Department of Neurology (K5Q), Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
J Neural Transm (Vienna). 2011 Sep;118(9):1301-9. doi: 10.1007/s00702-011-0601-1. Epub 2011 Feb 18.
Complex regional pain syndrome (CRPS) generally remains restricted to one limb but occasionally may spread to other limbs. Knowledge of the spreading pattern of CRPS may lead to hypotheses about underlying mechanisms but to date little is known about this process. The objective is to study patterns of spread of CRPS from a first to a second limb and the factors associated with this process. One hundred and eighty-five CRPS patients were retrospectively evaluated. Cox's proportional hazards model was used to evaluate factors that influenced spread of CRPS symptoms. Eighty-nine patients exhibited CRPS in multiple limbs. In 72 patients spread from a first to a second limb occurred showing a contralateral pattern in 49%, ipsilateral pattern in 30% and diagonal pattern in 14%. A trauma preceded the onset in the second limb in 37, 44 and 91%, respectively. The hazard of spread of CRPS increased with the number of limbs affected. Compared to patients with CRPS in one limb, patients with CRPS in multiple limbs were on average 7 years younger and more often had movement disorders. In patients with CRPS in multiple limbs, spontaneous spread of symptoms generally follows a contralateral or ipsilateral pattern whereas diagonal spread is rare and generally preceded by a new trauma. Spread is associated with a younger age at onset and a more severely affected phenotype. We argue that processes in the spinal cord as well as supraspinal changes are responsible for spontaneous spread in CRPS.
复杂性区域疼痛综合征（CRPS）通常局限于单一肢体，但偶尔也可能扩散至其他肢体。了解 CRPS 的扩散模式可能会对潜在机制产生假设，但迄今为止，对此过程知之甚少。本研究的目的是研究 CRPS 从第一肢体向第二肢体扩散的模式，以及与该过程相关的因素。回顾性评估了 185 例 CRPS 患者。采用 Cox 比例风险模型评估影响 CRPS 症状扩散的因素。89 例患者出现多肢体 CRPS。在 72 例患者中，从第一肢体扩散到第二肢体，表现为对侧模式 49%、同侧模式 30%和对角模式 14%。第二肢体的发病前分别有 37、44 和 91%的患者有创伤史。CRPS 扩散的风险随着受累肢体数量的增加而增加。与单侧 CRPS 患者相比，多肢体 CRPS 患者的平均年龄小 7 岁，运动障碍更常见。在多肢体 CRPS 患者中，症状的自发扩散通常遵循对侧或同侧模式，而对角扩散很少见，通常发生在新创伤之前。扩散与发病年龄较小和更严重的表型有关。我们认为，脊髓内和脊髓上的变化过程是 CRPS 自发扩散的原因。
