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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 49-year-old male worker developed persistent pain in his left wrist after work strain injuries. Clinical symptoms met with criteria for Complex Regional Pain Syndrome (CRPS) type I. In the present study, the effect of the experience of pain on the somatotopy of the primary cortical hand representation was investigated. Somatosensory evoked magnetic fields (SEF) elicited by non-painful tactile stimulation at the index finger of the affected and the unaffected hand were recorded when experiencing pain elicited by a moderate physical load condition (holding a 1.6 kg object in the hand). It was shown that MEG and subjective responses to innocuous tactile stimuli were reduced when simultaneous nociceptive stimulation was applied. These findings suggest a gating effect in the central nervous system elicited by concurrent simultaneous information from two different somatosensory modalities (pain and tactile). The results revealed the existence of nociceptive-induced plastic changes in the central nervous system associated with CRPS type I.
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PMID:Abnormal reactivity of the primary somatosensory cortex during the experience of pain in complex regional pain syndrome: a magnetoencephalograhic case study. 1719 Jul 48

Complex regional pain syndrome (CRPS) remains a challenging condition to diagnose and treat. There are few large-scale, randomized trials of pharmacologic agents, and most published studies are small, uncontrolled, or presented only in abstract form at meetings. The most commonly used agents, such as anticonvulsants, antidepressants, and opiates, have been found to be useful for other neuropathic pain conditions in large-scale trials but have not been adequately studied in CRPS. Systemic steroids delivered by multiple routes continue to be used, with some good evidence for short-term administration. N-methyl-D-aspartate antagonists have recently gained in popularity, without evidence from well-controlled trials. Bisphosphonates have been well studied and offer promise. In addition, there has been interest in thalidomide; however, we are still awaiting well-controlled trials. This article presents an overview of the available data regarding pharmacologic therapies for CRPS. These agents should be used in conjunction with a comprehensive interdisciplinary approach aimed at functional restoration and improved quality of life.
Curr Pain Headache Rep 2007 Feb
PMID:Pharmacologic therapies for complex regional pain syndrome. 1721 20

Physiotherapy is an important part of the treatment of reflex dystrophy or Complex Regional Pain Syndrome (CRPS)-type I, but this treatment is very painful. We report two cases of reflex dystrophy: a child with recurrent episodes and an adult. Both patients were treated with continuous peripheral nerve block in addition to physiotherapy. The method allows complete pain relief. At follow up (at 2 and 5 months) the results were excellent. By decreasing pain and thereby improving the ability to tolerate physical therapy, this method may have an advantage compared to other treatment modalities.
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PMID:[Treatment of reflex dystrophy with continuous peripheral nerve block]. 1721 90

We report the case of a 24-years-old man with parcellar Complex Regional Pain Syndrome I (CRPS I) of the patella, responsible for major functional limitation. The diagnosis was based on physical exam and X-ray, in the absence of other articular or peri-articular diseases. The patient received two pamidronate perfusions over a week, with a spectacular decrease of pain, which allowed him to follow the rehabilitation program in good conditions. He was therefore able to go back to work. The place of this treatment in CRPS I is discussed.
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PMID:[Complex regional pain syndrome of the knee: early and beneficial action of diphosphonates on pain and function]. 1731 64

Complex regional pain syndromes (CRPS) have been recognized with increasing frequency in children. These disorders appear to differ markedly from those observed in adults. The International Association for the Study of Pain diagnostic criteria for CRPS were developed based on adult studies; these criteria have not been validated for children. We performed standardized neurological examination and quantitative sensory testing (QST) in a group of pediatric patients to characterize features of sensory dysfunction. Forty-two patients, with unilateral lower extremity CRPS of a mean duration of the pain and symptoms of 12.6 months, who met IASP adult-based criteria for CRPS underwent standardized neurological examination and QST. QST parameters were compared to values previously derived from age- and sex-matched pediatric healthy controls. In most respects, QST parameters did not differ significantly between patients and the normal reference values except for cold and heat pain detection thresholds. Allodynia to cold and/or heat (P<0.001) occurred in 21 patients. Cold allodynia was the most common QST abnormality in our patients. Twenty-six patients showed a combination of mechanical dynamic and static allodynia and allodynia to punctate temporal summation. There was a significant correlation between mechanical dynamic allodynia and allodynia to punctate temporal summation (P<0.001). As with adult CRPS, the thermal and mechanical sensory abnormalities appear in different combinations in different patients with similar clinical presentations. In a majority of patients, the pathogenesis of pain is seemingly of central origin.
Pain 2007 Sep
PMID:Cutaneous sensory abnormalities in children and adolescents with complex regional pain syndromes. 1732 25

