scholarly journals Review of complex regional pain syndrome and the role of the neuroimmune axis

2021 ◽  
Vol 17 ◽  
pp. 174480692110066
Author(s):  
Amrita Prasad, MD ◽  
Krishnan Chakravarthy, MD
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Clinical Studies ◽  
Pain Treatment ◽  
Relevant Literature ◽  
Pain Syndrome ◽  
Immunomodulatory Effects ◽  
Pain Mechanisms ◽  
Preclinical And Clinical Studies ◽  
Neuroimmune Axis

Background Complex regional pain syndrome (CRPS) is a progressive and painful disease of the extremities that is characterized by continuous pain inconsistent with the initial trauma. CRPS is caused by a multi-mechanism process that involves both the peripheral and central nervous system, with a prominent role of inflammation in CRPS pathophysiology. This review examines what is currently known about the CRPS inflammatory and pain mechanisms, as well as the possible impact of neurostimulation therapies on the neuroimmune axis of CRPS. Study design A narrative review of preclinical and clinical studies provided an overview of the pain and inflammatory mechanisms in CRPS and addressed the effect of neurostimulation on immunomodulation. Methods A systematic literature search was conducted based on the PRISMA guidelines between September 2015 to September 2020. Data sources included relevant literature identified through searches of PubMed, Embase and the Cochrane Database of Systematic Reviews. Results Sixteen preclinical and eight clinical studies were reviewed. Preclinical studies identified different mechanisms of pain development in the acute and chronic CRPS phases. Several preclinical and clinical studies investigating inflammatory mechanisms, autoimmunity, and genetic profiles in CRPS, supported a role of neuroinflammation in the pathophysiology of CRPS. The immunomodulatory effects of neurostimulation therapy is still unclear, despite clinical improvement in the CRPS patients. Conclusions Increasing evidence supports a role for inflammation and neuroinflammation in CRPS pathophysiology. Preliminary neurostimulation findings, together with the role of (neuro)inflammation in CRPS, seems to provide a compelling rationale for its use in CRPS pain treatment. The possible immunomodulatory effects of neurostimulation opens new therapeutic possibilities, however further research is needed to gain a better understanding of the working mechanisms.

scholarly journals Venipuncture Induced Complex Regional Pain Syndrome Presenting as Inflammatory Arthritis

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Punit Pruthi ◽  
Pramod Arora ◽  
Manoj Mittal ◽  
Anugrah Nair ◽  
Waqia Sultana
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Inflammatory Arthritis ◽  
Young Male ◽  
Pain Syndrome ◽  
Poor Response ◽  
History Of ◽  
Diagnostic Modalities ◽  
Musculoskeletal Ultrasonography ◽  
The Right

Venipuncture is one of the most commonly done medical procedures. We report a unique case of a 23-year-old young male who presented with features suggestive of inflammatory arthritis. The symptoms, which initially started on the right side, also involved the other side after a few weeks. Although the patient’s symptoms and signs were simulating inflammatory arthritis, he had atypical features like poor response to anti-inflammatory medicines and normal laboratory parameters. His musculoskeletal ultrasonography was also not suggestive of arthritis. His history was reviewed and on direct questioning he revealed a history of venipuncture for blood sample withdrawal, done from right antecubital region for routine health check on the day prior to the onset of symptoms. Complex regional pain syndrome was suspected and triple-phase radioisotope bone scan was done which was highly suggestive of this diagnosis. The patient was managed with multidimensional approach and responded very well to the treatment. Complex regional pain syndrome is usually not thought of in the initial differential diagnosis of inflammatory arthritis. In this report we highlight the need to elicit the often overlooked history of trivial trauma like venipuncture, especially in atypical cases of arthritis. Also the role of newer diagnostic modalities in such cases is emphasized.

scholarly journals Increased calcium-mediated cerebral processes after peripheral injury: possible role of the brain in complex regional pain syndrome

2020 ◽  
Vol 33 (2) ◽  
pp. 131-137
Author(s):  
Francis Sahngun Nahm ◽  
Jae-Sung Lee ◽  
Pyung-Bok Lee ◽  
Eunjoo Choi ◽  
Woong Ki Han ◽  
...  
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Pain Syndrome ◽  
Peripheral Injury ◽  
The Brain

CRPS: what’s in a name? Taxonomy, epidemiology, neurologic, immune and autoimmune considerations

2019 ◽  
Vol 44 (3) ◽  
pp. 376-387 ◽  
Author(s):  
Michael d‘A Stanton-Hicks
Keyword(s):  
Nervous System ◽  
Autonomic Nervous System ◽  
Complex Regional Pain Syndrome ◽  
Severity Score ◽  
Clinical Management ◽  
Pain Syndrome ◽  
Clinical Syndromes ◽  
Shed Light ◽  
Historical Origins

This account of the condition now termed complex regional pain syndrome (CRPS) spans approximately 462 years since a description embodying similar clinical features was described by Ambroise Paré in 1557. While reviewing its historical origins, the text describes why it became necessary to change the taxonomies of two clinical syndromes with similar pathophysiologies to one which acknowledges this aspect but does not introduce any mechanistic overtones. Discussed at length is the role of the sympathetic component of the autonomic nervous system (ANS) and why its dysfunction has both directly and indirectly influenced our understanding of the inflammatory aspects of CRPS. As the following article will show, our knowledge has expanded in an exponential fashion to include musculoskeletal, immune, autoimmune, central and peripheral nervous system and ANS dysfunction, all of which increase the complexity of its clinical management. A burgeoning literature is beginning to shed light on the mechanistic aspects of these syndromes and the increasing evidence of a genetic influence on such factors as autoimmunity, and its importance is also discussed at length. An important aspect that has been missing from the diagnostic criteria is a measure of disease severity. The recent validation of a CRPS Severity Score is also included.

