MacRae Fraser Alexander, Boissonnault Eve, Winston Paul
Health Sciences, Western University, London, Canada.
Vancouver Island Health Authority, Victoria, Canada.
Can J Pain. 2023 Aug 1;7(1):2242892. doi: 10.1080/24740527.2023.2242892. eCollection 2023.
The objective of this study was to assess the outcomes of the use of electrodiagnosis in the diagnosis and management of discrete nerve injuries in patients with complex regional pain syndrome (CRPS).
This study is a secondary retrospective cohort analysis of patients diagnosed with CRPS from a single outpatient physical medicine and rehabilitation clinic and included all patients who had abnormal electrodiagnostic findings, in addition to CRPS.
Sixty patients of 248 diagnosed with CRPS underwent electrodiagnosis, 41 of whom had abnormal electrodiagnostic findings indicating a discrete nerve injury. Only 51% of the 41 referrals had indicated the suspicion of a nerve injury. Nearly all patients had undergone physiotherapy. Forty-one percent responded to treatment with oral prednisone alone, 54% had a functional improvement after a combination of treatments including corticosteroids, and 5% improved with treatments that did not involve corticosteroids. Surgical interventions for nerve injuries were required for 34% of patients in the cohort. All surgeries involved the median or ulnar nerve, with the exception of one fibular nerve. After treatment, 39 of 41 patients had functional recoveries or better.
Electrodiagnosis can inform diagnosis of nerve injury and direct intervention including the need for surgical intervention. Electrodiagnosis should be considered for patients with initial signs of concomitant discrete nerve injury or with CRPS who are not responding to treatments because a nerve injury may be underlying.
Complex Regional Pain Syndrome (CRPS) is a poorly understood pain condition. CRPS has been divided into two subtypes, the second subtype involves a discrete nerve injury with pain that extends beyond the territory of the nerve injury.
We observed that nerve injuries that may require surgical intervention are diagnosed just over half of the time upon initial assessment in patients with suspected CRPS. We observed that nerve injuries frequently required specifically directed interventions in place of or in conjunction with CRPS treatments. We suggest that electrodiagnosis is an important part of the triage protocol for CRPS II to reveal discrete nerve injuries that may be hidden. We recommend that electrodiagnosis be considered for patients with initial signs of concomitant discrete nerve injury or for CRPS patients who do not improve with medical therapies.
本研究的目的是评估电诊断在复杂性区域疼痛综合征（CRPS）患者离散性神经损伤诊断和管理中的应用结果。
本研究是对一家门诊物理医学与康复诊所诊断为CRPS的患者进行的二次回顾性队列分析，纳入了所有除CRPS外电诊断结果异常的患者。
248例诊断为CRPS的患者中有60例接受了电诊断，其中41例电诊断结果异常，提示存在离散性神经损伤。41例转诊患者中只有51%曾怀疑有神经损伤。几乎所有患者都接受过物理治疗。41%的患者仅口服泼尼松治疗有效，54%的患者在包括皮质类固醇在内的联合治疗后功能改善，5%的患者在不涉及皮质类固醇的治疗后有所改善。该队列中34%的患者需要对神经损伤进行手术干预。除1例腓总神经损伤外，所有手术均涉及正中神经或尺神经。治疗后，41例患者中有39例功能恢复或改善。
电诊断可为神经损伤的诊断提供依据，并指导干预措施，包括是否需要手术干预。对于有初始伴随离散性神经损伤迹象或对治疗无反应的CRPS患者，应考虑进行电诊断，因为可能存在神经损伤。
复杂性区域疼痛综合征（CRPS）是一种了解甚少的疼痛病症。CRPS已分为两个亚型，第二亚型涉及离散性神经损伤，疼痛范围超出神经损伤区域。
我们观察到，在疑似CRPS患者的初始评估中，可能需要手术干预的神经损伤仅有一半多一点的时间能被诊断出来。我们观察到，神经损伤经常需要针对性的干预措施来替代或结合CRPS治疗。我们建议，电诊断是CRPS II分诊方案的重要组成部分，以揭示可能隐藏的离散性神经损伤。我们建议，对于有初始伴随离散性神经损伤迹象的患者或对药物治疗无改善的CRPS患者，应考虑进行电诊断。