Complex regional pain syndrome (CRPS) is a chronic condition characterized by intense pain, swelling, redness, hypersensitivity and additional sudomotor effects. In all 13 cases of CRPS in the head and neck region reported in the literature, nerve injury was identified as the etiology for pain initiation. In this article, we present the case of a 30-year-old female patient with sympathetically maintained pain without apparent nerve injury. Her main symptoms--left-side preauricular pain and inability to open her mouth wide--mimicked temporomandibular joint arthralgia and myofascial pain of the masticatory muscles. Later, symptoms of intermittent preauricular pain and swelling developed, along with hyposalivation, which mimicked parotitis. After an extensive diagnostic process, no definitive underlying pathology could be identified and a diagnosis of neuropathic pain with a prominent sympathetic component was made. Two years after the onset of symptoms and initiation of care, treatment with repeated stellate ganglion blocks and enteral clonidine pharmacotherapy provided adequate pain relief.
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PMID:Sympathetically maintained pain presenting first as temporomandibular disorder, then as parotid dysfunction. 1735 8

Complex regional pain syndrome is characterised by an exaggerated response to injury in a limb with intense prolonged pain, vasomotor disturbance, delayed functional recovery and trophic changes. This review describes the current knowledge of the condition and outlines the methods of treatment available with particular emphasis on the knee.
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PMID:Complex regional pain syndrome with special emphasis on the knee. 1735 35

Complex Regional Pain Syndrome type I (CRPS I) is an illness which usually occurs due to major or minor tissue injury to the extremities. Because a unique pathophysiological mechanism for CRPS I has not yet been established, the diagnosis is based on observation and measurement of clinical symptoms and signs. In this study, a comparison was made between three sets of diagnostic criteria (the IASP, Bruehl et al. and Veldman et al.) based on patient reports and physicians' assessments of signs and symptoms associated with CRPS I, in 372 outpatients suspected of having CRPS I. Agreement between CRPS I diagnosis among the three sets was poor (kappa-range: 0.29-0.42), leading to positive CRPS I diagnoses according to Veldman et al.'s criteria in 218 cases (59%), according to the IASP in 268 cases (72%), and according to Bruehl et al. in 129 cases (35%). Significant differences in patient profiles were found between the diagnostic sets for the number of patients reporting continuing disproportionate pain, larger area affected than the initial trauma (both p<0.001), increase of symptoms due to exercise (p=0.009), edema (p=0.015), temperature asymmetry (p=0.015), hyperesthesia, allodynia (both p<0.001) and hyperalgesia (p=0.036). Similarly, significant differences emerged for physicians' observations of hyperesthesia and allodynia (both p<0.001). Highest combined values of sensitivity (SE) and specificity (SP) for the strongest cases of presence (n=108) or absence (n=62) of CRPS I were found for reported hyperesthesia (SE+SP:165%), allodynia (160%), observed color asymmetry (162%), hyperesthesia (157%), temperature asymmetry (154%) and edema (152%). The lack of agreement between the different diagnostic sets for CRPS I and the different clinical profiles that result from it may lead to different therapeutic and study populations, hampering adequate treatment and scientific development for this illness. We propose explicit reference to diagnostic criteria used in studies, and registration in trials of a broad variety of CRPS I features, as used in this study, to make subgroup phenotyping and post hoc analyses based on different diagnostic criteria possible.
Eur J Pain 2007 Nov
PMID:Diagnostic criteria for CRPS I: differences between patient profiles using three different diagnostic sets. 1740 Apr 90

The pain remaining after a needle stick is categorized as neuropathic pain. CRPS (Complex Regional Pain Syndrome) is a typical disease in this category. Neuropathic pain is extremely intractable when it becomes chronic pain, inducing psychological and physical pain in patients over a long period of time. Neuropathic pain is a complex system caused by various factors, and its mechanism remains unclear. For prevention, medical practioners should carefully select centesis, and apply necessary measures corresponding to the situation. There is no established treatment for neuropathic pain. We usually treat the disease with nerve block and drug therapy. Nerve block is useful for pain relief. We typically use a sympathetic nerve block (SGB; stellate ganglion block, IRSB; intravenous regional sympathetic block et. al.) as the initial treatment. In the stage of chronic pain, it is very important to improve patients' ADL (activity of daily living) and QOL (quality of life). If neuropathic pain is suspected, it is crucial to treat at an early stage. Therefore, it should be emphasized that when pain persists after a needle stick, the patient should immediately consult a pain clinician or an orthopedist.
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PMID:[Iatrogenic peripheral nerve injury; mechanism and therapy]. 1744 68

Complex regional pain syndrome is a painful disorder of unclear etiology, typically involving the distal part of one limb, represented by spontaneous and evoked pain as well as autonomic, motor and trophic abnormalities. It can be incapacitating and severely affect function and quality of life. Although full-blown complex regional pain syndrome can be diagnosed easily, less fulminate forms of the syndrome often remain undiagnosed. Controlled trials have demonstrated that a short course of oral corticosteroids, intranasal or intramuscular calcitonin, intravenous bisphosphonates, free-radical scavengers, gabapentin, regional intravenous sympathetic blocks with bretylium and spinal cord stimulation or physical therapy and occupational therapy can be efficacious for complex regional pain syndrome. Nonetheless, the management of this syndrome is difficult because currently available drugs and technologies do not provide adequate pain relief for a considerable percentage of sufferers. The present review focuses primarily on the pharmacotherapy of complex regional pain syndrome and describes briefly the epidemiology, pathogenesis and clinical manifestations of the syndrome.
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PMID:Pharmacotherapy options for complex regional pain syndrome. 1749 2


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