Hsu Eric S
Pain Management Center, Department of Anesthesiology, David Geffen School of Medicine, University of California, Los Angeles, LA, USA.
Am J Ther. 2009 Mar-Apr;16(2):147-54. doi: 10.1097/MJT.0b013e3181715671.
Complex regional pain syndrome (CRPS) describes a diversity of painful conditions following trauma, coupled with abnormal regulation of blood flow and sweating, trophic changes, and edema of skin. The excruciating pain and diverse autonomic dysfunctions in CRPS are disproportionate to any inciting and recovering event. CRPS type I is formerly identified as "reflex sympathetic dystrophy." CRPS type II is the new term for "causalgia" that always coexists with documented nerve injury. The present diagnostic criteria of CRPS I and II depend solely on meticulous history and physical examination without any confirmation by specific test procedure (or gold standard). There are only few clinical studies with large-scale randomized trials of pharmacologic agents on the treatment of CRPS. Bisphosphonates have been studied in multiple controlled trials, based on theoretical benefit of bone resorption, to offer pain relief and functional improvement in patients with CRPS. Many current rationales in treatment of CRPS (such as topical agents, antiepileptic drugs, tricyclic antidepressants, and opioids) are mainly dependent on efficacy originate in other common conditions of neuropathic pain. There are additional innovative therapies on CRPS that are still in infancy. No wonder all the treatment of individual CRPS case nowadays is pragmatic at best. Although the interventional therapies in CRPS (such as nerve blockade, sympathetic block, spinal cord and peripheral nerve stimulation, implantable spinal medication pumps, and chemical and surgical sympathectomy) may offer more rapid response, yet it is still controversial with unpredictable outcome. Nevertheless, we need to start pain management immediately with the ambition to restore function in every probable case of CRPS. An interdisciplinary setting with comprehensive approach (pharmacologic, interventional, and psychological in conjunction with rehabilitation pathway) has been proposed as protocol in the practical management of CRPS. It is crucial to have a high sensitivity value combined with a fair specificity in revising diagnostic criteria of CRPS. The validation and consensus for new rationalized diagnostic criteria of CRPS could facilitate further research to enhance clinical outcome including quality of life. These endeavors to minimize suffering from CRPS would certainly be appreciated by many patients and their loved ones.
复杂性区域疼痛综合征（CRPS）描述了创伤后多种疼痛状况，伴有血流和出汗调节异常、营养改变以及皮肤水肿。CRPS中难以忍受的疼痛和多种自主神经功能障碍与任何激发和恢复事件不成比例。CRPS I型以前被认定为“反射性交感神经营养不良”。CRPS II型是“灼性神经痛”的新术语，总是与记录在案的神经损伤并存。目前CRPS I型和II型的诊断标准仅依赖于详尽的病史和体格检查，无需通过特定检测程序（或金标准）进行确认。仅有少数关于治疗CRPS的药物进行大规模随机试验的临床研究。基于骨吸收的理论益处，双膦酸盐已在多项对照试验中进行研究，以减轻CRPS患者的疼痛并改善其功能。目前许多治疗CRPS的理论依据（如局部用药、抗癫痫药物、三环类抗抑郁药和阿片类药物）主要依赖于源自其他常见神经性疼痛状况的疗效。还有一些针对CRPS的创新疗法仍处于起步阶段。难怪如今对CRPS个体病例的所有治疗充其量只是实用主义的。尽管CRPS的介入疗法（如神经阻滞、交感神经阻滞、脊髓和周围神经刺激、植入式脊髓药物泵以及化学和手术交感神经切除术）可能会提供更快的反应，但结果仍存在争议且不可预测。然而，我们需要立即开始疼痛管理，目标是在每一例可能的CRPS病例中恢复功能。在CRPS的实际管理中，已提出采用综合方法（药物、介入和心理治疗并结合康复途径）的多学科模式作为方案。在修订CRPS诊断标准时，具有高敏感性值并结合合理的特异性至关重要。CRPS新的合理诊断标准的验证和共识有助于进一步研究以改善临床结果，包括生活质量。这些将CRPS痛苦降至最低的努力肯定会得到许多患者及其亲人的赞赏。
