Hernández-Porras Berenice Carolina, Plancarte-Sánchez Ricardo, Alarcón-Barrios Silvia, Sámano-García Marcela
Clínica del Dolor, Instituto Nacional de Cancerología, Ciudad de México, México.
Clínica del Dolor, Instituto Nacional de Cancerología, Ciudad de México, México.
Cir Cir. 2017 Jul-Aug;85(4):366-374. doi: 10.1016/j.circir.2016.11.004. Epub 2016 Dec 19.
Complex regional pain syndrome is characterized by spontaneous or induced pain disproportionate in relation to the initial event and is accompanied by a variety of regional and motor disturbances, leading to a variety of clinical presentations. It is often associated with surgery and minor trauma.
Three mechanisms are postulated: changes secondary to post traumatic inflammation, peripheral vasomotor dysfunction and structural and functional changes of the central nervous system as a result of maladaptation.
made based on the criteria of Budapest. The patient must have one symptom and sign of each criterion at diagnosis: Continuing pain, disproportionate to any inciting event. A sensory, vasomotor, oedema and motor/trophic change sign and symptoms that are not explained by another diagnosis or cause.
Multimodal treatment is suggested. There is no gold standard. In early stage NSAIDs or steroids can be used. Drugs used for neuropathic pain treatment have been suggested, but there is not enough evidence for any of these. There is low evidence that bisphosphonates, calcitonin, ketamine and mirror therapy are effective compared to placebo. Interventional treatment should be stepped from epidural block, neurostimulation, intrathecal pump to experimental therapies in case of intractable pain.
Although complex regional pain syndrome has been a recognized entity for over 100 years, no clear evidence exists for first-line treatments; however, new technologies that are applicable in complex regional pain syndrome treatment have been developed.
复杂性区域疼痛综合征的特征是自发或诱发的疼痛与初始事件不相称，并伴有各种局部和运动功能障碍，导致多种临床表现。它常与手术和轻微创伤相关。
提出了三种机制：创伤后炎症继发的变化、外周血管舒缩功能障碍以及由于适应不良导致的中枢神经系统结构和功能变化。
根据布达佩斯标准进行诊断。患者在诊断时必须具备每个标准的一个症状和体征：持续疼痛，与任何激发事件不相称。感觉、血管舒缩、水肿以及运动/营养改变的体征和症状不能用其他诊断或病因解释。
建议采用多模式治疗。没有金标准。在早期可使用非甾体抗炎药或类固醇。有人建议使用治疗神经性疼痛的药物，但尚无足够证据支持其中任何一种。与安慰剂相比，双膦酸盐、降钙素、氯胺酮和镜像疗法有效的证据不足。对于顽固性疼痛，介入治疗应从硬膜外阻滞、神经刺激、鞘内泵治疗逐步过渡到实验性治疗。
尽管复杂性区域疼痛综合征作为一个已被认可的疾病实体已有100多年历史，但一线治疗尚无明确证据；然而，已开发出适用于复杂性区域疼痛综合征治疗的新技术。
