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Nervenheilkunde 2012; 31(03): 154-159
DOI: 10.1055/s-0038-1628274
Schmerz
Schattauer GmbH

Vom M. Sudeck zum komplexregionalen Schmerzsyndrom

From Sudeck’s dystrophy to complex regional pain syndrome
M. Fechir
1   Klinik und Poliklinik für Neurologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz
,
F. Birklein
1   Klinik und Poliklinik für Neurologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz
› Author Affiliations
Further Information

Publication History

Eingegangen am: 26 August 2011

angenommen am: 29 August 2011

Publication Date:
23 January 2018 (online)

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Zusammenfassung

Nach Extremitätentraumata, Läsionen peripherer Nerven oder des zentralen Nervensystems und selten spontan kann es zum Auftreten von charakteristischen Symptomkonstellationen eines komplex-regionalen Schmerzsyndroms (CRPS) kommen. Diese bestehen aus motorischen, sensiblen sowie autonomen Störungen. Nachdem dieser Symptomkomplex in der Vergangenheit mit wechselnden Bezeichnungen (z. B. M. Sudeck, Kausalgie, sympathische Reflexdystrophie) belegt wurde, lautet die von der International Association for the Study of Pain vorgeschlagene und aktuell verwendete Bezeichnung „komplexregionales Schmerzsyndrom“ (complex regional pain syndrome, CRPS). Aufgrund pathophysiologischer Gesichtspunkte erscheint eine Einteilung in Abhängigkeit der Hauttemperatur prinzipiell sinnvoller (primär warmes oder primär kaltes CRPS) als eine Einteilung in Typ I und II, der die Abwesenheit oder das Vorliegen einer einzelnen und eindeutigen peripheren Nervenläsion zugrunde liegt. Eine frühzeitige Diagnosestellung und Beginn einer auf die Symptomatik individuell abgestimmten Therapie unter Einbeziehung nicht medikamentöser und medikamentöser Therapieverfahren sind wichtig, um eine Chronifizierung zu vermeiden und die Funktion der betroffenen Extremität zu erhalten oder wieder herzustellen.

Summary

Sometimes a characteristic constellation of symptoms can be observed following limb trauma, lesions of nerves, central nervous system damage, or even spontaneously. These consist of motor, sensory, and autonomic disturbances. Several terms had been used in the past for these symptoms (e. g. causalgia, sympathetic reflex dystrophy), now, the denomination complex regional pain syndrome (CRPS) has been introduced by the International Association for the Study of Pain. A classification by the initial skin temperature (primary warm or primary cold CRPS) seems more appropriate than the classification as type I or II, depending on the absence or presence of a nerve lesion. Early diagnosis and initiation of an individualized multi-disciplinary therapy with non-medical and medical strategies is essential to avoid chronification of pain and to restore function of the affected extremity.

Schlüsselwörter

CRPS - Kausalgie - Sympathische Reflexdystrophie - sympathisch unterhaltener Schmerz

