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PubMed2005

[CRPS type I psychological origin-case report].

The complex regional pain syndrome type I (CRPS I)-formerly named Sudeck's atrophy or reflex sympathetic dystrophy (RSD)-describes a complex of symptoms with chronic, poorly controllable pain, autonomic, sensomotor and trophic alterations. It is mainly caused by trauma or surgery. We describe the rare case of a spontaneous manifestation of a CRPS I in an adolescent patient with typical clinical and radiological findings and the recurrence of symptoms after a one-year symptom-free interval. Symptoms were resolved by an intense multimodal therapy concept. The likely psychosocial origin in this case is discussed. Clinical appearance, diagnostic means and therapy of the CRPS are described.

Adolescent↗
PubMed2000

Outcome measures for complex regional pain syndrome type I: an overview in the context of the international classification of impairments, disabilities and handicaps.

PURPOSE: To determine the availability of relevant and objective outcome measures concerning complex regional pain syndrome type I (CRPS I) for rehabilitation medicine. METHOD: Outcome measures were classified according to the International Classification of Impairments, Disabilities and Handicaps. For each outcome measure a description of concept, operationalization into variables and instrument was given. We performed a PUBMED MEDLINE search (1980-1998) using the following keywords: complex regional pain syndrome, reflex sympathetic dystrophy, impairment, disability, handicap, (long-term) outcome and effect/efficacy. RESULTS: Most outcome measures were concentrated on impairments, whereas measures at the level of disabilities and handicaps, the most relevant levels for rehabilitation medicine, were mentioned in very few studies. Objective outcome measures were merely found at the level of impairment. CONCLUSION: The results indicate a need for the development of relevant outcome measures at the level of disabilities and handicaps that can objectively measure treatment efficacy for CRPS I.

Activities of Daily Living↗
PubMed2005

The role of nuclear medicine in the evaluation of complex regional pain syndrome type I.

Chronic pain resulting from complex regional pain syndrome type I (CRPS I), formerly referred to as the reflex sympathetic dystrophy syndrome (RSDS), is a diagnostic challenge to the clinician. It involves multiple organ systems, namely peripheral as well as central nervous, vascular, soft tissue, and skeletal. It usually develops as a consequence of trauma, without nerve injury. Signs and symptoms vary depending on the time since the initiating event, and there is no confirmatory histopathologic diagnosis. This article summarizes the current consensus on the classification, pathophysiology, and diagnostic approaches, emphasizing the role of scintigraphy in the management of this multisystem disorder.

Bone Diseases↗
PubMed1999

Subcutaneous infusion of lidocaine provides effective pain relief for CRPS patients.

CASE REPORT: Nine patients with Complex Regional Pain Syndrome types I and/or II (CRPS), previously known as reflex sympathetic dystrophy (RSD) and causalgia, respectively, were selected for treatment with a continuous four to eight week subcutaneous infusion of 10% lidocaine. RESULTS AND CONCLUSIONS: Five patients completed the infusion treatment. The treatment significantly alleviated much of the pain and other symptomatology (i.e., dysesthesia, allodynia, hyperpathia, color and temperature changes, decreased range of motion of involved extremities, changes in hair and nail growth, etc.) commonly observed for CRPS/RSD patients. Upon discontinuation of the continuous subcutaneous infusion, patients appear to maintain the pain relief obtained. Periodic maintenance infusions may be needed.

Adult↗
PubMed1997

Interstitial laser photocoagulation of osteoid osteomas with use of CT guidance.

PURPOSE: To evaluate interstitial laser photocoagulation (a minimally invasive percutaneous technique of thermal destruction of deep-seated tumors, with low-power laser energy) in local destruction of osteoid osteoma, with computed tomographic (CT) guidance. MATERIALS AND METHODS: Fifteen patients (age range, 8-48 years) with presumed osteoid osteoma were treated with CT-guided interstitial laser photocoagulation of the nidus. A high-power semiconductor diode laser (805 nm) with a 400-microm optical fiber was used. The fiber was introduced into the nidus through an 18-gauge needle. Around the fiber tip, well-defined coagulative necroses from 5 to 9 mm (energy delivery, 400-1,000 J) were obtained. RESULTS: Fourteen patients had complete pain relief, which was apparent within 24 hours in eight patients. One patient had recurrence of pain after 6 weeks. The remaining nidus was treated a second time, with complete relief. Treatment was unsuccessful in one patient, and surgical excision was performed. Daily activities were not restricted after the intervention. All patients were followed up for more than 1 year, with no sign of recurrence. The only notable complication was a mild reflex sympathetic dystrophy of the wrist in one patient. Sclerosis of the nidus was observed 4-6 months after the procedure. CONCLUSION: Percutaneous interstitial laser photocoagulation of osteoid osteoma seems to be a promising, simple, precise, and minimally invasive alternative to traditional surgical and percutaneous ablations.

