Complex regional pain syndrome: an evolving perspective

2020 ◽  
pp. postgradmedj-2020-137808
Author(s):  
Steven Cutts ◽  
Shafat Gangoo ◽  
Sriram Harish Srinivasan ◽  
Nitin Modi ◽  
Chandra Pasapula ◽  
...  

BackgroundComplex regional pain syndrome (CRPS) is a heterogenous and poorly understood condition that can be provoked by quite minor injuries. The symptoms and signs of CRPS persist, long after the patient has recovered from the inciting event. In some cases, there is a clear association with a peripheral nerve injury. The degree of disability produced by CRPS is often out of proportion to the scale of the original insult and the condition is associated with protracted recovery times and frequent litigation.MethodsWe have performed a PubMed literature search, referenced landmark papers in the field and included a national expert in peripheral nerve injury and repair in our team of authors.Results and ConclusionsThe diagnostic criteria for CRPS have changed repeatedly over the last two centuries and much of the historical literature is difficult to compare with more recent research. In this review article, we consider how our understanding of the condition has evolved and discuss its pathogenesis, its apparent heterogenicity and the various investigations and treatments available to the clinician.

Pain ◽  
2012 ◽  
Vol 153 (4) ◽  
pp. 765-774 ◽  
Author(s):  
Janne Gierthmühlen ◽  
Christoph Maier ◽  
Ralf Baron ◽  
Thomas Tölle ◽  
Rolf-Detlef Treede ◽  
...  

2009 ◽  
Vol 13 (S1) ◽  
Author(s):  
J. Gierthmühlen ◽  
C. Maier ◽  
R. Baron ◽  
T. Tölle ◽  
R.D. Treede ◽  
...  

2002 ◽  
Vol 87 (4) ◽  
pp. 1763-1771 ◽  
Author(s):  
Antoni Valero-Cabré ◽  
Xavier Navarro

We investigated the changes induced in crossed extensor reflex responses after peripheral nerve injury and repair in the rat. Adults rats were submitted to non repaired sciatic nerve crush (CRH, n = 9), section repaired by either aligned epineurial suture (CS, n = 11) or silicone tube (SIL4, n = 13), and 8 mm resection repaired by tubulization (SIL8, n = 12). To assess reinnervation, the sciatic nerve was stimulated proximal to the injury site, and the evoked compound muscle action potential (M and H waves) from tibialis anterior and plantar muscles and nerve action potential (CNAP) from the tibial nerve and the 4th digital nerve were recorded at monthly intervals for 3 mo postoperation. Nociceptive reinnervation to the hindpaw was also assessed by plantar algesimetry. Crossed extensor reflexes were evoked by stimulation of the tibial nerve at the ankle and recorded from the contralateral tibialis anterior muscle. Reinnervation of the hindpaw increased progressively with time during the 3 mo after lesion. The degree of muscle and sensory target reinnervation was dependent on the severity of the injury and the nerve gap created. The crossed extensor reflex consisted of three bursts of activity (C1, C2, and C3) of gradually longer latency, lower amplitude, and higher threshold in control rats. During follow-up after sciatic nerve injury, all animals in the operated groups showed recovery of components C1 and C2 and of the reflex H wave, whereas component C3 was detected in a significantly lower proportion of animals in groups with tube repair. The maximal amplitude of components C1 and C2 recovered to values higher than preoperative values, reaching final levels between 150 and 245% at the end of the follow-up in groups CRH, CS, and SIL4. When reflex amplitude was normalized by the CNAP amplitude of the regenerated tibial nerve, components C1 (300–400%) and C2 (150–350%) showed highly increased responses, while C3 was similar to baseline levels. In conclusion, reflexes mediated by myelinated sensory afferents showed, after nerve injuries, a higher degree of facilitation than those mediated by unmyelinated fibers. These changes tended to decline toward baseline values with progressive reinnervation but still remained significant 3 mo after injury.


2020 ◽  
Author(s):  
Camila Cardoso Diogo ◽  
Bárbara Fonseca ◽  
Francisca S.M. Almeida ◽  
Luís Maltez da Costa ◽  
José Eduardo Pereira ◽  
...  

Abstract Background: Analysis of locomotion is often used as a measure for impairment and recovery following experimental peripheral nerve injury. Compared to rodents, sheep offer several attractive features as an experimental model for studying peripheral nerve regeneration. There are no studies on locomotion outcomes after peripheral nerve injury and repair in the sheep model. In the present study, we performed and compared two-dimensional (2D) and, for the first time, three-dimensional (3D) hindlimb kinematics during obstacle avoidance in the ovine model. This study aimed to obtain kinematic data to serve as a template for an objective assessment of the ankle joint motion in future studies of common peroneal nerve (CP) injury and repair in the ovine model. Results: The strategy used by the sheep to bring the hindlimb over a moderately high obstacle, set to 10% of its hindlimb length, was the pronounced knee, ankle and metatarsophalangeal flexion when approaching and clearing the obstacle. Despite the overall time course kinematic patterns about the hip, knee, ankle, and metatarsophalangeal were identical, we found significant differences between values of the 2D and 3D joint angular motion. Conclusions: Our results show that the most apparent changes that occurred during the gait cycle were for the ankle and metatarsophalangeal joints, whereas the hip and knee joints were much less affected. Data and techniques described here are likely to be useful for an objective assessment of altered gait after CP injury and repair in an ovine model.


2015 ◽  
Vol 8 (6) ◽  
pp. 553-564 ◽  
Author(s):  
Y. Xiao ◽  
A. Faucherre ◽  
L. Pola-Morell ◽  
J. M. Heddleston ◽  
T.-L. Liu ◽  
...  

2005 ◽  
Vol 30 (3) ◽  
pp. 252-264 ◽  
Author(s):  
C. JEROSCH-HEROLD

Recovery of sensibility after peripheral nerve injury and repair needs to be assessed using psychometrically robust measures. In this study the literature was reviewed to identify what tests are available to quantify sensibility and to assess their validity, reliability and responsiveness. The databases Medline, CINAHL, Embase and AMED were searched for studies reporting the psychometric properties of sensibility tests. While there is a plethora of tests and studies reporting the outcomes after peripheral nerve suture only a few of the tests have evidence of validity, reliability and responsiveness. Currently the touch threshold test using monofilaments such as the Weinstein Enhanced Sensory Test (WEST) or Semmes–Weinstein Monofilament Test (SWMT) and the shape–texture identification (STI™) test for tactile gnosis are the only tests which meet criteria for a standardized test and have had their psychometric properties evaluated and quantified.


2006 ◽  
Vol 1098 (1) ◽  
pp. 49-60 ◽  
Author(s):  
Anna Puigdellívol-Sánchez ◽  
Alberto Prats-Galino ◽  
Carl Molander

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