Keywords

CRPS - causalgia - sympathetic reflex dystrophia - sympathetic maintained pain
 

  • Literatur

  • 1 Mitchell SW, Morehouse GR, Keen WW. Gunshot wounds and other injuries of nerves. New York: Lipincott JP; 1864
    Search in Google Scholar
  • 2 Leriche R. De la causalgie envisagée comme une névrite du sympathique et de son traitement par la dénudation et l‘excision des plexus nerveux périartériels. Presse Med 1916; 24: 178-80.
    Search in Google Scholar
  • 3 Livingston WK. Pain mechanisms. A physiologic interpretation of causalgia and its relevant states. New York: Macmillan; 1944
    Search in Google Scholar
  • 4 Doupe J, Cullen CR, Chance GR. Post-traumatic pain and the causalgic syndromes. J Neurol Neurosurg Psychiatry 1944; 7: 33-48.
    CrossrefPubMedSearch in Google Scholar
  • 5 Evans JA. Reflex sympathetic dystrophy. Surg Clin North Am 1946; 26: 435-48.
    Search in Google Scholar
  • 6 Sudeck P. Über die akute entzündliche Knochenatrophie. Arch Klin Chir 1900; 62: 144-56.
    Search in Google Scholar
  • 7 Sudeck P. Die so genannte akute Knochenatrophie als Entzündungsvorgang. Der Chirurg 1942; 15: 449-57.
    Search in Google Scholar
  • 8 Stanton-Hicks M. et al. Reflex sympathetic dystrophy: changing concepts and taxonomy. Pain 1995; 63 (Suppl. 01) 127-33.
    CrossrefPubMedSearch in Google Scholar
  • 9 Birklein F. et al. Pattern of autonomic dysfunction in time course of complex regional pain syndrome. Clin Auton Res 1998; 8 (Suppl. 02) 79-85.
    CrossrefPubMedSearch in Google Scholar
  • 10 Bruehl S. et al. Complex regional pain syndrome: are there distinct subtypes and sequential stages of the syndrome?. Pain 2002; 95 1–2 119-24.
    CrossrefPubMedSearch in Google Scholar
  • 11 Birklein F, Kunzel W, Sieweke N. Despite clinical similarities there are significant differences between acute limb trauma and complex regional pain syndrome I (CRPS I). Pain 2001; 93 (Suppl. 02) 165-71.
    CrossrefPubMedSearch in Google Scholar
  • 12 Eberle T. et al. Warm and cold complex regional pain syndromes: differences beyond skin temperature?. Neurology 2009; 72 (Suppl. 06) 505-12.
    CrossrefPubMedSearch in Google Scholar
  • 13 Vaneker M. et al. Patients initially diagnosed as ‘warm’ or ‘cold’ CRPS 1 show differences in central sensory processing some eight years after diagnosis: a quantitative sensory testing study. Pain 2005; 115 1–2 204-11.
    CrossrefPubMedSearch in Google Scholar
  • 14 Vaneker M. et al. Impairments as measured by ISS do not greatly change between one and eight years after CRPS 1 diagnosis. Eur J Pain 2006; 10 (Suppl. 07) 639-44.
    CrossrefPubMedSearch in Google Scholar
  • 15 Geertzen JH. et al. Relationship between impairments, disability and handicap in reflex sympathetic dystrophy patients: a long-term follow-up study. Clin Rehabil 1998; 12 (Suppl. 05) 402-12.
    CrossrefPubMedSearch in Google Scholar
  • 16 Birklein F. et al. Neurological findings in complex regional pain syndromes – analysis of 145 cases. Acta Neurol Scand 2000; 101 (Suppl. 04) 262-9.
    CrossrefPubMedSearch in Google Scholar
  • 17 Maihofner C, Handwerker HO, Birklein F. Functional imaging of allodynia in complex regional pain syndrome. Neurology 2006; 66 (Suppl. 05) 711-7.
    CrossrefPubMedSearch in Google Scholar
  • 18 Maihofner C. et al. Mechanical hyperalgesia in complex regional pain syndrome: a role for TNF-alpha?. Neurology 2005; 65 (Suppl. 02) 311-3.
    CrossrefPubMedSearch in Google Scholar
  • 19 Maier C. et al. Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): somatosensory abnormalities in 1236 patients with different neuropathic pain syndromes. Pain 2010; 150 (Suppl. 03) 439-50.
    CrossrefPubMedSearch in Google Scholar
  • 20 Frettloh J, Huppe M, Maier C. Severity and specificity of neglect-like symptoms in patients with complex regional pain syndrome (CRPS) compared to chronic limb pain of other origins. Pain 2006; 124 1–2 184-9.
    CrossrefPubMedSearch in Google Scholar
  • 21 Lewis JS. et al. Wherever is my arm? Impaired upper limb position accuracy in complex regional pain syndrome. Pain 2010; 149 (Suppl. 03) 463-9.
    CrossrefPubMedSearch in Google Scholar
  • 22 Reinersmann A. et al. Left is where the L is right. Significantly delayed reaction time in limb laterality recognition in both CRPS and phantom limb pain patients. Neurosci Lett 2010; 486 (Suppl. 03) 240-5.
    CrossrefPubMedSearch in Google Scholar