Activities of Daily Living↗
PubMed2000

[Comparison of manual lymph drainage with physical therapy in complex regional pain syndrome, type I. A comparative randomized controlled therapy study].

Sympathetic blockage and physiotherapy are among the most effective treatment approaches for the complex regional pain syndrome (CRPS). It is important to institute the treatment as early as possible in order to avoid major functional limitations of the affected limb. Unfortunately, there is a paucity of vigorously applied randomised or placebo-controlled trials for these therapeutic approaches. A prospective randomised study of 35 outpatient clinic patients with type I complex regional pain syndrome of the lower extremities lasting less than 6 months is described. One of two treatments, exercise alone or exercise in combination with manual lymph drainage, was applied for six weeks, three times a week, to the affected limb. Clinical and subjective parameters for pain, swelling, temperature, and range of motion were evaluated. Manual lymph drainage was chosen as adequate therapy for oedema reduction, whereas exercise was applied as standard therapy for contracture prophylaxis in reflex sympathetic dystrophy. Both groups were asked not to use analgesics but received extensive instructions for avoiding pain. Significant improvements in clinical parameters were observed in both groups, but no significant effect between treatment groups was found. Pain measurement alone with a verbal rating scale showed a tendency towards greater pain reduction in the group receiving lymph drainage. The results indicate that, during the first 6 months of complex regional pain syndrome type I, manual lymph drainage provides no additional benefit when applied in conjunction with an intensive exercise program.

Drainage↗
PubMedDate not supplied

Radiofrequency lumbar sympatholysis. The evolution of a technique for managing sympathetically maintained pain.

BACKGROUND AND OBJECTIVES: To develop lumbar radiofrequency sympatholysis for the relief of pain in patients with neuropathic pain who had previously responded to sympathectomy or sympathetic blocks. METHODS: The technique described by Sluijter was modified to attempt to obtain long lasting pain relief in each patient. No one technique was universally applicable. The variations in technique are illustrated by the case reports. The basic technique that evolved is as follows: a 20-gauge 15-cm insulated needle with a 5-mm active tip was inserted in the direction of an x-ray beam (C arm). The initial target was slightly cephalad to the middle of the L3 vertebra. Contrast medium was injected to confirm the location of the needle. The temperature of the tip of the needle was controlled at 80 degrees C for 90 seconds. RESULTS: Thirty-eight procedures were performed on 20 patients. Reproduction of the pain for which the sympatholysis was undertaken, induced dysesthesia, spread of dye, rapidity of temperature rise in the legs, and increase in pulse volume of the toes were useful guides to proper placement of the needle. Five patients continue to be pain free 5 months to 3 years after the last radiofrequency sympatholysis. Fifteen had temporary relief or no relief at all. The procedure was temporarily complicated by an excessively hot, swollen foot, and postsympathectomy neuralgia in a few cases. CONCLUSIONS: A single technique of radiofrequency sympatholysis does not appear to be applicable to all patients with reflex sympathetic dystrophy or sympathetically maintained pain. Despite early successful sympathetic block with radiofrequency, as confirmed by a warm foot, long lasting pain relief was difficult to obtain. The author concludes that individualized patient management is necessary when considering radiofrequency sympatholysis in the treatment of patients with sympathetically maintained pain.

Adult↗
PubMed1997

[Recent, closed trapezio-metacarpal luxation, treated by pinning.Apropos of 7 cases with a median follow-up of 8 years].

