Lumbar Sympathetic Plexus Radiofrequency Ablation for Chronic Non-Cancer Pain: A Brief Review and Two Case Reports

2020 ◽  
pp. 85-92
Author(s):  
Andrea Tinnirello
Keyword(s):  
Chronic Pain ◽  
Complex Regional Pain Syndrome ◽  
Lower Limb ◽  
Case Reports ◽  
Pain Syndrome ◽  
Lower Limbs ◽  
Ischemic Pain ◽  
Sympathetically Maintained Pain ◽  
Ischemic Disease ◽  
Conventional Medical Therapy

Background: Lumbar sympathetic plexus (LSP) has been described as a target for managing chronic pain with a sympathetic component in the lower limbs such as complex regional pain syndrome (CRPS) or pain of ischemic origin. LSP neurolysis with phenol or ethanol has been applied; more recently, radiofrequency (RF) lesioning has been proposed as an alternative. RF denervation has the advantage of avoiding the complications associated with ethanol/phenol spread. Case Report: We describe 2 cases in which RF denervation of LSP was performed in patients suffering from chronic pain from CRPS and chronic ischemic disease of the lower limb. Conclusion: RF denervation of LSP could be considered as a treatment for CRPS and chronic ischemic pain when conventional medical therapy fails. Compared to chemical neurolysis, RF denervation carries less risk for postprocedural deafferentation pain. Key words: Complex regional pain syndrome; ischemic pain; lumbar sympathetic plexus; neurolysis; radiofrequency; sympathetically maintained pain

Ketamine Infusions for Complex Regional Pain Syndrome

2016 ◽  
Author(s):  
Roy K. Esaki
Keyword(s):  
Chronic Pain ◽  
Complex Regional Pain Syndrome ◽  
Hepatic Dysfunction ◽  
Case Reports ◽  
Pain Syndrome ◽  
Nmda Receptor Antagonist ◽  
Treatment Resistant ◽  
Urinary Tract Symptoms ◽  
Chronic Pain Conditions ◽  
Lower Urinary

Ketamine is an N-methyl-d-aspartate (NMDA) receptor antagonist that has been increasingly used in the management of treatment-resistant chronic pain conditions, particularly representing neuropathic involvement or central sensitization. Complex regional pain syndrome (CRPS) is a prototypical condition often treated with ketamine infusions. Although the analgesic benefits of ketamine as an opioid-sparing adjunct in the preoperative period have been well studied, the use of ketamine to mitigate chronic pain conditions remains largely anecdotal, composed largely of case reports and uncontrolled small studies. The limited evidence and published reports support the use of ketamine infusions as one aspect of a comprehensive, multimodal approach for CRPS. Although ketamine infusions are relatively safe when titrated appropriately, with minimal respiratory depression, side effects include sympathetic activation, unpleasant psychomimetic effects, lower urinary tract symptoms, and hepatic dysfunction. 

Complex regional pain syndrome

2011 ◽  
Author(s):  
Roger M. Atkins
Keyword(s):  
Chronic Pain ◽  
Complex Regional Pain Syndrome ◽  
Pain Syndrome ◽  
Functional Restoration ◽  
Lower Limbs ◽  
Pharmacological Intervention ◽  
Unknown Aetiology ◽  
Chronic Pain Condition ◽  
Chronic Disability ◽  
Maximum Period

♦ Complex regional pain syndrome (CRPS) is a disabling chronic pain condition of unknown aetiology♦ Traditionally it was thought to be rare; however, prospective studies demonstrate it to be common following both trauma and operative procedures involving the upper and lower limbs♦ The condition is usually self-limiting over a maximum period of 2 years, although minor abnormalities may remain♦ In a minority of cases it does not resolve and is responsible for severe chronic disability♦ Treatment is aimed at functional restoration of limb function supported by pharmacological intervention.

scholarly journals Complex Regional Pain Syndrome in Athletes: Scoping Review

Medicina ◽  
2021 ◽  
Vol 57 (11) ◽  
pp. 1262
Author(s):  
Antimo Moretti ◽  
Angela Palomba ◽  
Marco Paoletta ◽  
Sara Liguori ◽  
Giuseppe Toro ◽  
...  
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Case Reports ◽  
Management Strategies ◽  
Case Series ◽  
Pain Syndrome ◽  
Assessment Tools ◽  
Lower Limbs ◽  
Online Databases ◽  
High Prevalence