  • 23 Forderreuther S, Sailer U, Straube A. Impaired self-perception of the hand in complex regional pain syndrome (CRPS). Pain 2004; 110 (Suppl. 03) 756-61.
    CrossrefPubMedSearch in Google Scholar
  • 24 Veldman PH. et al. Signs and symptoms of reflex sympathetic dystrophy: prospective study of 829 patients. Lancet 1993; 342 8878 1012-6.
    CrossrefPubMedSearch in Google Scholar
  • 25 Birklein F. et al. Cutaneous norepinephrine application in complex regional pain syndrome. Eur J Pain 1997; 1 (Suppl. 02) 123-32.
    CrossrefPubMedSearch in Google Scholar
  • 26 Deuschl G, Blumberg H, Lucking CH. Tremor in reflex sympathetic dystrophy. Arch Neurol 1991; 48 (12) 1247-52.
    CrossrefPubMedSearch in Google Scholar
  • 27 Jankovic J, Van der Linden C. Dystonia and tremor induced by peripheral trauma: predisposing factors. J Neurol Neurosurg Psychiatry 1988; 51 (12) 1512-9.
    CrossrefPubMedSearch in Google Scholar
  • 28 van Hilten JJ, van de Beek WJ, Roep BO. Multifocal or generalized tonic dystonia of complex regional pain syndrome: a distinct clinical entity associated with HLA-DR13. Ann Neurol 2000; 48 (Suppl. 01) 113-6.
    CrossrefPubMedSearch in Google Scholar
  • 29 Harden RN. et al. Validation of proposed diagnostic criteria (the „Budapest Criteria“) for Complex Regional Pain Syndrome. Pain 2010; 150 (Suppl. 02) 268-74.
    CrossrefPubMedSearch in Google Scholar
  • 30 Baron R, Janig W. Complex regional pain syndromes – how do we escape the diagnostic trap?. Lancet 2004; 364 9447 1739-41.
    CrossrefPubMedSearch in Google Scholar
  • 31 Gradl G. et al. [Acute CRPS I (morbus sudeck) following distal radial fractures – methods for early diagnosis]. Zentralbl Chir 2003; 128 (12) 1020-6.
    Thieme ConnectPubMedSearch in Google Scholar
  • 32 Wuppenhorst N. et al. Sensitivity and specificity of 3-phase bone scintigraphy in the diagnosis of complex regional pain syndrome of the upper extremity. Clin J Pain 2010; 26 (Suppl. 03) 182-9.
    CrossrefPubMedSearch in Google Scholar
  • 33 Schurmann M. et al. Imaging in early posttraumatic complex regional pain syndrome: a comparison of diagnostic methods. Clin J Pain 2007; 23 (Suppl. 05) 449-57.
    CrossrefPubMedSearch in Google Scholar
  • 34 Graif M. et al. Synovial effusion in reflex sympathetic dystrophy: an additional sign for diagnosis and staging. Skeletal Radiol 1998; 27 (Suppl. 05) 262-5.
    CrossrefPubMedSearch in Google Scholar
  • 35 Wasner G, Schattschneider J, Baron R. Skin temperature side differences – a diagnostic tool for CRPS?. Pain 2002; 98 1–2 19-26.
    CrossrefPubMedSearch in Google Scholar
  • 36 Krumova EK. et al. Long-term skin temperature measurements – a practical diagnostic tool in complex regional pain syndrome. Pain 2008; 140 (Suppl. 01) 8-22.
    CrossrefPubMedSearch in Google Scholar
  • 37 Wasner G. et al. Vascular abnormalities in reflex sympathetic dystrophy (CRPS I): mechanisms and diagnostic value. Brain 2001; 124 Pt 3 587-99.
    CrossrefPubMedSearch in Google Scholar
  • 38 Maihofner C. et al. Patterns of cortical reorganization in complex regional pain syndrome. Neurology 2003; 61 (12) 1707-15.
    CrossrefPubMedSearch in Google Scholar
  • 39 Maihofner C. et al. Cortical reorganization during recovery from complex regional pain syndrome. Neurology 2004; 63 (Suppl. 04) 693-701.
    CrossrefPubMedSearch in Google Scholar
  • 40 Blaes F. et al. Autoimmunity in complex-regional pain syndrome. Ann N Y Acad Sci 2007; 1107: 168-73.
    CrossrefPubMedSearch in Google Scholar
  • 41 Kemler MA. et al. HLA-DQ1 associated with reflex sympathetic dystrophy. Neurology 1999; 53 (Suppl. 06) 1350-1.
    CrossrefPubMedSearch in Google Scholar
  • 42 van de Beek WJ. et al. Susceptibility loci for complex regional pain syndrome. Pain 2003; 103 1–2 93-7.
    CrossrefPubMedSearch in Google Scholar
  • 43 Harden RN. et al. Prospective examination of pain-related and psychological predictors of CRPS-like phenomena following total knee arthroplasty: a preliminary study. Pain 2003; 106 (Suppl. 03) 393-400.
    CrossrefPubMedSearch in Google Scholar
  • 44 Bruehl S. et al. Psychological differences between reflex sympathetic dystrophy and non-RSD chronic pain patients. Pain 1996; 67 (Suppl. 01) 107-14.
    CrossrefPubMedSearch in Google Scholar
  • 45 Geertzen JH. et al. Stressful life events and psychological dysfunction in Complex Regional Pain Syndrome type I. Clin J Pain 1998; 14 (Suppl. 02) 143-7.
    CrossrefPubMedSearch in Google Scholar