Seven cases of acute and closed traumatic dislocation of the trapezio-metacarpal joint treated by percutaneous pinning adapted by Wiggins are reported with an average follow-up of eight years. Seven patients (five men and two women) aged 18 to 62 were treated. The injury was due to a road traffic accident in four cases. The dominant hand was injured in six cases. The metacarpal base was always dislocated dorsally and closed reduction always remained unstable. All cases consisted of closed dislocation but in two cases dislocation was associated with upper limb fractures. On the initial radiographs no patients had degenerative changes. All patients were treated as an emergency or the following during the days injury by reduction and stabilization by one or two percutaneous kirschner wires followed by a scaphoid cast for three to six weeks. All patients were followed and reviewed for this study between two and thirteen years (mean eight years) after injury. Enquiries were made about return to work, pain, stability, range of movement, key-pinch and grasp compared with the uninjured side. The joint was examined radiographically with particular attention to the presence of subluxation and degenerative changes. 2 patients with associated complex injury of the upper limb developed reflex sympathetic dystrophy. 2 patients had moderate pain, 2 patients had limitation of joint movement, 1 patient presented a reduction of strength (pinch and grasp) but none had subluxation, instability, or degenerative changes. Closed reduction and stabilization by percutaneous pinning is a simple method and gives good or excellent results in the treatment of acute traumatic dislocation of the trapezio-metacarpal joint.

Accidents, Traffic↗
PubMed1997

[A historical review of algodystrophy: part II].

Second part of this paper deals with developing of the etiopathological concepts on algodystrophy. Variety of terms have been used to describe the syndrome during over hundred years. The name "reflex sympathetic dystrophy" introduced by J.A. Evans in 1946 is commonly used in English and American literature. French rheumatologists proposed the term "algodystrophy" in 1960; this seemed very satisfactory, because did not imply involvement of any particular tissue, localization or etiology but reflected the combination of pain and dystrophic changes. Current taxonomic concepts were also presented e.g. "complex regional pain syndrome". A discrepancies on the incidence rates of the condition were mentioned and their causes suggested. Current diagnostic criteria of the syndrome were presented. The contribution of Polish authors was reminded. In spite of considerable progress in understanding of the syndrome, its many aspects remain controversial or obscure.

England↗
PubMed1993

A functional and psychosocial assessment of patients with post-Sudeck atrophy amputation.

Twelve patients with reflex sympathetic dystrophy were referred to a comprehensive orthopaedic rehabilitation center after failure of conservative management. Ten underwent amputation of the affected limb and, although functional improvement occurred in the patients undergoing lower limb amputation, psychosocial dysfunction persisted. All the patients required psychological support. In cases of post-Sudeck amputation, early orthopaedic diagnosis and referral to a comprehensive treatment center are recommended. In the 12 cases described here, apart from the obvious limb pathology, severe psychological inadequacies were found to be present.

Activities of Daily Living↗
PubMed1994

Limb dystonia following electrical injury.

Electrical injuries of the extremities may cause paralysis, muscle atrophy, sensory deficit, causalgia, and reflex sympathetic dystrophy (RSD). Limb dystonia has rarely been reported following electrical injury to an extremity, although it may result from cerebral hemisphere electrical trauma. Following electrical injury to the upper extremity, three patients developed limb dystonia accompanied by severe pain and sensory symptoms in two patients and features of RSD in one patient. Two patients received botulinum toxin injections without functional benefit. The mechanism of dystonia following peripheral trauma is unknown but may relate to reorganization of central synaptic connections, possibly in the spinal cord.

Adult↗
PubMed1999

Low dose gabapentin for shoulder-hand syndrome induced by phenobarbital: a three-month study.

Both the pathogenetic interpretation and treatment of phenobarbital-induced rheumatism are uncertain. The reflex sympathetic dystrophy syndrome which complicates antiepileptic drug therapy is a problem for rheumatologists. The aim of our study was to test the effect of gabapentin as an additional therapy in patients suffering from phenobarbital-induced shoulder-hand syndrome when these patients were treated with gabapentin instead of receiving phenobarbital only. After a 3-month observation period, the pain and the movement range from the shoulder to the wrist and to the hand improved more than in the control group using acetaminophen. Further studies are required to confirm this observation.

Acetates↗
PubMed1993

Recognizable dysfunction syndromes.

Many presentations of dysfunctional postures of the upper extremity have been described in the literature. Attempts have been made to differentiate these situations by describing their physical and pathophysiologic circumstances. Unfortunately, these attempts to define and differentiate the various conditions that are recognizable patterns of upper-extremity dysfunction syndromes have not been entirely successful. This failure is perhaps because hard and firm diagnostic criteria that would specifically delineate each of these circumstances are wanting. At best, it can be said that there are patients who will present with pain as their primary complaint and who present with physical findings that would best support a diagnosis of reflex sympathetic dystrophy. There are others who present with dysfunctional postures in which pain is not a primary presenting complaint. In addition, are those in an intermediate zone, where pain and dysfunction are intermixed, and where prolonged observation may help to place them in one category or the other. Recent evidence has suggested that patients with painless dysfunctional syndrome benefit from the attentions of psychically oriented providers. The timing and appropriateness of such interventions require further study. The literature of the behavioral scientists and that of the practitioners of the medical arts is bereft of concrete explanations for causation and specific definitive solutions.

