Quality of life after amputation in patients with advanced complex regional pain syndrome: a systematic review

The majority of included studies (8 out of 11, n = 54) supported the concept of considering amputation for selected, unresponsive cases of complex regional pain syndrome (CRPS) as a justifiable alternative to an unsuccessful multimodality nonoperative option. Of patients who underwent amputation, 66% experienced improvement in quality of life (QOL) and 37% were able to use a prosthesis, 16% had an obvious decline in QOL and for 12% of patients, no clear details were given, although it was suggested by authors that these patients also encountered deterioration after amputation. Complications of phantom limb pain, recurrence of CRPS and stump pain were predominant risks and were noticed in 65%, 45% and 30% of cases after amputation, respectively and two-thirds of patients were satisfied. Amputation can be considered by clinicians and patients as an option to improve QOL and to relieve agonizing, excruciating pain of severe, resistant CRPS at a specialized centre after multidisclipinary involvement but it must be acknowledged that evidence is limited, and the there are risks of aggravating or recurrence of CRPS, phantom pain and unpredictable consequences of rehabilitation. Amputation, if considered for resistant CRPS, should be carried out at specialist centres and after MDT involvement before and after surgery. It should only be considered if requested by patients with poor quality of life who have failed to improve after multiple treatment modalities. Further high quality and comprehensive research is needed to understand the severe form of CRPS which behaves differently form less severe stages. Cite this article: EFORT Open Rev 2019;4:533-540. DOI: 10.1302/2058-5241.4.190008

Download Full-text

Poststroke Pain

Seminars in Neurology ◽

10.1055/s-0040-1722641 ◽

2021 ◽

Vol 41 (01) ◽

pp. 067-074

Author(s):

Seoyon Yang ◽

Min Cheol Chang

Keyword(s):

Quality Of Life ◽

Complex Regional Pain Syndrome ◽

Shoulder Pain ◽

Conventional Treatment ◽

Pain Syndrome ◽

Psychological State

AbstractPain is common but often underrecognized after stroke. Poststroke pain (PSP) hinders recovery, impairs quality of life, and is associated with the psychological state of patients with stroke. The most common subtypes of PSP include central PSP, complex regional pain syndrome, shoulder pain, spasticity-related pain, and headache. The pathophysiologies of these PSP subtypes are not yet clearly understood, and PSP is refractory to conventional treatment in many patients. However, recent studies have proposed potential pathophysiologies of PSP subtypes, which may help prioritize therapies that target specific mechanisms.

Download Full-text

Factors related to phantom limb pain and its effect on quality of life

Somatosensory & Motor Research ◽

10.1080/08990220.2021.1973405 ◽

2021 ◽

pp. 1-5

Author(s):

Cemile S. Polat ◽

Hatice E. Konak ◽

Elif U. Altas ◽

Meltem G. Akıncı ◽

Sule S. Onat

Keyword(s):

Quality Of Life ◽

Phantom Limb Pain ◽

Phantom Limb ◽

Limb Pain

Download Full-text

Prednisolone in Complex Regional Pain Syndrome

January 2018 - Pain Physician ◽

10.36076/ppj.2014/17/179 ◽

2014 ◽

Vol 2;17 (2;3) ◽

pp. 179-185 ◽

Cited By ~ 3

Author(s):

Nilgun Simsir Atalay

Keyword(s):

