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Osteologie 2012; 21(01): 5-14
DOI: 10.1055/s-0037-1621661
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Schattauer GmbH

Komplexes regionales Schmerzsyndrom

Complex-regional pain syndromes
M. E. Kraenzlin
1   Klinik für Endokrinologie, Diabetologie und Metabolismus, Universitätsspital Basel, Schweiz; Endokrinologische Praxis & Labor, Basel, Schweiz
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Publication History

eingereicht: 20 February 2012

angenommen: 23 February 2012

Publication Date:
04 January 2018 (online)

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Zusammenfassung

Das komplexe regionale Schmerzsyndrom (CRPS) umschreibt eine Vielzahl von schmerzhaften Zuständen, die charakterisiert sind durch anhaltende Schmerzen, die die Dauer und Intensität des normalerweise zu erwartenden Verlaufs übersteigen. Zwischen zwei Typen kann unterschieden werden: Das CRPS Typ 1 entwickelt sich nach einem Trauma oder einer Fraktur, eine eigentliche Nervenläsion liegt nicht vor. Beim CRPS Typ 2 (Causalgia) liegt eine definierbare Nerven läsion vor. Epidemiologische, genetische und experimentelle Studien lassen darauf schließen, dass die Pathophysiologie des CRPS multifaktoriell ist. Drei Mechanismen sind für die Entwicklung des CRPS verantwortlich: neurogene Entzündung, autonome Dysfunktion und neuroplastische Veränderungen im ZNS. Die Symptomatik des CRPS umfasst autonome, sensorische, motorische und trophische Störungen. Die Hauptsymptome sind spontane Schmerzen, Hyperalgesie, Allodynie, abnormale vasomotorische Aktivität und abnormale sudomotorische Aktivität. Die Diagnose ist klinisch und basiert auf der Anamnese und klinischen Befunden mit Anwendung der diagnostischen Kriterien der Internationalen Gesellschaft zum Studium des Schmerzes (IASP) und kann durch zusätzliche diagnostische Interventionen, wie das konventionelle Röntgenbild, 3-Phasen-Skelett-Szintigrafie und MRI unterstützt werden. Die Therapie ist multidisziplinär. Nicht medikamentöse Therapien umfassen insbesondere Physio-/Ergotherapie, physikalische Maßnahmen und psychologische Betreuung. Medikamentöse Therapien orientieren sich an der individuellen Symptomkonstellation und umfassen Pharmakotherapie der neuropathischen Schmerzen und Substanzen, die in den Knochenstoffwechsel eingreifen. Auch Glukokortikoide und Radikalfänger können zum Einsatz kommen. Zu den invasiven Maßnahmen zählen Sympathikusblockaden, die bei Vorliegen eines sympathisch unterhaltenen Schmerzsyndroms eingesetzt werden können, und die rückenmarksnahe Elektrostimulation.

Summary

Complex-regional pain syndromes (CRPS) belong to the neuropathic pain syndromes. CRPS is characterized by pain out of proportion to the initiating event. CRPS can be divided in two types. In type I, which develops typically after minor trauma or fracture, no overt nerve lesion is detected. In type II (Causalgia), a definable nerve injury is present. Several pathophysiological concepts have been proposed to explain the complex symptoms of CRPS: facilitated neurogenic inflammation, pathological sympatho-afferent coupling, and neuroplastic changes within the CNS. The key features are spontaneous pain, hyeralgesia, allodynia, abnormal vasomotor activity and abnormal sudomotor activity. Diagnosis is mainly based on clinical signs using the diagnostic criteria developed by the International Association for the Study of Pain (IASP). However, additional laboratory and radiological examinations may help to corroborate correct diagnosis. Therapy is based on a multidisciplinary approach. Non-pharmacological approaches include physiotherapy and occupational therapy. Pharmacotherapy is based on individual symptoms and includes treatment of neuropathic pain, agents interfering with bone metabolism, steroids, and eventually free radical scavengers. Invasive therapeutic concepts include sympathetic blocks for the treatment of sympathetically maintained pain and implantation of spinal cord stimulators.

Schlüsselwörter

Komplexes regionales Schmerzsyndrom - CRPS - Pathophysiologie - Diagnostik - Therapie

Keywords

Complex regional pain syndrome - CRPS - pathophysioplogy - diagnosis - treatment
 

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