A search for activation of C nociceptors by sympathetic fibers in complex regional pain syndrome

Although the term 'reflex sympathetic dystrophy' has been replaced by 'complex regional pain syndrome' (CRPS) type I, there remains a widespread presumption that the sympathetic nervous system is actively involved in mediating chronic neuropathic pain ["sympathetically maintained pain" (SMP)], even in the absence of detectable neuropathophysiology.

Continuous extradural analgesia in a cow with complex regional pain syndrome

A chronic pain syndrome, similar to the complex regional pain syndrome (CRPS) described in human beings, was diagnosed in a cow with persisting severe pelvic limb lameness. Diagnosis was based on the disproportionate relationship between the severity and duration of pain and the lesion, the failure of conventional analgesic and surgical therapy and the presence of characteristic clinical features. Multimodal therapy, i.e. a mixture of methadone, ketamine and bupivacaine was administered continuously for 17 days via an extradural catheter to counteract nociceptive hypersensitization. Doses were adjusted daily after assessing the effect, using a composite pain score. Physiotherapy was also performed. The diagnosis of CRPS in cattle is unusual. In this case, treatment was successful and the cow was discharged mildly lame and in improving physical condition. Long-term extradural analgesia proved to be safe and effective in the treatment of this syndrome, which was nonresponsive to conventional therapy.

Spontaneous onset of complex regional pain syndrome Type I in a woman infected with Bartonella koehlerae

After a short-term fever, complex regional pain syndrome, characterized by hyperalgesia, intermittent swelling, erythema and cyanosis of both feet, was diagnosed in a female veterinarian. The woman was infected with Bartonella koehlerae and she was also Bartonella vinsonii subsp. berkhoffii seroreactive. Having failed other treatments, symptoms resolved following initiation of antibiotics.

Caracterización del síndrome doloroso regional complejo en el sistema de riesgos profesionales colombiano

El propósito de esta revisión fue demostrar que el Síndrome Doloroso Regional Complejo, se convirtió en el recurso seudocientífico que explica una evolución no convencional de patologías relativamente anodinas, diagnosticándose sin la rigurosidad ajustada a los criterios, esencialmente clínicos, propuestos por las organizaciones internacionales que estudian este problema. Para probar esa hipótesis, los investigadores efectuamos revisión de historias clínicas de pacientes que, habiendo presentado una contingencia de origen ocupacional, de la que se derivaron distinto tipo de lesiones que denominamos diagnóstico primario, en algún momento de su evolución y sin importar la especialidad que los estuviere tratando, se les realizó un diagnóstico de SDRC con el cual fueron remitidos a Clínica del Dolor para valoración y manejo. La revisión de los expedientes se realizó a la luz de tres distintas, aunque entrañablemente relacionadas, escalas para el diagnóstico de presunción del mencionado síndrome: La propuesta por Gibbons en el año 1992, la formulada por la Asociación Internacional para el Estudio del Dolor (IASP) en 1994 y la emanada del Consenso de Budapest en el 2003, que pretende llenar las imprecisiones de la escala IASP. Los investigadores revisamos 89 expedientes de los cuales 63 cumplieron con los criterios de selección de caso; encontrando que en el 68% de estos, los criterios diagnósticos propuestos por las tres escalas, no se cumplieron y que en el 28,5%, las Clínicas del Dolor tampoco cumplieron con su rol de autoridad técnica, en la medida en que avalaron una condición no probada suficientemente.

Central poststroke pain: somatosensory abnormalities and the presence of associated myofascial pain syndrome

Background: Central post-stroke pain (CPSP) is a neuropathic pain syndrome associated with somatosensory abnormalities due to central nervous system lesion following a cerebrovascular insult. Post-stroke pain (PSP) refers to a broader range of clinical conditions leading to pain after stroke, but not restricted to CPSP, including other types of pain such as myofascial pain syndrome (MPS), painful shoulder, lumbar and dorsal pain, complex regional pain syndrome, and spasticity-related pain. Despite its recognition as part of the general PSP diagnostic possibilities, the prevalence of MPS has never been characterized in patients with CPSP patients. We performed a cross-sectional standardized clinical and radiological evaluation of patients with definite CPSP in order to assess the presence of other non-neuropathic pain syndromes, and in particular, the role of myofascial pain syndrome in these patients. Methods: CPSP patients underwent a standardized sensory and motor neurological evaluation, and were classified according to stroke mechanism, neurological deficits, presence and profile of MPS. The Visual Analogic Scale (VAS), McGill Pain Questionnaire (MPQ), and Beck Depression Scale (BDS) were filled out by all participants. Results: Forty CPSP patients were included. Thirty-six (90.0%) had one single ischemic stroke. Pain presented during the first three months after stroke in 75.0%. Median pain intensity was 10 (5 to 10). There was no difference in pain intensity among the different lesion site groups. Neuropathic pain was continuous-ongoing in 34 (85.0%) patients and intermittent in the remainder. Burning was the most common descriptor (70%). Main aggravating factors were contact to cold (62.5%). Thermo-sensory abnormalities were universal. MPS was diagnosed in 27 (67.5%) patients and was more common in the supratentorial extra-thalamic group (P <0.001). No significant differences were observed among the different stroke location groups and pain questionnaires and scales scores. Importantly, CPSP patients with and without MPS did not differ in pain intensity (VAS), MPQ or BDS scores. Conclusions: The presence of MPS is not an exception after stroke and may present in association with CPSP as a common comorbid condition. Further studies are necessary to clarify the role of MPS in CPSP.

Uso de estimulación eléctrica medular en el manejo de síndrome doloroso regional complejo: revisión sistemática

La estimulación eléctrica medular (EEM), es una técnica mínimamente invasiva, segura, con pocos efectos secundarios y resultados favorables en patologías crónicas asociadas a dolor severo de difícil manejo, tal como es el caso del Síndrome Doloroso Regional Complejo (SDRC). La evidencia actual señala beneficios en esta patología particular, motivo por el cuál es de interés hacer una revisión actualizada sobre la EEM en SDRC.

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

JUSTIFICATIVA E OBJETIVOS: A Síndrome Dolorosa Complexa Regional (SDCR), assim denominada a partir de 1994 pelo Consenso da Associação Internacional para o Estudo da Dor (AIED) e anteriormente denominada de várias formas, tais como Distrofia Simpático Reflexa, Causalgia, Algodistrofia ou Atrofia de Sudeck, é uma doença cuja compreensão dos limites clínicos, fisiopatologia e implicações de patogenia ainda é pobre. Disto resulta a enorme insatisfação não só para os pacientes como para os profissionais da saúde quanto aos métodos terapêuticos atualmente disponíveis. O objetivo deste trabalho é rever a literatura e atualizar um conjunto de informações com o intuito da melhor compreensão desta importante síndrome dolorosa. CONTEÚDO: Este é um trabalho de revisão da literatura nos diversos aspectos da SDCR, com ênfase em suas causas, definição e taxonomia, fisiopatologia, características clínicas, testes diagnósticos e propostas de tratamentos mais recentes. CONCLUSÕES: Poucos são os estudos controlados adequadamente, encobertos e aleatórios, publicados com grandes amostras, havendo muitas dúvidas sobre esta doença. Desta forma, ainda há enorme empirismo na sua terapêutica, e os resultados obtidos são insatisfatórios.