Quality Of Life ◽

Range Of Motion ◽

Grip Strength ◽

Complex Regional Pain Syndrome ◽

Upper Extremity ◽

Functional Ability ◽

Clinical Symptoms ◽

Pain Syndrome ◽

Sf 36

Background: Although there are several studies of systemic corticosteroid therapies in various doses and various durations in complex regional pain syndrome (CRPS), the outcome measurement parameters are limited to the range of motion measurements, edema, and symptoms of CRPS. Objective: To investigate the effects of prednisolone on clinical symptoms, pain, hand grip strength, range of motion, as well as on functional ability and quality of life in patients who developed CRPS after traumatic upper extremity injury. Study Design: Retrospective evaluation. Methods: Forty-five patients who used prednisolone for CRPS of the upper extremity were retrospectively studied. Prednisolone was started with a dose of 30 mg and tapered by 5 mg every 3 days until discontinuation after 3 weeks. Clinical symptoms (morning stiffness, cold intolerance, shoulder pain, numbness of fingers, hyperesthesia, abnormal sweating, and cyanosis that is exacerbated by exposure to cold temperature), pain (Visual Analogue Scale-Rest [VAS-R] and VASActivity [VAS-A]) were reviewed. The muscle strength with grip strength (GS) (kg), lateral pinch (LP) (pound), tip-to-tip pinch (TP) (pound), and chuck pinch (CP) (pound) measurements; the joint range of motion with using third finger tip-distal crease distance (FT-DC) (cm); functional ability with Quick-Disabilities of the Arm, Shoulder and Hand (Q-DASH) score; and quality of life with Short Form-36 (SF-36) score were evaluated. Results: Mean age was 43.53 ± 11.43 years. After 3 weeks of therapy, patients showed significant improvements in clinical symptoms compared to the basal assessments (P < 0.05). The comparison of pre- and post-treatment results revealed that VAS-R, VAS-A, GS, LP, TP, CP, FT-DC, Q-DASH scores, and all SF-36 subscores were significantly improved (P < 0.05). Limitations: The retrospective design and data collection procedure was limited to the medical records of patients. Conclusion: A short-term oral prednisolone therapy significantly reduced the symptoms and signs of CRPS, and improved the functional abilities and quality of life. Key words: Complex regional pain syndrome, prednisolone, function, quality of life

Download Full-text

Spinal Cord Stimulation Is Effective in Management of Complex Regional Pain Syndrome I: Fact or Fiction

Neurosurgery ◽

10.1227/neu.0b013e3182181e60 ◽

2011 ◽

Vol 69 (3) ◽

pp. 566-580 ◽

Cited By ~ 71

Author(s):

Krishna Kumar ◽

Syed Rizvi ◽

Sharon Bishop Bnurs

Keyword(s):

Quality Of Life ◽

Spinal Cord ◽

Functional Status ◽

Complex Regional Pain Syndrome ◽

Spinal Cord Stimulation ◽

Pain Syndrome ◽

Sf 36

Abstract BACKGROUND: Complex regional pain syndrome (CRPS) I is a debilitating neuropathic pain disorder characterized by burning pain and allodynia. Spinal cord stimulation (SCS) is effective in the treatment of CRPS I in the medium term but its long-term efficacy and ability to improve functional status remains controversial. OBJECTIVE: To evaluate the ability of SCS to improve pain, functional status, and quality of life in the long term. METHODS: We retrospectively analyzed 25 patients over a mean follow-up period of 88 months. The parameters for evaluation were visual analog scale (VAS), Oswestry Disability Index (ODI), Beck Depression Inventory (BDI), EuroQoL-5D (EQ-5D) and Short Form 36 (SF-36), and drug consumption. Evaluations were conducted at point of entry, 3 months, 12 months, and last follow-up at 88 months (mean). RESULTS: At baseline, the mean scores were VAS 8.4, ODI 70%, BDI 28, EQ-5D 0.30, and SF-36 24. In general, maximum improvement was recorded at follow-up at 3 months (VAS 4.8, ODI 45%, BDI 15, EQ-5D 0.57, and SF-36 45). At last follow-up, scores were 5.6, 50%, 19, 0.57, and 40, respectively. Despite some regression, at last follow-up benefits were maintained and found to be statistically significant (P < .001) compared with baseline. Medication usage declined. SCS did not prevent disease spread to other limbs. Best results were achieved in stage I CRPS I, patients under 40 years of age, and those receiving SCS within 1 year of disease onset. CONCLUSION: SCS improves pain, quality of life, and functional status over the long term and consequently merits early consideration in the treatment continuum.

