Thimineur M, Sood P, Kravitz E, Gudin J, Kitaj M
Comprehensive Pain and Headache Treatment Center, L.L.C., Department of Anesthesiology, Griffin Hospital, Derby, Connecticut 06418, USA.
Clin J Pain. 1998 Sep;14(3):256-67. doi: 10.1097/00002508-199809000-00013.
Sensory and motor abnormalities are common among patients with complex regional pain syndrome (CRPS). The purpose of the present study was to define and characterize these abnormalities and to develop a hypothesis regarding the area of the central nervous system from which they derive.
Data were acquired from study subjects using clinical examination and quantitative assessment of neurological function. Subjects were divided into four groups. CRPS patients were differentiated into two groups based on the presence or absence of sensory deficit on the face to clinical examination. The other two groups were composed of patients with other chronic pain syndromes and normal individuals without chronic pain or disability. Clinical and quantitative data were compared between groups.
One hundred forty-five CRPS patients, 69 patients with other pain conditions, and 26 normal individuals were studied.
A high incidence of trigeminal hypoesthesia was observed in CRPS patients. CRPS patients with trigeminal hypoesthesia manifested bilateral deficits of sensory function, with a predominant hemilateral pattern. These patients also manifested bilateral motor weakness with a more prominent hemiparetic pattern. Both sensory and motor deficits were greatest ipsilateral to the painful side of the body. These features differed significantly from those of CRPS patients lacking clinical trigeminal deficit, other pain patients, and normals. A lower cranial nerve abnormality (sternocleidomastoid weakness) and a myelopathic feature (Hoffman's reflex) were more common in CRPS patients with trigeminal hypoesthesia.
Nearly half of CRPS patients had abnormalities of spinothalamic, trigeminothalamic, and corticospinal function that may represent dysfunction of the medulla. One-third of the remaining CRPS patients had neuroimaging evidence of spinal cord or brain pathology. The majority of CRPS patients in this study have measurable abnormalities of the sensory and motor systems or neuroimaging evidence of spinal cord or brain dysfunction.
感觉和运动异常在复杂性区域疼痛综合征（CRPS）患者中很常见。本研究的目的是定义和描述这些异常，并就其起源的中枢神经系统区域提出一个假设。
通过临床检查和神经功能定量评估从研究对象获取数据。研究对象分为四组。CRPS患者根据临床检查时面部是否存在感觉缺陷分为两组。另外两组由患有其他慢性疼痛综合征的患者和无慢性疼痛或残疾的正常个体组成。对各组之间的临床和定量数据进行比较。
研究了145例CRPS患者、69例患有其他疼痛病症的患者和26名正常个体。
在CRPS患者中观察到三叉神经感觉减退的高发生率。患有三叉神经感觉减退的CRPS患者表现出双侧感觉功能缺陷，以单侧为主。这些患者还表现出双侧肌无力，偏瘫模式更为突出。感觉和运动缺陷在身体疼痛侧的同侧最为严重。这些特征与缺乏临床三叉神经缺陷的CRPS患者、其他疼痛患者和正常个体的特征有显著差异。较低的颅神经异常（胸锁乳突肌无力）和脊髓病特征（霍夫曼反射）在患有三叉神经感觉减退的CRPS患者中更为常见。
近一半的CRPS患者存在脊髓丘脑束、三叉丘脑束和皮质脊髓功能异常，这可能代表延髓功能障碍。其余三分之一的CRPS患者有脊髓或脑部病变的神经影像学证据。本研究中的大多数CRPS患者有可测量的感觉和运动系统异常或脊髓或脑功能障碍的神经影像学证据。
