Frettlöh Jule, Hüppe Michael, Maier Christoph
Department of Pain Management, BG Kliniken Bergmannsheil-Ruhr University Bochum, Germany.
Pain. 2006 Sep;124(1-2):184-9. doi: 10.1016/j.pain.2006.04.010. Epub 2006 May 30.
In the literature, the neglect-like syndrome is described as an additional phenomenon of CRPS. The perception of the affected limb as strange, disordered and not belonging to the body is typical of and characterises this syndrome. Since this phenomenon has never been studied in other pain conditions, we assessed occurrence and extent of neglect-like symptoms in patients with CRPS of the upper and lower limb (n = 123) and in a control group with chronic limb pain of other origins (n = 117). Our questionnaire for describing the neglect-like syndrome encompassed five items following Galer and Jensen [Galer BS, Jensen M. Neglect-like symptoms in complex regional pain syndrome: results of a self-administered survey. Journal of Pain and Symptom Management 1999;18:213-6], with a six-point response scale inquiring the extent of respective symptoms. Results show that CRPS-patients as well as patients with non-CRPS limb pain exhibit the so-called neglect-like syndrome. However, the number of patients confirming such symptoms was significantly higher (OR = 2.87) in the CRPS group, moreover, these patients reported more severe symptoms (F = 17.74; p = 0.001). If the neglect-like total score is > or = 5, the diagnostic sensitivity is low (21.1%), but the specificity for the diagnosis of CRPS reaches 90.6%. In this study, patients with CRPS of the upper and lower limb were included. The only difference between these two localisations concerning the neglect-like syndrome was the symptom of 'involuntary movements', which occurs significantly more often in affected legs. In conclusion, we recommend to evaluate neglect-like symptoms and to use them as an additional criterion in the diagnosis of CRPS. High scores of > or = 5 confirm the diagnosis of CRPS, whereas lower scores must not be used for disease classification.
在文献中，疏忽样综合征被描述为复杂性区域疼痛综合征（CRPS）的一种附加现象。将患侧肢体感知为陌生、紊乱且不属于自身身体，是该综合征的典型特征。由于此现象从未在其他疼痛病症中得到研究，我们评估了上肢和下肢CRPS患者（n = 123）以及其他病因所致慢性肢体疼痛的对照组患者（n = 117）中疏忽样症状的发生率和程度。我们用于描述疏忽样综合征的问卷包含了Galer和Jensen提出的五个项目[Galer BS, Jensen M. 复杂性区域疼痛综合征中的疏忽样症状：一项自我管理调查的结果。《疼痛与症状管理杂志》1999年；18:213 - 6]，采用六点反应量表询问各症状的程度。结果显示，CRPS患者以及非CRPS肢体疼痛患者均表现出所谓的疏忽样综合征。然而，CRPS组中确认有此类症状的患者数量显著更多（比值比 = 2.87），此外，这些患者报告的症状更为严重（F = 17.74；p = 0.001）。若疏忽样总分≥5，诊断敏感性较低（21.1%），但CRPS诊断的特异性达到90.6%。本研究纳入了上肢和下肢CRPS患者。在疏忽样综合征方面，这两个部位的唯一差异在于“不自主运动”症状，该症状在患侧腿部出现的频率显著更高。总之，我们建议评估疏忽样症状并将其作为CRPS诊断的附加标准。≥5的高分可确诊CRPS，而低分则不能用于疾病分类。