Download Full-text

Phantom Limb Pain

10.1093/med/9780190271787.003.0013 ◽

2018 ◽

Author(s):

Kenneth D. Candido ◽

Teresa M. Kusper ◽

Alexei Lissounov ◽

Nebojsa Nick Knezevic

Keyword(s):

Alternative Therapy ◽

Phantom Limb Pain ◽

Body Part ◽

Phantom Limb ◽

Treatment Modalities ◽

Phantom Pain ◽

Limb Pain ◽

Surgical Interventions ◽

Neurologic Sequelae ◽

The 19Th Century

Post-amputation pain (PAP) has challenged clinicians for centuries. The first written record of this perplexing condition came from the 16th-century French military surgeon Ambrose Paré. The term phantom limb pain (PLP) was coined by Silas Weir Mitchell, who provided a comprehensive description of the condition during the 19th century. Since that time, the understanding of PLP has greatly expanded; however, our knowledge of the exact mechanisms underlying it is still very deficient. Amputation of a body part can result in one sequela or more than one neurologic sequelae occurring concurrently: phantom sensation, phantom pain, and stump pain. The incidence and prevalence vary across the spectrum of these syndromes. A myriad of treatment modalities are employed in an attempt to terminate PLP, including pharmacotherapy, injections, alternative therapy, surgical interventions, and neuromodulation. Despite an extensive search for effective therapeutic options, PLP remains a highly challenging and debilitating condition.

Download Full-text

Mycophenolate for persistent complex regional pain syndrome, a parallel, open, randomised, proof of concept trial

Scandinavian Journal of Pain ◽

10.1515/sjpain-2017-0154 ◽

2018 ◽

Vol 18 (1) ◽

pp. 29-37 ◽

Cited By ~ 3

Author(s):

Andreas Goebel ◽

Anu Jacob ◽

Bernhard Frank ◽

Paul Sacco ◽

Guillermo Alexander ◽

...

Keyword(s):

Quality Of Life ◽

Pain Intensity ◽

Complex Regional Pain Syndrome ◽

Rating Scales ◽

Rating Scale ◽

Pain Syndrome ◽

Analysis Of Covariance ◽

Proof Of Concept ◽

Numeric Rating

Abstract Background and aims: Current therapies for persistent complex regional pain syndrome (CRPS) are grossly inadequate. With accruing evidence to support an underlying immunological process and anecdotal evidence suggesting potential efficacy of mycophenolate, we wished to explore the feasibility and effectiveness of this treatment in patients with CRPS. Methods: A randomised, open, parallel, proof of concept trial was conducted. Patients with Budapest research criteria CRPS of >2-year duration and moderate or high pain intensity (numeric rating scale score ≥5) were enrolled. Eligible patients were randomised 1:1 to openly receive mycophenolate as add-on treatment, or their usual treatment alone, over 5.5 months. They then switched to the other treatment arm for 5.5 months. The main outcome was average the patients’ average pain intensity recorded over 14 days, between 5.0 and 5.5 months post randomisation, on 11-point (0–10) numeric rating scales, compared between trial arms. Skin sensitivities and additional outcomes were also assessed. Results: Twelve patients were enrolled. Nine provided outcomes and were analysed for the main outcome. Mycophenolate treatment was significantly more effective than control [drug-group mean (SD): pre: 7.4 (1.2)- post: 5.2 (1.3), n=4, control: pre: 7.7 (1.4)- post: 8.1 (0.9), n=5; −2.8 (95% CI: −4.7, −1.0), p=0.01, analysis of covariance]. There were four treatment responders (to mycophenolate treatment either before, or after switch), whose initial exquisite skin hyper-sensitivities, function and quality of life strongly improved. Side effects including itchiness, skin-cryptitis, increased pain, and increased depression caused 45% of the subjects to stop taking mycophenolate. Conclusions: Mycophenolate appears to reduce pain intensity and improve quality of life in a subgroup of patients with persistent CRPS. Implications: These results support the feasibility of conducting a definite trial to confirm the efficacy and effect size of mycophenolate treatment for persistent CRPS (EudraCT 2015-000263-14).

Download Full-text