Williams Kayode A, Korto Kau, Cohen Steven P
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, 550North Broadway Suite 309A, Baltimore, MD 21205, USA.
Pain Med. 2009 May-Jun;10(4):762-6. doi: 10.1111/j.1526-4637.2009.00630.x.
Complex regional pain syndrome type I (CRPS I) is a neuropathic pain disorder of unclear etiology. It commonly follows a trivial injury and is characterized by spontaneous pain manifesting regionally that is disproportionate to the inciting event. Associated signs and symptoms include allodynia, hyperalgesia, edema, sudomotor, vasomotor abnormalities, and trophic changes. Although multiple modalities exist to treat CRPS I, significant disability, diminution in quality of life, and reduction in overall health often accompany the syndrome.
A case of a 57-year-old man with CRPS I who was treated with spinal cord stimulation (SCS) after failing conservative therapy is presented. One month following treatment, he experienced complete symptom resolution such that stimulation was subsequently discontinued without recurrence over the 1-year follow-up period.
To date there is currently no reliably validated "cure" for CRPS. There has only been one recent report where SCS resulted in the complete eradication of the signs and symptoms associated with CRPS. This series involved adolescent girls aged 11-14 years of age, who tend to have a more benign and self-limited treatment course than that seen in adults. This raises the question as to whether a "neural switch" exists, and if so, where it is located. We postulate that the inter-neuronal connections between the central and peripheral nervous systems implicated by the current pathophysiological model is the most plausible site of this "neural switch," and that reorganization of this interface can account for the ability of SCS to effect a complete "cure" in CRPS.
I型复杂性区域疼痛综合征（CRPS I）是一种病因不明的神经性疼痛疾病。它通常继发于轻微损伤，其特征是局部出现与诱发事件不相称的自发痛。相关的体征和症状包括痛觉过敏、痛觉超敏、水肿、汗腺功能、血管舒缩异常以及营养改变。尽管有多种方法可用于治疗CRPS I，但该综合征常伴有严重残疾、生活质量下降和整体健康状况降低。
本文介绍了一例57岁患有CRPS I的男性患者，在保守治疗失败后接受了脊髓刺激（SCS）治疗。治疗后一个月，他的症状完全缓解，随后在1年的随访期内停止刺激且未复发。
迄今为止，尚无可靠验证的CRPS“治愈”方法。最近仅有一份报告称SCS完全消除了与CRPS相关的体征和症状。该系列研究涉及11 - 14岁的青春期女孩，她们的治疗过程往往比成年人更良性且具有自限性。这就提出了一个问题，即是否存在“神经开关”，如果存在，它位于何处。我们推测，当前病理生理模型所涉及的中枢和外周神经系统之间的神经元间连接是这个“神经开关”最合理的位置，并且这个界面的重组可以解释SCS能够在CRPS中实现完全“治愈”的能力。
