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

Reflex sympathetic dystrophy (RSD) is a complex and poorly-understood condition characterized by: (a) pain and altered sensation; (b) motor disturbance and soft tissue change; (c) vasomotor and autonomic changes; and (d) psychosocial disturbance. Neurological symptoms typically do not conform to any particular pattern of nerve damage. Many different names have been ascribed to this condition and most recently the term 'complex regional pain syndrome' has been coined to emphasize the complex interaction of somatic, psychological and behavioural factors. Diagnostic criteria have been proposed by the International Association for the Study of Pain, but are still subject to debate. This review article describes the clinical features which may present as part of the condition, and the patho-physiology and pre-disposing factors so far identified. The evidence for effectiveness of different interventions is presented and a treatment approach outlined for inter-disciplinary management. While RSD is traditionally associated with pain in the extremities, the possibility is raised that the same process may underlie chronic pain syndromes affecting more central structures, such as testicular or pelvic pain.
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PMID:Reflex sympathetic dystrophy--a complex regional pain syndrome. 1252 47

The authors describe the effectiveness of motor cortex stimulation (MCS) in a patient with complex regional pain syndrome (CRPS) Type II, formerly known as causalgia, with hemibody allodynia. During MCS, a subjective sensation of warm paresthesia developed in the painful hand and forearm and spread toward the trunk. Pain and allodynia in the areas associated with this sensation were alleviated significantly. The analgesic effect of stimulation proved to be long lasting and was still present at the 12-month follow up. The authors speculate that MCS might exert its effect through the modulation of thalamic activity in this particular case of CRPS with hemisensory deficit. A central mechanism associated with functional disturbance in noxious-event processing in the thalamus might have an important role in the pathogenesis of the condition.
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PMID:Motor cortex stimulation in a patient with intractable complex regional pain syndrome type II with hemibody involvement. Case report. 1254 68

Understanding the pathophysiology of a pain syndrome is helpful in selecting appropriate treatment strategies. Nociceptive pain is related to damage to tissues due to thermal, chemical, mechanical, or other types of irritants. Neuropathic pain results from injury to the peripheral or central nervous system. Common examples of neuropathic pain include postherpetic neuralgia, diabetic neuropathy, complex regional pain syndrome, and pain associated with spinal cord injuries. Nociceptive pain may have similar clinical characteristics to neuropathic pain. It is also possible for acute nociceptive pain to become neuropathic in nature, as with myofascial pain syndrome. A clear benefit of botulinum toxin therapy for treatment of neuropathic pain disorders is that it often relieves pain symptoms. Although the precise mechanism of pain relief is not completely understood, the injection of botulinum toxin may reduce various substances that sensitize nociceptors. As a result, botulinum toxin types A and B are now being actively studied in nociceptive and neuropathic pain disorders to better define their roles as analgesics.
Clin J Pain
PMID:A focused review on the use of botulinum toxins for neuropathic pain. 1256 66

Pain may be a leading symptom in complex regional pain syndrome type I (CRPS I) and may hinder functional recovery. In this case, a pharmacotherapeutic approach to pain should be part of the individually tailored interdisciplinary treatment regimen. However, operational criteria for determining which patient may profit from what therapeutic intervention are lacking. This article discusses a conceptual framework in which the rapid progress made in basic pain research may contribute to the clinical management of pain in CRPS I. First, recent insights in the pathophysiologic mechanisms underlying CRPS I are reviewed. CRPS I is considered a neuropathic pain syndrome with a mixed and time-dependent profile of a regional inflammation, sensitization of primary somatosensory afferents (peripheral sensitization), and sensitization of spinal neurons (central sensitization). The dominant mechanisms may vary across individual patients with different time profiles. Second, a model was constructed in which signs and symptoms in an individual patient are related to these mechanisms. Finally, relating the clinical picture to the underlying pathophysiology may help determine the pharmacotherapeutic approach for an individual patient. Pharmacologic options are discussed in this context. The presented framework does not aim to provide an evidence-based treatment algorithm, ready to be used in daily clinical practice; rather it offers a crude, first step toward a mechanism-based pharmacotherapy in CRPS I, in an effort to shift from a mainly empirical treatment paradigm toward theory-driven treatment procedures.
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PMID:Pharmacologic treatment of complex regional pain syndrome I: a conceptual framework. 1258 36

A case of complex regional pain syndrome (CRPS) secondary to peripheral nerve injury occurring during venipuncture for post-contrast CT examination is presented. The puncture site was in the left antecubital fossa. Anatomically, cutaneous nerves lie close to cutaneous veins, making them vulnerable to injury during the procedure. This syndrome is characterized by continuing pain, allodynia, or hyperalgesia that is disproportionate to any inciting event in severity, and may lead to loss of the involved limb. The syndrome is poorly understood by radiologists and is often misdiagnosed. Early recognition and appropriate therapy are most important in treating this disorder.
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PMID:[A case of venipuncture-induced complex regional pain syndrome]. 1260 53

