Sinis N, Birbaumer N, Schwarz A, Gustin S, Unertl K, Schaller H-E, Haerle M
Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie, BG-Unfallklinik, Eberhard-Karls-Universität Tübingen.
Handchir Mikrochir Plast Chir. 2006 Jun;38(3):164-71. doi: 10.1055/s-2006-924180.
In recent studies a central nervous system involvement in the pathogenesis of Complex Regional Pain Syndrome (CRPS) was suggested, stimulating the introduction of central acting drugs. Animal studies have demonstrated an increased expression of the N-methyl-D-aspartate (NMDA) receptors in experimental neuropathic pain.
The aim of this study was to investigate the relationship between NMDA receptor blockers and CRPS.
Three patients suffering from CRPS of one upper extremity where treated with oral NMDA antagonist Memantine for eight weeks. Patients expressed their pain levels with a visual analog scale ranging from zero to ten at rest and after fist clenching. Furthermore, the range of movement of the fingers and the wrist were documented. To assess force, a pinchmeter and a dynamometer were used. Cortical reorganisation was studied with functional Magnetic Resonance Imaging (fMRI) and Magnetoencephalography (MEG).
Six months after treatment with Memantine no rest pain was present in any of the patients. Furthermore, an increase in finger movement was observed after six-month follow-up with no deficits and free movement ranges. Additionally, wrist movement was improved and an increase of force was measured after six months with the dynamometer and the pinchmeter. Moreover the functional impairment, cortical reorganisation was observed in all patients before treatment. These changes returned to a normal pattern after eight weeks of treatment with Memantine.
These first results demonstrate central nervous system involvement in the development and maintenance of CRPS. The results (functional, pain, fMRI, MEG) after treatment with Memantine indicate the importance of the NMDA receptor system in neuropathic pain syndromes and provide a promising approach for the treatment of CRPS.
最近的研究表明复杂区域疼痛综合征（CRPS）的发病机制涉及中枢神经系统，这促使了中枢作用药物的引入。动物研究已证实在实验性神经病理性疼痛中N-甲基-D-天冬氨酸（NMDA）受体的表达增加。
本研究的目的是调查NMDA受体阻滞剂与CRPS之间的关系。
三名患有单侧上肢CRPS的患者口服NMDA拮抗剂美金刚治疗八周。患者通过视觉模拟量表表达其在休息时和握拳后的疼痛程度，范围为0至10。此外，记录手指和手腕的活动范围。为评估力量，使用了捏力计和测力计。采用功能磁共振成像（fMRI）和脑磁图（MEG）研究皮质重组。
美金刚治疗六个月后，所有患者均无静息痛。此外，六个月随访后观察到手指活动增加，无功能障碍且活动范围正常。另外，手腕活动得到改善，六个月后使用测力计和捏力计测量力量增加。此外，所有患者在治疗前均观察到功能损害和皮质重组。美金刚治疗八周后，这些变化恢复到正常模式。
这些初步结果表明中枢神经系统参与了CRPS的发生和维持。美金刚治疗后的结果（功能、疼痛、fMRI、MEG）表明NMDA受体系统在神经病理性疼痛综合征中的重要性，并为CRPS的治疗提供了一种有前景的方法。