The Role of Periaqueductal Gray and Cingulate Cortex During Suppression of Pain in Complex Regional Pain Syndrome

2011 ◽  
Vol 27 (9) ◽  
pp. 796-804 ◽  
Author(s):  
Wolfgang Freund ◽  
Arthur P. Wunderlich ◽  
Gregor Stuber ◽  
Florian Mayer ◽  
Peter Steffen ◽  
...  
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Pain Syndrome ◽  
Cingulate Cortex ◽  
Periaqueductal Gray

scholarly journals The role of enhanced cutaneous IL-1β signaling in a rat tibia fracture model of complex regional pain syndrome

Pain ◽  
2009 ◽  
Vol 144 (3) ◽  
pp. 303-313 ◽  
Author(s):  
Wen-wu Li ◽  
Ilya Sabsovich ◽  
Tian-Zhi Guo ◽  
Rong Zhao ◽  
Wade S. Kingery ◽  
...  
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Pain Syndrome ◽  
Tibia Fracture ◽  
Fracture Model ◽  
Rat Tibia

scholarly journals Complex Regional Pain Syndrome (CRPS/RSD) and Neuropathic Pain: Role of Intravenous Bisphosphonates as Analgesics

2008 ◽  
Vol 8 ◽  
pp. 229-236 ◽  
Author(s):  
Jennifer Yanow ◽  
Marco Pappagallo ◽  
Letha Pillai
Keyword(s):  
Clinical Trials ◽  
Neuropathic Pain ◽  
Animal Models ◽  
Complex Regional Pain Syndrome ◽  
Bone Pain ◽  
Treatment Options ◽  
Pain Syndrome ◽  
Pain Pathways ◽  
Intravenous Bisphosphonates

Neuropathic pain is a sequela of dysfunction, injuries, or diseases of the peripheral and/or central nervous system pain pathways, which has historically been extremely difficult to treat. Complex regional pain syndrome (CRPS) types 1 and 2 are neuropathic pain conditions that have a long history in the medical literature but whose pathophysiology remains elusive and whose available treatment options remain few. While an exact animal model for CRPS doesn't yet exist, there are several animal models of neuropathic pain that develop behaviors of hypersensitivity, one of the hallmark signs of neuropathic pain in humans.Bisphosphonates have been used for pathologic conditions associated with abnormal bone metabolism, such as osteoporosis, Paget’s disease and cancer-related bone pain for many years. More recently, results of clinical trials have indicated the potential role of bisphosphonates in the treatment of CRPS/RSD.In this paper we will review the preclinical studies regarding the use of bisphosphonates as analgesics in animal models of neuropathic pain, and also summarize the clinical trials that have been done to date. We will give an overview of bisphosphonate pharmacology and discuss several potential mechanisms by which bisphosphonates may be analgesic in CRPS/RSD and bone pain of noncancer origin.

scholarly journals Role of Biphosphonates and Lymphatic Drainage Type Leduc in the Complex Regional Pain Syndrome (Shoulder–Hand Syndrome)

Pain Medicine ◽  
2009 ◽  
Vol 10 (1) ◽  
pp. 179-185 ◽  
Author(s):  
Andrea Santamato ◽  
Maurizio Ranieri ◽  
Francesco Panza ◽  
Vincenzo Solfrizzi ◽  
Vincenza Frisardi ◽  
...  
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Pain Syndrome ◽  
Lymphatic Drainage

scholarly journals Ketamine for Non-Neuropathic Pain

2021 ◽  
Author(s):  
Subbulakshmi Sundaram ◽  
Ashok Swaminathan Govindarajan
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Complex Regional Pain Syndrome ◽  
Antinociceptive Effect ◽  
Pain Syndrome ◽  
Well Being ◽  
Pain Mechanisms ◽  
Cardiovascular Side Effects ◽  
Chronic Pain Conditions ◽  
Rescue Agent

Chronic pain is one of the leading causes of years lost to disability, as most of the time it is refractory to conventional treatment. Recent advances in understanding the pain mechanisms have favored the use of ketamine as a rescue agent in refractory chronic pain conditions, as it has potential modulating effect on both sensory-discriminative and affective motivational components of pain. Preclinical studies also suggested the antinociceptive effect of sub anesthetic dose of ketamine against central and peripheral neuropathic pain conditions and non-neuropathic pain conditions such as inflammatory and nociceptive pain states. Subanesthetic infusion of ketamine along with adjuvants such as midazolam and clonidine is found to reduce the psychomimetic and cardiovascular side effects of ketamine. Even though the consensus guidelines for intravenous use of ketamine for chronic pain advocate the use of ketamine only for complex regional pain syndrome, various other clinical studies suggested its role in other refractory painful conditions. Hence the present topic focuses specifically on the effect of ketamine on non-neuropathic pain conditions such as complex regional pain syndrome, fibromyalgia, headache, ischemic limb pain, etc. Many studies had shown that ketamine not only reduces the pain scores but also the analgesic medications, which further improves the well-being and quality of life.

Sign in / Sign up

Export Citation Format

Share Document