Vol. 10 | Issue 2 | August-September 2022 | Page: 36-39 | Kishore Vellingiri, Anil K Bhat, Ashwath M Acharya, Mithun Pai G

DOI: https://doi.org/10.13107/jkoa.2022.v10i02.051

Authors: Kishore Vellingiri [1], Anil K Bhat [1], Ashwath M Acharya [1], Mithun Pai G [1]

[1] Department of Hand Surgery, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.

Address of Correspondence

Dr. Anil K. Bhat,
Associate Dean, Professor and Head Department of Hand Surgery, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
E-mail: anilbhatortho@gmail.com

Abstract

A painful and incapacitating condition known as complex regional pain syndrome (CRPS) can develop following a stroke, an injury to the limbs, or occasionally even without any known precipitating event. There are two categories for CRPS: Patients with CRPS-I do not have a verified nerve injury, but those with CRPS-II have linked nerve damage. Different physiopathology can cause CRPS. Both peripheral and central mechanisms, including neuroplastic changes like cortical reorganization, altered afferent-efferent feedback, and central autonomic dysregulation, have been observed. Peripheral mechanisms include inflammation, peripheral sensitization, and sympatho-afferent coupling. Patients with CRPS types 1 and 2 may experience clinical symptoms and their severity in this situation differently. The Budapest Criteria stipulates that a patient must exhibit at least one symptom in two or more of the four categories of sensory, vasomotor, sudomotor/edema, and/or motor/trophic at the time of evaluation. Ketamine, memantine, intravenous immunoglobulin, epidural clonidine, intrathecal clonidine/baclofen/adenosine, aerobic exercise, mirror therapy, virtual body swapping, and dorsal root ganglion stimulation may all have therapeutic benefit. Experiments have also shown an increasing role for peripheral sympathetic nerve blocks, as well as lumbar/thoracic sympathetic, stellate ganglion, and brachial plexus blocks.
Keywords: Complex regional pain syndrome, Budapest, Ketamine, Vitamin C

References

1. de Mos M, Sturkenboom MCJM and Huygen FJPM. Current understandings on complex regional pain syndrome. Pain Pract 2009; 9: 86–99.
2. Goh EL, Chidambaram S, Ma D. Complex regional pain syndrome: a recent update. Burns Trauma. 2017;5:2.
3. Birklein F, Handwerker HO. Complex regional pain syndrome: how to resolve the complexity?. Pain. 2001;94(1):1-6.
4. Aneja R, Grover R, Dhir V, Shankar S and Kumar A. Complex regional pain syndrome – Management options. Indian Journal of Rheumatology 2006; 1(3): 111–115.
5. Gierthmühlen J, Binder A and Baron R. Mechanism-based treatment in complex regional pain syndromes. Nat Rev Neurol 2014; 10(9): 518–528
6. Campero M, Bostock H, Baumann TK and Ochoa JL. A search for activation of C nociceptors by sympathetic fibers in complex regional pain syndrome. Clin Neurophysiol 2010; 477 121(7): 1072–1079.
7. Harden NR, Bruehl S, Perez RSGM, et al. Validation of proposed diagnostic criteria (the “Budapest Criteria”) for Complex Regional Pain Syndrome. Pain. 2010;150(2):268-274.
8. Duong S, Bravo D, Todd KJ, Finlayson RJ, Tran Q. Treatment of complex regional pain syndrome: an updated systematic review and narrative synthesis. Traitement du syndrome douloureux régional complexe : étude systématique actualisée et synthèse narrative. Can J Anaesth. 2018;65(6):658-684.
9. Méndez-Rebolledo G, Gatica-Rojas V, Torres-Cueco R, Albornoz-Verdugo M, Guzmán-Muñoz E. Update on the effects of graded motor imagery and mirror therapy on complex regional pain syndrome type 1: A systematic review. J Back Musculoskelet Rehabil. 2017;30(3):441-449.
10. Chitneni A, Patil A, Dalal S, Ghorayeb JH, Pham YN, Grigoropoulos G. Use of Ketamine Infusions for Treatment of Complex Regional Pain Syndrome: A Systematic Review. Cureus. 2021;13(10):e18910.
11. van den Berg C, de Bree PN, Huygen FJPM, Tiemensma J. Glucocorticoid treatment in patients with complex regional pain syndrome: A systematic review. Eur J Pain. 2022;26(10):2009-2035.
12. Kwak SG, Choo YJ, Chang MC. Effectiveness of prednisolone in complex regional pain syndrome treatment: A systematic narrative review. Pain Pract. 2022;22(3):381-390.
13. Dirckx M, Stronks DL, Groeneweg G, Huygen FJ. Effect of immunomodulating medications in complex regional pain syndrome: a systematic review. Clin J Pain. 2012;28(4):355-363.
14. Wiffen PJ, Derry S, Bell RF, et al. Gabapentin for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2017;6(6):CD007938.
15. Seth I, Bulloch G, Seth N, et al. Effect of Perioperative Vitamin C on the Incidence of Complex Regional Pain Syndrome: A Systematic Review and Meta-Analysis. J Foot Ankle Surg. 2022;61(4):748-754.
16. Giustra F, Bosco F, Aprato A, Artiaco S, Bistolfi A, Masse A. Vitamin C Could Prevent Complex Regional Pain Syndrome Type I in Trauma and Orthopedic Care? A Systematic Review of the Literature and Current Findings. Sisli Etfal Hastan Tip Bul. 2021;55(2):139-145.
17. Fassio A, Mantovani A, Gatti D, et al. Pharmacological treatment in adult patients with CRPS-I: a systematic review and meta-analysis of randomized controlled trials. Rheumatology (Oxford). 2022;61(9):3534-3546.
18. Vescio A, Testa G, Culmone A, et al. Treatment of Complex Regional Pain Syndrome in Children and Adolescents: A Structured Literature Scoping Review. Children (Basel). 2020;7(11):245
19. Mbizvo GK, Nolan SJ, Nurmikko TJ, Goebel A. Placebo responses in long-standing complex regional pain syndrome: a systematic review and meta-analysis. J Pain. 2015;16(2):99-115.

                                          (Abstract Text HTML)      (Download PDF)