Fernández-Cuadros M E, Martín-Martín L M, Albaladejo-Florín M J, Pérez-Moro O S, Goizueta-San-Martín G
Servicio de Rehabilitación y Medicina Física, Hospital Universitario Santa Cristina, Madrid, España.
Servicio de Neurofisiología Clínica, Hospital Universitario Santa Cristina, Madrid, España.
Rehabilitacion (Madr). 2024 Jan-Mar;58(1):100807. doi: 10.1016/j.rh.2023.100807. Epub 2023 Oct 18.
To evaluate the sensitivity of sympathetic skin response (SSR) and compare it with scintigraphy in patients with complex regional pain syndrome diagnosed according to the Budapest criteria.
Twenty-two patients with complex regional pain syndrome who attended the Rehabilitation and Physical Medicine Department between January-2018 and May-2022 have been prospectively evaluated. The scintigraphy was considered positive if in the 1st-2nd phase slight asymmetric and diffuse uptake was observed, or when in the 3rd phase marked periarticular radioisotope uptake was observed. SSR was abnormal if: a) no response after 20 stimuli; b) lack of habituation with permanence of the stimuli greater than 67.2%.
Age 55.4±8.57 years. Complex regional pain syndrome was more frequent in women (90.9%), more common in upper limbs (68.2%) than lower limbs (31.8%). In SSR, we have observed normal response (<67.2%) in 2 patients (11.1%), lack of SSR in 2 patients (11.1%) and lack of habituation (>67.2%) in 14 patients (77.8%). In total, 16 patients presented abnormal or absent responses (88.8%). The diagnostic sensitivity of scintigraphy is similar to that of SSR (89.5% vs 88.8%), with no statistical difference (P=.6721).
Scintigraphy has shown similar sensitivity to SSR, although the simplicity, security, low cost, non-ionizing and non-invasiveness of the latter technique suggest that it could be more cost-effective. The lack of habituation and the absence of response could identify response patterns and localize the involvement in the afferent, central, efferent or post-ganglionic pathways.
评估交感神经皮肤反应（SSR）的敏感性，并将其与根据布达佩斯标准诊断为复杂性区域疼痛综合征的患者的骨闪烁显像进行比较。
对2018年1月至2022年5月期间在康复与物理医学科就诊的22例复杂性区域疼痛综合征患者进行前瞻性评估。如果在第1-2期观察到轻微不对称和弥漫性摄取，或在第3期观察到明显的关节周围放射性核素摄取，则骨闪烁显像被视为阳性。如果出现以下情况，则SSR异常：a）20次刺激后无反应；b）刺激持续时间超过67.2%时缺乏习惯化。
年龄55.4±8.57岁。复杂性区域疼痛综合征在女性中更常见（90.9%），在上肢（68.2%）比下肢（31.8%）更常见。在SSR方面，我们观察到2例患者（11.1%）反应正常（<67.2%），2例患者（11.1%）缺乏SSR，14例患者（77.8%）缺乏习惯化（>67.2%）。总共有16例患者出现异常或无反应（88.8%）。骨闪烁显像的诊断敏感性与SSR相似（89.5%对88.8%），无统计学差异（P = 0.6721）。
骨闪烁显像显示出与SSR相似的敏感性，尽管后者技术的简单性、安全性、低成本、非电离和非侵入性表明它可能更具成本效益。缺乏习惯化和无反应可以识别反应模式，并确定传入、中枢、传出或节后通路的受累情况。