Background and Objectives: Complex regional pain syndrome (CRPS) is a chronic condition characterized by disproportionate regional pain, usually affecting distal limbs, that follows trauma or surgery. Athletes may develop CRPS because of exposure to traumatic or overuse injuries. The aim of the present study is to review the available literature about CRPS type 1 in athletes. Materials and Methods: We searched two online databases (PubMed and Web of Science), selecting papers aiming at investigating CRPS type 1 (algodystrophy) in athletes. The analysis of databases was made considering original articles published until 30 June 2021, written in English. Results: Fifteen papers (12 case reports, 3 case series) were selected for a total of 20 clinical cases (15 females, 5 males), aged between 10 and 46 years (mean age 18.4 ± 9.8 standard deviation years). Patients included practiced different types of sport (soccer, athletics, gymnastics, basketball). The most involved anatomical sites were lower limbs, and time to diagnosis ranged from 2 days to 4 years. The most used treatments were pharmacological and physical therapies, but sometimes invasive approaches, as regional nerve, or lumbar sympathetic blocks, were provided. The main assessed outcomes were return to activity and pain. Conclusions: Our review suggests a higher prevalence of CRPS type 1 in younger people and in lower limbs than in general population but confirms the higher prevalence in females. However, the number of studies addressing CRPS in athletes is limited, as well as the number of involved patients, considering that only few and heterogeneous case reports were published about this topic. Moreover, the high prevalence of old studies (only 5 available studies in the last 10 years) might have influenced the choice of both assessment tools and management strategies. Despite these limitations, athletes showing disproportionate pain after sport-related injury should be promptly evaluated and treated through a multidimensional approach to avoid long-term consequences of algodystrophy.

scholarly journals NEW APPROACH TO SOLVING THE PROBLEM OF COMPLEX REGIONAL PAIN SYNDROME

2017 ◽  
Vol 2 (3) ◽  
pp. 32-38
Author(s):  
AS S Pankratov ◽  
SV V Ardatov ◽  
DA A Ogurtsov ◽  
YuD D Kim ◽  
DS S Shitikov
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Lower Limb ◽  
Technology Use ◽  
Bone Fractures ◽  
Pain Syndrome ◽  
Integrated Approach ◽  
Lower Limbs ◽  
New Approach ◽  
Limb Bones ◽  
Prolonged Immobilization

Aim - to improve the results of treatment of patients with complex regional pain syndrome (CRPS) in bone fractures of the lower extremities by applying a new integrated approach. Methods. A new approach to solving the problem of complex regional pain syndrome in fractures of lower limb bones is proposed, including the use of modern minimally invasive methods for surgical treatment of fractures of the lower limb bones, such as blocked osteosynthesis, Fixion technology, use of angular stability plates, metal structures for osteosynthesis of the proximal femur. All these measures help to minimize the negative effect that is produced on the bone by such factors as prolonged immobilization and absence of early movements of the joints, which will make it possible to perform CRPS prophylaxis in bone fractures of the lower limbs more effectively. If it is not possible to prevent the development of CRPS, then it is necessary to administer complex therapy, including psychoemotional correction, adherence to the regime, proper immobilization, rehabilitation exercises, physiotherapy, medical treatment, hyperbaric oxygenation, and gravitational therapy. Results. Clinical tests, radiography, densitometry, method of statistical analysis and mathematical modeling with elements of evidencebased medicine objectively confirmed the activation of the restorative processes in altered tissues of the lower limbs due to the use of the new complex. Conclusion. The analysis of the obtained data of clinical and functional methods of research has proved that the total value of positive results is 80%.

