Das Complex regional Pain Syndrome (CRPS) oder früher Morbus Sudeck wird nach wie
vor als eine Art „mystische“ Erkrankung angesehen. Trotz zahlreicher Studien und Leitlinien
herrscht in der
Versorgungsrealität oft Unsicherheit über das korrekte diagnostische und therapeutische
Vorgehen, sodass die Fehldiagnoserate hoch und die Therapie oft nicht leitliniengerecht
ist. Diese
Übersicht soll als Update insbesondere den praxisrelevanten „State of the Art“ in
Diagnostik und Therapie darstellen.
Abstract
The complex regional pain syndrome (CRPS) usually occurs within a few weeks in 2–5%
of all patients after trauma or surgery or subsequent measures of the distal extremities.
There are
certain risk factors for its occurrence but no “CRPS personality”, instead there are
factors that negatively influence the course. The prognosis is generally good (“rule
of thirds”), but
remaining limitations are common. The diagnosis is clinically possible according to
the “Budapest criteria”. Additional examinations are possible in case of doubt but
are neither
conclusive nor exclusive. Corticoids and bisphosphonates are used alongside drugs
that have an effect on neuropathic pain. Invasive therapies do not have good evidence
and have therefore
lost their importance. The rehabilitative therapy is carried out actively and with
a lot of self-exercises at an early stage. Invasive anesthetic, passive therapies
are obsolete. Special
forms of treatment are “graded exposure” (GEXP) in the case of dominant anxiety and,
e.g., “graded motor imagery” (GMI) in case of neglect-like symptoms. In addition to
educational and
behavioral therapy elements, psychotherapy for CRPS also includes participation as
part of graded exposure.
Schlüsselwörter
Morbus Sudeck - Graded Motor Imagery - Graded Exposure - Budapest-Kriterien
Keywords
Sudeck's disease - graded motor imagery - graded exposure - Budapest criteria
