Samuel Essa A, Ahmad Khoula, Manongi Naelijwa J, Rajapandian Ramkumar, Moti Wala Sajida, AlEdani Esraa M, Khan Safeera
Physical Medicine and Rehabilitation, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Cureus. 2024 Nov 22;16(11):e74248. doi: 10.7759/cureus.74248. eCollection 2024 Nov.
Complex regional pain syndrome (CRPS) is a chronic debilitating multisystem neuropathic pain disorder. It is characterized by continuous pain, usually out of proportion to any known tissue injury, vasomotor changes, sudomotor or edema, and motor or trophic changes. The objective of this study is to assess the efficacy of neuromodulation, interventional, and unconventional treatments for CRPS. The primary focus is pain reduction, assessed through various scales, with secondary outcomes examining effects on autonomic, sensory, motor, and psychological aspects, and quality of life. PubMed, Cochrane Library, MDPI, and ScienceDirect databases were thoroughly searched using our detailed search strategy and relevant literature compiled. Articles were assessed using our eligibility criteria and quality appraisal tools. All types of study designs were considered. Initially, 463 articles were identified; after a thorough assessment, 23 articles comprising 2307 patients were shortlisted. Neuromodulation interventions, specifically Dorsal Root Ganglion (DRG) and Spinal Cord Stimulation (SCS) demonstrated statistically significant pain reduction (43-82% and up to 70%, respectively). Both modalities demonstrate improvement in secondary outcomes and quality of life. Interventional interventions, specifically nerve blockade ranging from sympathetic, stellate ganglion, and regional nerve blocks, all demonstrate varying levels of efficacy on measured pain and secondary outcomes. Unconventional: Botulinum toxin injections through multiple delivery systems demonstrated varying levels of efficacy in treating pain and improving secondary outcomes. In conclusion, DRG stimulation and SCS, nerve blockade, and botulinum toxin all display promise in alleviating symptoms of CRPS. Definite conclusions were not made due to a lack of clinical trial data, and longer multi-year follow-up is recommended.
复杂性区域疼痛综合征（CRPS）是一种慢性致残性多系统神经病理性疼痛障碍。其特征为持续性疼痛，通常与任何已知的组织损伤程度不相称，伴有血管舒缩改变、汗腺分泌或水肿以及运动或营养改变。本研究的目的是评估神经调节、介入性和非常规治疗方法对CRPS的疗效。主要重点是通过各种量表评估疼痛减轻情况，次要结果则检查对自主神经、感觉、运动和心理方面以及生活质量的影响。使用我们详细的检索策略对PubMed、Cochrane图书馆、MDPI和ScienceDirect数据库进行了全面检索，并汇编了相关文献。使用我们的纳入标准和质量评估工具对文章进行评估。考虑了所有类型的研究设计。最初，识别出463篇文章；经过全面评估，筛选出23篇文章，共涉及2307名患者。神经调节干预措施，特别是背根神经节（DRG）刺激和脊髓刺激（SCS）显示出有统计学意义的疼痛减轻（分别为43%-82%和高达70%）。这两种方式在次要结果和生活质量方面均有改善。介入性干预措施，特别是包括交感神经、星状神经节和区域神经阻滞在内的神经阻滞，在测量的疼痛和次要结果方面均显示出不同程度的疗效。非常规治疗：通过多种给药系统注射肉毒杆菌毒素在治疗疼痛和改善次要结果方面显示出不同程度的疗效。总之，DRG刺激、SCS、神经阻滞和肉毒杆菌毒素在缓解CRPS症状方面均显示出前景。由于缺乏临床试验数据，未得出明确结论，建议进行更长时间的多年随访。
