Stanton-Hicks M, Baron R, Boas R, Gordh T, Harden N, Hendler N, Koltzenburg M, Raj P, Wilder R
Pain Management Center, The Cleveland Clinic Foundation, OH 44195, USA.
Clin J Pain. 1998 Jun;14(2):155-66. doi: 10.1097/00002508-199806000-00012.
This report aims to present an orderly approach to the treatment of Chronic Regional Pain Syndrome (CRPS) types I and II through an algorithm. The central theme is functional restoration: a coordinated but progressive approach that introduces each of the treatment modalities needed to achieve both remission and rehabilitation. Reaching objective and measurable rehabilitation goals is an essential element. Specific exercise therapy to reestablish function after musculoskeletal injury is central to this functional restoration. Its application to CRPS is more contingent on varying rates of progress that characterize the restoration of function in patients with CRPS. Also, the various modalities that may be used, including analgesia by pharmacologic means or regional anesthesia or the use of neuromodulation, behavioral management, and the qualitatively different approaches that are unique to the management of children with CRPS, are provided only to facilitate functional improvement in a stepwise but methodical manner. Patients with CRPS need an individual approach that requires extreme flexibility. This distinguishes the management of these conditions from other well-described medical conditions having a known pathophysiology. In particular, the special biopsychosocial factors that are critical to achieving a successful outcome are emphasized. This algorithm is a departure from the contemporary heterogeneous approach to treatment of patients with CRPS. The underlying principles are motivation, mobilization, and desensitization facilitated by the relief of pain and the use of pharmacologic and interventional procedures to treat specific signs and symptoms. Self-management techniques are emphasized, and functional rehabilitation is the key to the success of this algorithm.
本报告旨在通过一种算法，提出一种有序治疗Ⅰ型和Ⅱ型复杂性区域疼痛综合征（CRPS）的方法。核心主题是功能恢复：一种协调但循序渐进的方法，引入实现缓解和康复所需的各种治疗方式。实现客观且可衡量的康复目标是一个关键要素。针对肌肉骨骼损伤后重建功能的特定运动疗法是这种功能恢复的核心。将其应用于CRPS更取决于CRPS患者功能恢复所特有的不同进展速度。此外，可能使用的各种方式，包括药物镇痛或区域麻醉，或神经调节的使用、行为管理，以及CRPS患儿管理所特有的性质不同的方法，仅以逐步但有条不紊的方式促进功能改善。CRPS患者需要一种极其灵活的个体化方法。这将这些病症的管理与其他具有已知病理生理学的已明确描述的病症区分开来。特别强调了对取得成功结果至关重要的特殊生物心理社会因素。这种算法与当代治疗CRPS患者的异质性方法不同。其基本原则是通过缓解疼痛以及使用药物和介入程序治疗特定体征和症状来促进动机、活动和脱敏。强调自我管理技术，功能康复是该算法成功的关键。
