Kaye Alan D, Nguyen Angela, Boullion Jolie, Blue Mary-Elizabeth F, Allen Dillion W Hopson, Kelkar Rucha A, Mouhaffel Aya, Ro Andrew T, Ahmadzadeh Shahab, Shekoohi Sahar, Robinson Christopher L
Departments of Anesthesiology and Pharmacology, Toxicology, and Neurosciences, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA.
School of Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA.
Curr Pain Headache Rep. 2025 Jan 4;29(1):4. doi: 10.1007/s11916-024-01329-0.
Complex regional pain syndrome (CRPS) is a chronic condition characterized by disproportional pain typically affecting an extremity. Management of CRPS is centered around specific symptomatology, which tends to be a combination of autonomic dysfunction, nociceptive sensitization, chronic inflammation, and/or motor dysfunction. Targeting the autoimmune component of CRPS provides a way to both symptomatically treat as well as minimize progression of CRPS.
Understanding the physiology of CRPS and strategies for treating and targeting immunophysiology behind CRPS allows examination of the efficacy of such treatments. IL-1 receptor antagonism, glucocorticoid administration, IVIG infusion, and TNFα inhibitors are treatments that target the immune response and decrease inflammation, thereby reducing pain and enhancing function in patients with CRPS. IL-1 receptor antagonism is thought to inhibit the inflammatory effects of IL-1, a key player in the inflammatory process in CRPS. Glucocorticoids have anti-inflammatory properties and can reduce inflammation in affected tissues. IVIG infusion involves administering immunoglobulins, which may modulate the immune response and reduce autoimmunity in CRPS. TNFα inhibitors block the action of TNFα, a pro-inflammatory cytokine associated with CRPS development. These therapies are further discussed at the extent of mechanism of action as well as advantages and limitations of such therapies. The present investigation provides a detailed summary of the mechanism of action, advantages, and limitations of novel immunomodulatory therapies and recent studies and trials that investigated these therapies for CRPS. Future studies are warranted related to the role of immunomodulators in the treatment of CRPS.
复杂性区域疼痛综合征（CRPS）是一种慢性疾病，其特征为通常累及一个肢体的不成比例的疼痛。CRPS的管理围绕特定症状展开，这些症状往往是自主神经功能障碍、伤害性感受敏感化、慢性炎症和/或运动功能障碍的组合。针对CRPS的自身免疫成分提供了一种对症治疗以及将CRPS进展最小化的方法。
了解CRPS的生理学以及治疗和针对CRPS背后免疫生理学的策略，有助于检验此类治疗的疗效。白细胞介素-1受体拮抗、糖皮质激素给药、静脉注射免疫球蛋白（IVIG）输注和肿瘤坏死因子α（TNFα）抑制剂是针对免疫反应并减轻炎症的治疗方法，从而减轻CRPS患者的疼痛并增强其功能。白细胞介素-1受体拮抗被认为可抑制白细胞介素-1的炎症作用，白细胞介素-1是CRPS炎症过程中的关键参与者。糖皮质激素具有抗炎特性，可减轻受影响组织的炎症。IVIG输注涉及给予免疫球蛋白，这可能调节免疫反应并减少CRPS中的自身免疫。TNFα抑制剂阻断TNFα的作用，TNFα是一种与CRPS发展相关的促炎细胞因子。这些疗法的作用机制、优势和局限性将进一步讨论。本研究详细总结了新型免疫调节疗法的作用机制、优势和局限性，以及研究这些疗法用于CRPS的最新研究和试验。未来有必要开展与免疫调节剂在CRPS治疗中的作用相关的研究。
