Risk factors for complex regional pain syndrome in patients with traumatic extremity injury.
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BACKGROUND: It is not clear why complex regional pain syndrome (CRPS) develops in some patients but not in others, despite similar initiating events. The aim of this study was to investigate risk factors for CRPS in cases who had suffered traumatic upper extremity injury. METHODS: One hundred sixty-five patients who had suffered a mechanical traumatic injury isolated to their hand or forearm were included in this study. Age, gender, body mass index, tissue types injured, and side of affected forearm/hand were investigated as possible risk factors for CRPS. RESULTS: CRPS was diagnosed in 84 patients. Female/male ratio was higher in patients with CRPS versus those without. The mean age was higher in patients with CRPS. The affected forearm/hand was the dominant side in 62.9% of patients without CRPS and in 64.2% of patients with CRPS. CRPS incidence was higher in patients with motor nerve injury and in patients with sensory nerve injury. A logistic regression showed that risk for CRPS was higher in patients with motor nerve injury and in females. CONCLUSION: This study indicates that motor nerve injury and female gender are risk factors for CRPS. The prevention measures should be focused mainly on females and patients with motor nerve injury in order to reduce the risk of CRPS. (+info)
Disease-related knowledge of patients with chronic regional pain syndrome.
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Pharmacodynamic profiles of ketamine (R)- and (S)- with 5-day inpatient infusion for the treatment of complex regional pain syndrome.
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BACKGROUND: Ketamine might be effective in blocking central sensitization of pain transmission neurons through its effect on NMDA receptors in refractory Complex Regional Pain Syndrome (CRPS) patients. At higher doses, ketamine infusions can be associated with significant risks; outpatient therapy requires return visits for a 10-day period with variable efficacy and duration. OBJECTIVE: This study determined the efficacy of a 5-day moderate dose, continuous racemic ketamine infusion. The pharmacodynamic responses to racemic ketamine and norketamine were examined. DESIGN: Observational study METHODS: In this study, ketamine was titrated from 10-40 mg/hour in 16 CRPS patients, and maintained for 5 days. Pain was assessed daily. Ketamine and norketamine concentrations were obtained on Day 1 before starting the infusion; at 60 to 90 minutes, 120 to 150 minutes, 180 to 210 minutes, and 240 to 300 minutes after the initiation of the infusion on Days 2, 3, 4, and 5; and on Day 5 at 60 minutes after the conclusion of the infusion. The plasma concentrations of (R)-ketamine, (S)-ketamine, (R)-norketamine and (S)-norketamine were determined using an enantioselective liquid chromatography - mass spectrometry method. RESULTS: Ketamine and norketamine infusion rates stabilized 5 hours after the start of the infusion. The subjects showed no evidence of significant tachycardia, arterial oxygen desaturation, or hallucinatory responses. Subjects generally experienced minimal pain relief on day one followed by significant relief by day 3. Mean pain scores decreased from the 8-9 to 3-5 ranges; however, the analgesic response to ketamine infusion was not uniform. On Day 5, there was little or no change in the pain measure assessed as the worst pain experienced over the last 24 hours in 37% of the subjects. (R)- and (S)-ketamine concentrations peaked at 240-300 min. (R)- and (S)-norketamine concentrations were lower and peaked on Day 2 of the infusion, as opposed to Day 1 for (R)- and (S)-ketamine. Significant pain relief was achieved by the second day of infusion and correlated with the maximum plasma levels of ketamine and norketamine. Pain relief continued to significantly improve over the 5-day infusion at concentrations of 200-225 ng/mL for (R)- and (S)-ketamine, and 90-120 ng/mL for (R)- and (S)-norketamine. CONCLUSIONS: A 5-day ketamine infusion for the treatment of severe CRPS provided significant (p <0.05) pain relief by Day 3 compared to baseline. The pain relief experienced on Day 2 of the infusion continued to improve over the 5-day infusion period and correlated with the maximum plasma levels of ketamine and norketamine. We speculate that downstream metabolites of ketamine and norketamine might be playing a role in its therapeutic efficacy. (+info)
Use of continuous interscalene brachial plexus block and rehabilitation to treat complex regional pain syndrome of the shoulder.
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Leprosy: a precipitating factor for complex regional pain syndrome.
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Complex regional pain syndrome (CRPS) usually develops after trauma. We are reporting the first case of CRPS with leprosy as a precipitating cause. A fifty-five-year male presented in the pain clinic with complaint of pain and swelling in the right arm. There was no history of trauma to the limb. On reviewing the history, patient was found to be on treatment for leprosy. X-ray of the right hand showed severe osteoporosis. A diagnosis of CRPS associated with leprosy was made. A diagnostic stellate ganglion block relived his pain completely. Thereafter patient is on treatment with tablet etoricoxib 90 mg once a day, gabapentin 100 mg twice a day and continuing to have 100% pain relief. The diagnosis of the type of CRPS was difficult in our case as no history of trauma or neurological injury was present. The presence of leprosy along with ulnar nerve thickening may be the precipitating factor for CRPS, this has not been reported so far in the literature. We managed the patient with sympathetic block along with medical therapy for chronic pain and leprosy chemotherapy. (+info)