Chronic pain syndromes

2018 ◽  
pp. 623-642
Author(s):  
Gavin Clunie ◽  
Nick Wilkinson ◽  
Elena Nikiphorou ◽  
Deepak R. Jadon
Keyword(s):  
Chronic Pain ◽  
General Practitioner ◽  
Children And Adolescents ◽  
Complex Regional Pain Syndrome ◽  
Musculoskeletal Pain ◽  
Pain Syndrome ◽  
Pain Syndromes ◽  
Pain Medications ◽  
Cross Reference ◽  
Chronic Pain Syndromes

The Oxford Handbook of Rheumatology 4th edition, has been extensively updated to thoroughly review aspects of musculoskeletal pain. Pain pathophysiology is reviewed. Chronic pain and fibromyalgia in adults and in children and adolescents is dealt with in detail. The reader is advised to cross reference from this chapter to Chapters 1–3 in the Handbook, where regional musculoskeletal pain conditions are listed and reviewed. In localized pain syndromes, the chapter has an overview of complex regional pain syndrome (CRPS), which is not infrequently encountered in rheumatology and musculoskeletal clinics. Included in detail for this edition, is the assessment and management of pain in children, which is a highly specialized clinical area of medicine and will be of use to the adult rheumatologist and general practitioner as well as paediatric specialists. Readers should cross reference to Chapter 23 on medications, for ‘pain medications’ in the Handbook

scholarly journals Successful Treatment of Lower Limb Complex Regional Pain Syndrome following Three Weeks of Hyperbaric Oxygen Therapy

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Rita Katznelson ◽  
Shira C. Segal ◽  
Hance Clarke
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Hyperbaric Oxygen ◽  
Lower Limb ◽  
Hyperbaric Oxygen Therapy ◽  
Skin Color ◽  
Oxygen Therapy ◽  
Pain Syndrome ◽  
Animal Pain ◽  
History Of ◽  
One Year

Hyperbaric oxygen therapy (HBOT) is a treatment that delivers 100% oxygen at increased atmospheric pressures. The efficacy of HBOT for treating pain has been described in various animal pain models and may have clinical efficacy in the treatment of human chronic pain syndromes. We present our experience with posttraumatic Complex Regional Pain Syndrome (CRPS) type 2 in a patient who underwent 15 sessions of HBOT. A 41-year-old male with one-year history of CRPS of left foot followed by left ankle fracture demonstrated less pain, decreased swelling, less allodynia, and improvement in skin color and range of motion of the lower limb after 3 weeks of HBOT. Patient was back to work for the first time in over a year. HBOT may be considered as a valuable therapeutic tool in the treatment of long-standing CRPS.

scholarly journals The effectiveness of therapeutic massage in lumbar and cervical spine pain syndrome – case study

2015 ◽  
Vol 9 (2) ◽  
pp. 24-27
Author(s):  
Iwona Wilk
Keyword(s):  
Cervical Spine ◽  
Lower Limb ◽  
Pain Syndrome ◽  
Lymphatic Drainage ◽  
Lower Limbs ◽  
Substantial Part ◽  
Therapeutic Massage ◽  
Spine Pain ◽  
Patient Reported ◽  
Pain Symptoms

Background: The spine pain syndrome is a common problem in a substantial part of the population which currently affects younger and younger people. The underlying risk factors include the character of work, sedentary lifestyle and lack of physical activity. Except for complex physiotherapy which should be applied during treatment, a lifestyle prophylaxis also seems to be a key factor. Aim of the study: The aim of this study was to present the possibility to use the classical and therapeutic massage of the back, and a lymphatic drainage of lower limbs in case of the lumbar and cervical spine pain syndrome accompaniedby the lower limb swelling. Material and methods: A young woman with the lumbar and cervical spine pain syndrome received a 55-minute lymphatic drainage (four sessions), a 30-minute classical massage (four sessions) and a 45-minute therapeutic massage (two sessions). All the procedures were performed every two days. Results: After the application of all kinds of the massage, selected individually to current symptoms and needs of the patient, the pain in the area of the spine was relieved. After the therapy the pressure pain in the back muscles such as: latissimus dorsi (lats), trapezius (traps) and spinal erectors was also decreased. The swelling in the area of the lower limb was reduced and the patient reported general decrease of pain. Conclusions: A massage may constitute an effective anti-pain therapy in case of the lumbar and cervical spine pain syndrome. Combined with educating patients about proper motor habits might prevent similar pain symptoms in the future.

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.

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