Russo Marc A, Santarelli Danielle M
Hunter Pain Clinic, Broadmeadow, New South Wales, Australia.
Pain Pract. 2016 Jan;16(1):E14-20. doi: 10.1111/papr.12404. Epub 2015 Nov 7.
Evidence suggests that complex regional pain syndrome (CRPS) is a manifestation of microvascular dysfunction. Topical combinations of α2-adrenergic receptor agonists or nitric oxide donors with phosphodiesterase or phosphatidic acid inhibitors formulated to treat microvascular dysfunction have been shown to reduce allodynia in a rat model of CRPS-I. Driven by these findings, we assessed the outcomes of CRPS patients treated with a compound analgesic cream (CAC) consisting of ketamine 10%, pentoxifylline 6%, clonidine 0.2%, and dimethyl sulfoxide 6% to 10%.
An audit was conducted on 13 CRPS patients who trialed the CAC. A detailed report was compiled for each patient which comprised baseline characteristics, including CRPS description, previous treatments, and pain scores (numerical pain rating scale; 0 to 10). Recorded outcomes consisted of pain scores, descriptive outcomes, and concurrent medications/treatments, for which basic analysis was performed to determine the effectiveness of the CAC. Case reports are presented for 3 patients with varying outcomes.
Nine patients (69%) reported pain/symptom reduction (4.4 ± 2.1 vs. 6.3 ± 1.9) with use of the CAC. Six patients reported sustained benefits after 2 months of CAC use, and 2 patients reported complete resolution of pain/symptoms: one had early CRPS-I and the other received a partial CRPS diagnosis. An otherwise medication refractory and intolerant patient found partial benefit with the CAC.
These results demonstrate promise for this topical combination as a useful treatment in multimodal therapy for patients with CRPS, with the potential to resolve pain/symptoms in early CRPS patients.
有证据表明，复杂性区域疼痛综合征（CRPS）是微血管功能障碍的一种表现。已证实，将α2 - 肾上腺素能受体激动剂或一氧化氮供体与磷酸二酯酶或磷脂酸抑制剂联合制成用于治疗微血管功能障碍的局部用药，可减轻CRPS - I大鼠模型中的异常性疼痛。受这些研究结果的推动，我们评估了使用一种复合镇痛乳膏（CAC）治疗CRPS患者的效果，该乳膏含有10%的氯胺酮、6%的己酮可可碱、0.2%的可乐定以及6%至10%的二甲基亚砜。
对13名试用CAC的CRPS患者进行了一项审计。为每位患者编制了一份详细报告，其中包括基线特征，如CRPS描述、既往治疗情况以及疼痛评分（数字疼痛评定量表；0至10）。记录的结果包括疼痛评分、描述性结果以及同时使用的药物/治疗方法，并对其进行基本分析以确定CAC的有效性。现呈现3例不同治疗结果患者的病例报告。
9名患者（69%）报告使用CAC后疼痛/症状减轻（从4.4±2.1降至6.3±1.9）。6名患者报告在使用CAC两个月后仍持续受益，2名患者报告疼痛/症状完全缓解：1例为早期CRPS - I患者，另1例为部分CRPS诊断患者。一名原本对药物难治且不耐受的患者使用CAC后有部分改善。
这些结果表明，这种局部用药组合有望成为CRPS患者多模式治疗中的一种有效治疗方法，有可能使早期CRPS患者的疼痛/症状得到缓解。