Adolescent↗
PubMed1990

Intravenous regional sympatholysis: a double-blind comparison of guanethidine, reserpine, and normal saline.

This double-blind, randomized study was designed to compare the effectiveness of intravenous regional sympatholysis using guanethidine, reserpine and normal saline. Twenty-one patients with reflex sympathetic dystrophy of an upper or lower extremity were enrolled and received intravenous regional blockade (IVRB) with one of the three medications. There was significant pain relief in all three groups at 30 min. There were no significant differences among the three groups in the degree of pain relief, the number of patients obtaining pain relief in the 30 min after the block, or the number of patients reporting more than 50% pain relief for more than 24 hr. The saline group's high rate of pain relief could be partially due to a mechanism of tourniquet-induced analgesia.

Adult↗
PubMed1994

Intraspinal delivery of opiates by an implantable, programmable pump in patients with chronic, intractable pain of nonmalignant origin.

The use of intraspinal therapy for the management of intractable pain from nonmalignant causes has not been widely discussed. An implantable, externally programmable infusion pump was used for intraspinal delivery of morphine sulfate to 15 patients with intractable pain from reflex sympathetic dystrophy, arachnoiditis after spinal surgery, or an unknown cause. Dosage patterns were individualized. At follow-up ranging from 2 to 44 months, pain relief was reported as excellent by 8 patients, good by 3, and fair by 4. Six patients have returned to work. Two patients chose to terminate therapy. Few complications occurred, but most patients needed increasingly larger doses over time to maintain pain relief. Intraspinal infusion of morphine sulfate by use of an implanted, externally programmable pump is safe and effective in selected patients with intractable pain of nonmalignant origin.

Adult↗
PubMed2000

A follow-up study of 14 young adults with complex regional pain syndrome type I.

The purpose of this study was to evaluate the present symptom experience and functional status of 27 young adults with Reflex Sympathetic Dystrophy Syndrome, now known as Complex Regional Pain Syndrome (CRPS) type I. All were originally diagnosed and studied more than 12 years ago. Only 15 subjects could be located; 14 participated in this research. A descriptive exploratory research design was utilized. A tool was designed to gather data about daily living variables, psychosocial variables, and symptom variables. Although many questions required the use of Likert scales, there were some open-ended questions to capture the qualitative descriptions of the participants' symptom experiences. Findings contribute to the clinical literature about CRPS and its effects on clients over time.

Activities of Daily Living↗
PubMed1991

[Sudeck's disease--MRT as a new diagnostic procedure].

In this prospective study, we determined the value of MR as an imaging technique in diagnosis and therapy with the option of simultaneous assessment of bone and soft tissue. 20 patients with clinical diagnosis of reflex sympathetic dystrophy syndrome (RSDS) and positive results in radiogram and three-phase radionuclide bone scanning were examined by MR, using T1- and T2-weighted images before and after Gadolinium-DTPA i.v. Soft tissue and bone signal intensity changes can be classified in our diagnostic-therapeutic scheme and proven by histopathological changes. The differentiation between clinical stages is possible and allows an evaluation of course and therapy. The higher costs are justified by shorter examination time without using radiation.

Adult↗
PubMed2001

[Stellate ganglion radiofrequency neurolysis under CT guidance. Preliminary study].

Sympathetically maintained pain syndrome of the upper limb is difficult to treat even with high doses of specific medication. Stellate ganglion block by in situ injection of a local anesthetic is an efficient and accepted method for diagnosis and treatment. The sedative effect is however transitory linked to the short effect of the drug. CT guidance, displaying an excellent contrast between soft tissues, bones, vessels and nerves, is a well suited and safe mean of guidance. Seven patients suffering from reflex sympathetic dystrophy were treated by stellate ganglion radiofrequency (RF) neurolysis at two sites (C7 and T1). Patients were evaluated for pain before and immediately after the procedure and at three months. Four patients had a significant (50%) pain relief lasting at 3 month. One patient had a temporary pain (one week) and 2 no pain relief. No patient had a Horner syndrome. One patient had a temporary neuralgia of surrounding nerves (brachial plexus). RF neurolysis of stellate ganglion under CT-guidance is precise and appears efficient but further investigation on a larger cohort of patients is needed.

Adult↗