Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, Ohio, USA.
Top Stroke Rehabil. 2010 May-Jun;17(3):151-62. doi: 10.1310/tsr1703-151.
Poststroke Complex Regional Pain Syndrome (CRPS) affects a significant number of moderate to severely impaired stroke survivors. Until recently, advances in the assessment and management of CRPS have been limited due to the lack of a consensus on diagnostic criteria; however, with the development of the International Association for the Study of Pain diagnostic criteria, the medical and scientific communities are poised to make significant strides. Biomechanical factors and microtrauma to the hemiparetic shoulder may have a significant role in the genesis of CPRS, although the exact pathophysiology that links these triggers to the observed disease manifestation remains uncertain. Sympathetic dysfunction has historical importance in the CRPS literature. However, this appears to be only one of several possible pathophysiologic mechanisms; somatic nervous system dysfunction, inflammation, hypoxia, and psychological factors are also likely contributors to the disease process. There is no definitive treatment for CRPS, and most patients are treated empirically. Nevertheless, there is consensus that the treatment approach should be interdisciplinary with the goals of edema and pain control, maintenance of joint and muscle biomechanics, and functional restoration. As more rigorous clinical trials emerge, the treatment approach will become more rational with selection of interventions based on a specific mechanism or a combination of mechanisms responsible for a given individual's disease manifestation.
脑卒中后复杂性区域疼痛综合征（CRPS）影响了相当数量的中重度残疾脑卒中幸存者。直到最近，由于缺乏诊断标准的共识，CRPS 的评估和管理进展一直受到限制；然而，随着国际疼痛研究协会诊断标准的发展，医疗和科学界有望取得重大进展。偏瘫肩部的生物力学因素和微创伤可能在 CRPS 的发生中起重要作用，尽管将这些触发因素与观察到的疾病表现联系起来的确切病理生理学仍然不确定。交感神经功能障碍在 CRPS 文献中具有重要意义。然而，这似乎只是几种可能的病理生理机制之一；躯体神经系统功能障碍、炎症、缺氧和心理因素也可能是疾病过程的促成因素。目前还没有针对 CRPS 的明确治疗方法，大多数患者都采用经验性治疗。然而，人们普遍认为，治疗方法应该是跨学科的，目标是控制水肿和疼痛、维持关节和肌肉生物力学以及功能恢复。随着更严格的临床试验的出现，治疗方法将变得更加合理，根据特定的机制或导致特定个体疾病表现的多种机制来选择干预措施。