Pain in the forearm, wrist or hand may arise from one of several discrete rheumatic disorders of soft tissues, such as tenosynovitis, or from a non-specific regional pain syndrome. Symptoms are prevalent in the general population and both patterns of illness are well represented. Many epidemiological investigations of prevalence, incidence, causal risk factors, management and prevention exist, although surveys have used a wide variety of case definitions, hampering comparisons. Improved standardized approaches to classification are in prospect and these are described. A synthesis is also attempted of the main findings of existing surveys. A growing body of evidence now links distal arm pain with physical risk factors in the workplace (e.g. repetition, force, duration, short cycle time and awkwardness of posture); some possible ergonomic solutions to occupational arm pain are discussed. But occupational and psychosocial factors are also linked with symptom reporting and disability, and their role in pathogenesis may be important in primary prevention and the management of recalcitrant cases. Some key research questions are proposed aimed at preventing chronicity and disablement from arm pain.
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PMID:Regional musculoskeletal conditions: pain in the forearm, wrist and hand. 1265 24

To compare the effects of two free radical scavengers, dimethylsulfoxide 50% (DMSO) and N-acetylcysteine (NAC), for treatment of complex regional pain syndrome I (CRPS I), a randomized, double-dummy controlled, double-blind trial was conducted. Two outpatient clinics of two university hospitals in The Netherlands participated in the study and 146 patients, were included over a period of 24 months. Patients were randomized into two treatment groups, one was instructed to apply DMSO 50% five times daily to the affected extremity, the second was treated with NAC 600mg effervescent tablets three times daily, both combined with placebo. Interventions were accompanied by pain medication, occupational therapy for upper extremity CRPS I and physical therapy for lower extremity CRPS I in specific circumstances. Treatment was given for 17 weeks, with a possibility to continue or switch medication after this period, up to 1 year following the onset of treatment. An impairment level sum score was the primary outcome measure. Upper and lower extremity skills and functions, and general health status were also evaluated. Overall, no significant differences were found between NAC and DMSO after 17 and 52 weeks on impairment level and general health status. Significant differences were found for subscores of lower extremity function, in favor of DMSO-treatment. Subgroup analysis showed more favorable results for DMSO for warm CRPS I and significantly better performance of NAC for patients with a cold CRPS I. Results tended to be negatively influenced if the duration of the complaint was longer. Treatment with DMSO and NAC are generally equally effective in treatment of CRPS I. Strong indications exist for differences in effects for subgroups of patients with warm or cold CRPS I: for warm CRPS I, DMSO-treatment appears more favorable, while for cold CRPS I, NAC-treatment appears to be more effective.
Pain 2003 Apr
PMID:The treatment of complex regional pain syndrome type I with free radical scavengers: a randomized controlled study. 1267 Jun 72

Involvement of the (efferent) autonomic nervous system in the generation of pain is ongoing matter of debate. Based on clinical and experimental observations, there are good arguments that the sympathetic nervous system may be involved in pain following trauma, with and without nerve lesion, at an extremity, such as in complex regional pain syndrome type I and II. However, the mechanisms involved are in many cases still unclear. In various types of headache there is no convincing evidence that the sympathetic nervous system is involved in the generation of pain, although these pains may be accompanied by considerable autonomic reactions which are dependent on activity in sympathetic neurons. Migraine and headaches with autonomic symptoms are accompanied by autonomic reactions which are dependent on activity in cranial parasympathetic neurons. Whether parasympathetic neurons innervating cranial blood vessels are involved in activation or sensitization of trigemino-vascular afferents is discussed and needs experimental verification.
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PMID:Relationship between pain and autonomic phenomena in headache and other pain conditions. 1269 58

Complex regional pain syndrome consists of pain and other symptoms that are unexpectedly severe or protracted after an injury. In type II complex regional pain syndrome, major nerve injury, often with motor involvement, is the cause; in complex regional pain syndrome I, the culprit is a more occult lesion, often a lesser injury that predominantly affects unmyelinated axons. In florid form, disturbances of vasoregulation (eg, edema) and abnormalities of other innervated tissues (skin, muscle, bone) can appear. Because of these various symptoms and the difficulty in identifying causative lesions, complex regional pain syndrome is difficult to treat or cure. Complex regional pain syndrome has not been systematically investigated; there are few controlled treatment trials for established complex regional pain syndrome. This article reviews the existing studies (even if preliminary) to direct clinicians toward the best options. Treatments for other neuropathic pain syndromes that may be efficacious for complex regional pain syndrome also are discussed. Some common treatments (eg, local anesthetic blockade of sympathetic ganglia) are not supported by the aggregate of published studies and should be used less frequently. Other treatments with encouraging published results (eg, neural stimulators) are not used often enough. We hope to encourage clinicians to rely more on evidence-supported treatments for complex regional pain syndrome.
Curr Pain Headache Rep 2003 Jun
PMID:Complex regional pain syndrome: a review of evidence-supported treatment options. 1272 May 98

An association between HLA-DR13 and patients with complex regional pain syndrome (CRPS) who progressed towards multifocal or generalized tonic dystonia was recently reported. We now report on a new locus, centromeric in HLA-class I, which was significantly associated with a spontaneous development of CRPS, suggesting an interaction between trauma severity and genetic factors conferring CRPS susceptibility. Additionally, an association with the D6S1014 locus was found, supporting the previous finding of an association with HLA-DR13.
Pain 2003 May
PMID:Susceptibility loci for complex regional pain syndrome. 1274 63


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