Watson C Peter N, Midha Rajiv, Ng Denise W
University of Toronto, Toronto, ON, Canada.
Department of Clinical Neurosciences, Section of Neurosurgery, University of Calgary, Calgary, AB, Canada.
Can J Neurol Sci. 2024 May;51(3):351-356. doi: 10.1017/cjn.2023.260. Epub 2023 Jul 25.
Causalgia and complex regional pain syndrome (CRPS) type II with nerve injury can be difficult to treat. Surgical peripheral nerve denervation for causalgia has been largely abandoned by pain clinicians because of a perception that this may aggravate a central component (anesthesia dolorosa).
We selectively searched Pubmed, Cochrane, MEDLINE, EMBASE, CINAHL Plus, and Scopus from 1947 for articles, books, and book chapters for evidence of surgical treatments (nerve resection and amputation) and treatment related to autoimmunity and immune deficiency with CRPS.
Reviews were found for the treatment of causalgia or CRPS type II ( = 6), causalgia relieved by nerve resection ( = 6), and causalgia and CRPS II treated by amputation ( = 8). Twelve reports were found of autoimmunity with CRPS, one paper of these on associated immune deficiency and autoimmunity, and two were chosen for discussion regarding treatment with immunoglobulin and one by plasma exchange. We document a report of a detailed and unique pathological examination of a CRPS type II affected amputated limb and related successful treatment with immunoglobulin.
Nerve resection, with grafting, and relocation may relieve uncomplicated causalgia and CRPS type II in some patients in the long term. However, an unrecognized and treatable immunological condition may underly some CRPS II cases and can lead to the ultimate failure of surgical treatments.
伴有神经损伤的灼性神经痛和复杂性区域疼痛综合征（CRPS）II型可能难以治疗。由于疼痛临床医生认为手术性外周神经去神经支配可能会加重中枢性成分（痛性麻木），因此这种治疗灼性神经痛的方法在很大程度上已被放弃。
我们从1947年开始在PubMed、Cochrane、MEDLINE、EMBASE、CINAHL Plus和Scopus中进行选择性检索，以查找有关手术治疗（神经切除术和截肢术）以及与CRPS的自身免疫和免疫缺陷相关治疗的文章、书籍和书籍章节。
发现了关于灼性神经痛或CRPS II型治疗的综述（n = 6）、神经切除术缓解灼性神经痛的综述（n = 6）以及截肢术治疗灼性神经痛和CRPS II型的综述（n = 8）。发现了12篇关于CRPS自身免疫的报告，其中1篇关于相关免疫缺陷和自身免疫，选择了2篇讨论免疫球蛋白治疗，1篇讨论血浆置换治疗。我们记录了一份对CRPS II型受累截肢肢体进行详细且独特病理检查以及用免疫球蛋白进行相关成功治疗的报告。
神经切除术联合移植和重新定位可能会使一些患者的单纯性灼性神经痛和CRPS II型得到长期缓解。然而，一些CRPS II型病例可能存在未被认识和可治疗的免疫状况，这可能导致手术治疗最终失败。
