Hofbauer H, Brinkmann A, Maurer E, Weber B, Hänle G, Steffen P
Sektion Schmerztherapie, Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland.
Klinik für Anästhesie, operative Intensivmedizin und spezielle Schmerztherapie, Klinikum Heidenheim, Schloßhaustraße 100, 89522, Heidenheim, Deutschland.
Schmerz. 2024 Sep 28. doi: 10.1007/s00482-024-00837-7.
Complex regional pain syndrome (CRPS) can lead to severe pain and limited functionality in the long term. Guidelines should help to optimize treatment procedures. It should be investigated which outcome is achieved after 1 year with guideline-based therapy.
In a prospective multicenter study, 40 patients with newly diagnosed CRPS were examined to determine how their pain and functional limitations changed within 1 year. In addition, it was investigated whether the time of diagnosis and invasive measures influence these outcome parameters.
All patients received physiotherapy and/or ergotherapy, treatment with glucocorticoids and/or bisphosphonates 29 (72.5%); various invasive measures were carried out in 13 (32.5%). After 1 year, both pain and functionality were significantly improved; two-thirds reported a tolerable average pain intensity. Severe functional impairment according to von Korff disability points was found after 1 year in 9 (22.5%), and a moderate or severe impairment according to medical evaluation in 6 (15%) and 3 (7.5%) patients, respectively. Earlier diagnosis and corresponding earlier start of treatment correlated with better outcome in terms of pain and functionality according to von Korff, but not according to medical evaluation. The influence of invasive procedures on the outcome parameters tended to be low.
Guideline-based treatment led to a good outcome in terms of pain and functionality in the majority of patients. Early diagnosis correlated with better outcome, so suspected cases should be referred quickly to a medical facility with appropriate expertise.
复杂性区域疼痛综合征（CRPS）长期可导致严重疼痛和功能受限。指南应有助于优化治疗程序。应研究基于指南的治疗1年后能取得何种结果。
在一项前瞻性多中心研究中，对40例新诊断的CRPS患者进行检查，以确定其疼痛和功能受限在1年内如何变化。此外，还研究了诊断时间和侵入性措施是否会影响这些结果参数。
所有患者均接受了物理治疗和/或职业治疗，29例（72.5%）接受了糖皮质激素和/或双膦酸盐治疗；13例（32.5%）进行了各种侵入性措施。1年后，疼痛和功能均有显著改善；三分之二的患者报告平均疼痛强度可耐受。1年后，根据冯·科尔夫残疾评分，9例（22.5%）患者存在严重功能障碍，根据医学评估，分别有6例（15%）和3例（7.5%）患者存在中度或重度功能障碍。根据冯·科尔夫评分，早期诊断及相应的早期开始治疗与疼痛和功能方面的更好结果相关，但根据医学评估则不然。侵入性操作对结果参数的影响往往较小。
基于指南的治疗在大多数患者的疼痛和功能方面取得了良好效果。早期诊断与更好的结果相关，因此疑似病例应迅速转诊至具备适当专业知识的医疗机构。
