Síndrome dolorosa complexa regional: epidemiologia, fisiopatologia, manifestações clínicas, testes diagnósticos e propostas terapêuticas

Abstract

There are few well controlled, double blind and randomized CRPS studies with large samples, and there are still several questions about this disease. The treatment is usually empirical and the patient outcome is poor.

Raquianestesia total após bloqueio de gânglio estrelado em paciente com síndrome dolorosa complexa regional: relato de caso

“…Many other names have been already suggested for the same presentation, such as reflex sympathetic dystrophy, post-traumatic vasomotor disorder and Sudeck atrophy 1 . In a consensus published in 1994 2 by IASP (International Association for the Study of Pain) and updated in 2006 3 , names were standardized and CRPS was defined as: continuous regional pain condition (spontaneous and/or evoked) disproportional to trauma time or degree or other initial injury, in general followed by sensory, motor, vasomotor symptoms or trophic findings.…”

“…Although recognized for such a Oliveira TR and Andrade EMF Rev Dor. São Paulo, 2013 abr-jun;14(2):151-3 long time 1 , its etiology is not totally clear and available management options still fail to improve pain and rehabilitate patients with such syndrome. One therapeutic option is the sympathetic block, being stellate ganglion block indicated for upper limbs CRPS.…”

Uso da lidocaína tópica a 4% para terapia ocupacional em pacientes com síndrome dolorosa complexa regional: relato de casos

“…In general, CRPS is triggered by a physical injury such as: fractures, torsions and surgeries. With regard to diagnosis, the International Association for the Study of Pain (IASP) has published a consensus, in 1994, where the following criteria were defined: a) continuous pain disproportional to the initial event; b) presence of initial injury may be disregarded; c) signs and symptoms shall be divided in different groups; d) patients must have at least two of the following symptoms: sensory such as hyperesthesia, vasomotor such as change in temperature and color, sudomotor such as edema and sweating, and motor such as decreased motricity, weakness, shivering, functional limb amputation, or all; e) presence of at least two of the following signs: vasomotor, sudomotor and motor 2,3 . Treatment has to be started early to allow patients' recovery, however in some situations the approach is ineffective and unsuccessful.…”

“…In our group of 5 patients, mean age was 59 years with predominance of males with CRPS in one upper limb and the major cause was fracture with immobilization. Treatment is multidisciplinary involving psychologists for cognitive behavioral treatment, physical therapists to orient exercises, occupational therapists for return to labor activities, anesthesiologists to induce blockades, psychiatrists to treat psychosocial disorders, in addition to nurses and dietitians, among others 2,3 . There are several alternatives to treat CRPS: 1) sympathetic block 2,6 of stellate ganglion with local anesthetics, however there may be numerous complications, such as vertebral or carotid artery puncture, subarachnoid space injection, pneumothorax and brachial plexus injury.…”

“…Its pathophysiology is not clear. Patients refer pain in the affected limb, allodynia, hyperalgesia, autonomic and trophic changes, loss of function, inflammation and hypoxia 2,3 . CRPS is divided in two types: type I, when there is no nervous injury and previously called reflex sympathetic dystrophy, and type II, when there is nervous injury and previously called causalgia.…”