed S, Abdi S. Use of anticonvulsants and antidepressants for treatment of complex regional pain syndrome: a literature review. Pain Manag. 2021;11:189-99. [Crossref]  [PubMed] 
  43. Chitneni A, Patil A, Dalal S, et al. Use of ketamine infusions for treatment of complex regional pain syndrome: a systematic review. Cureus. 2021;13:e18910. [Crossref]  [PubMed]  [PMC] 
  44. Yoo Y, Lee CS, Kim J, et al. Botulinum toxin type a for lumbar sympathetic ganglion block in complex regional pain syndrome: a randomized trial. Anesthesiology. 2022;136:314-25. [Crossref]  [PubMed] 
  45. Aïm F, Klouche S, Frison A, et al. Efficacy of vitamin C in preventing complex regional pain syndrome after wrist fracture: a systematic review and meta-analysis. Orthop Traumatol Surg Res. 2017;103:465-70. [Crossref]  [PubMed] 
  46. Giustra F, Bosco F, Aprato A, et al. Vitamin C could prevent complex regional pain syndrome type i in trauma and orthopedic care? A systematic review of the literature and current findings. Sisli Etfal Hastan Tip Bul. 2021;55:139-45. [Crossref]  [PubMed]  [PMC] 
  47. Ettehad H, Mirbolook A, Mohammadi F, et al. Changes in the serum level of vitamin d during healing of tibial and femoral shaft fractures. Trauma Mon. 2014;19:e10946. Erratum in: Trauma Mon. 2014;19:e22699. [Crossref]  [PubMed]  [PMC] 
  48. Cheng J, Salmasi V, You J, et al. Outcomes of sympathetic blocks in the management of complex regional pain syndrome: a retrospective cohort study. Anesthesiology. 2019;131:883-93. [Crossref]  [PubMed] 
  49. O'Connell NE, Wand BM, Gibson W, et al. Local anaesthetic sympathetic blockade for complex regional pain syndrome. Cochrane Database Syst Rev. 2016;7:CD004598. [PubMed]  [PMC] 
  50. Oliveira MJ, Matis GK. Spinal cord stimulation as a treatment option for complex regional pain syndrome: a narrative review. Br J Neurosurg. 2022:1-5. [Crossref]  [PubMed] 
  51. Kemler MA, Barendse GA, van Kleef M, et al. Spinal cord stimulation in patients with chronic reflex sympathetic dystrophy. N Engl J Med. 2000;343:618-24. [Crossref]  [PubMed] 
  52. Deer TR, Levy RM, Kramer J, et al. Dorsal root ganglion stimulation yielded higher treatment success rate for complex regional pain syndrome and causalgia at 3 and 12 months: a randomized comparative trial. Pain. 2017;158:669-81. [Crossref]  [PubMed]  [PMC] 
  53. Yang S, Chang MC. Effect of repetitive transcranial magnetic stimulation on pain management: a systematic narrative review. Front Neurol. 2020;11:114. [Crossref]  [PubMed]  [PMC] 
  54. Houde F, Harvey MP, Tremblay Labrecque PF, et al. Combining transcranial direct current stimulation and transcutaneous electrical nerve stimulation to relieve persistent pain in a patient suffering from complex regional pain syndrome: a case report. J Pain Res. 2020;13:467-73. [Crossref]  [PubMed]  [PMC] 
  55. Hájek M, Chmelar D, Tlapák J, et al. Hyperbaric oxygen treatment in recurrent development of complex regional pain syndrome: a case report. Diving Hyperb Med. 2021;51:107-10. [PubMed]  [PMC] 
  56. Kiralp MZ, Yildiz S, Vural D, et al. Effectiveness of hyperbaric oxygen therapy in the treatment of complex regional pain syndrome. J Int Med Res. 2004;32:258-62. [Crossref]  [PubMed] 
  57. Rowen RJ, Robins H. Ozone therapy for complex regional pain syndrome: review and case report. Curr Pain Headache Rep. 2019;23:41. [Crossref]  [PubMed]  [PMC] 
  58. Eldufani J, Elahmer N, Blaise G. A medical mystery of complex regional pain syndrome. Heliyon. 2020;6:e03329. [Crossref]  [PubMed]  [PMC]Â