  • 46 Oerlemans HM. et al. Pain and reduced mobility in complex regional pain syndrome I: outcome of a prospective randomised controlled clinical trial of adjuvant physical therapy versus occupational therapy. Pain 1999; 83 (Suppl. 01) 77-83.
    CrossrefPubMedSearch in Google Scholar
  • 47 Oerlemans HM. et al. Adjuvant physical therapy versus occupational therapy in patients with reflex sympathetic dystrophy/complex regional pain syndrome type I. Arch Phys Med Rehabil 2000; 81 (Suppl. 01) 49-56.
    CrossrefPubMedSearch in Google Scholar
  • 48 McCabe CS. et al. A controlled pilot study of the utility of mirror visual feedback in the treatment of complex regional pain syndrome (type 1). Rheumatology (Oxford) 2003; 42 (Suppl. 01) 97-101.
    PubMedSearch in Google Scholar
  • 49 Cacchio A. et al. Mirror therapy for chronic complex regional pain syndrome type 1 and stroke. N Engl J Med 2009; 361 (Suppl. 06) 634-6.
    CrossrefPubMedSearch in Google Scholar
  • 50 Moseley GL. Graded motor imagery is effective for long-standing complex regional pain syndrome: a randomised controlled trial. Pain 2004; 108 1–2 192-8.
    CrossrefPubMedSearch in Google Scholar
  • 51 Moseley GL. Graded motor imagery for pathologic pain: a randomized controlled trial. Neurology 2006; 67 (12) 2129-34.
    CrossrefPubMedSearch in Google Scholar
  • 52 de Jong JR. et al. Reduction of pain-related fear in complex regional pain syndrome type I: the application of graded exposure in vivo. Pain 2005; 116 (Suppl. 03) 264-75.
    CrossrefPubMedSearch in Google Scholar
  • 53 Ek JW. et al. Pain exposure physical therapy may be a safe and effective treatment for longstanding complex regional pain syndrome type 1: a case series. Clin Rehabil 2009; 23 (12) 1059-66.
    CrossrefPubMedSearch in Google Scholar
  • 54 Lee BH. et al. Physical therapy and cognitive-behavioral treatment for complex regional pain syndromes. J Pediatr 2002; 141 (Suppl. 01) 135-40.
    CrossrefPubMedSearch in Google Scholar
  • 55 Bruehl S, Chung OY. Psychological and behavioral aspects of complex regional pain syndrome management. Clin J Pain 2006; 22 (Suppl. 05) 430-7.
    CrossrefPubMedSearch in Google Scholar
  • 56 Turner JA, Mancl L, Aaron LA. Short- and long-term efficacy of brief cognitive-behavioral therapy for patients with chronic temporomandibular disorder pain: a randomized, controlled trial. Pain 2006; 121 (Suppl. 03) 181-94.
    CrossrefPubMedSearch in Google Scholar
  • 57 Christensen K, Jensen EM, Noer I. The reflex dystrophy syndrome response to treatment with systemic corticosteroids. Acta Chir Scand 1982; 148 (Suppl. 08) 653-5.
    PubMedSearch in Google Scholar
  • 58 Kalita J, Vajpayee A, Misra UK. Comparison of prednisolone with piroxicam in complex regional pain syndrome following stroke: a randomized controlled trial. QJM 2006; 99 (Suppl. 02) 89-95.
    CrossrefPubMedSearch in Google Scholar
  • 59 Zuurmond WW. et al. Treatment of acute reflex sympathetic dystrophy with DMSO 50% in a fatty cream. Acta Anaesthesiol Scand 1996; 40 (Suppl. 03) 364-7.
    CrossrefPubMedSearch in Google Scholar
  • 60 Perez RS. et al. The treatment of complex regional pain syndrome type I with free radical scavengers: a randomized controlled study. Pain 2003; 102 (Suppl. 03) 297-307.
    CrossrefPubMedSearch in Google Scholar
  • 61 Adami S. et al. Bisphosphonate therapy of reflex sympathetic dystrophy syndrome. Ann Rheum Dis 1997; 56 (Suppl. 03) 201-4.
    CrossrefPubMedSearch in Google Scholar
  • 62 Manicourt DH. et al. Role of alendronate in therapy for posttraumatic complex regional pain syndrome type I of the lower extremity. Arthritis Rheum 2004; 50 (11) 3690-7.
    CrossrefPubMedSearch in Google Scholar
  • 63 Varenna M. et al. Intravenous clodronate in the treatment of reflex sympathetic dystrophy syndrome. A randomized, double blind, placebo controlled study. J Rheumatol 2000; 27 (Suppl. 06) 1477-83.
    Search in Google Scholar
  • 64 Robinson JN, Sandom J, Chapman PT. Efficacy of pamidronate in complex regional pain syndrome type I. Pain Med 2004; 5 (Suppl. 03) 276-80.
    CrossrefPubMedSearch in Google Scholar
  • 65 Finnerup NB, Sindrup SH, Jensen TS. The evidence for pharmacological treatment of neuropathic pain. Pain 2010; 150 (Suppl. 03) 573-81.
    CrossrefPubMedSearch in Google Scholar
  • 66 van de Vusse AC. et al. Randomised controlled trial of gabapentin in Complex Regional Pain Syndrome type 1 [ISRCTN84121379]. BMC Neurol 2004; 4: 13.
    CrossrefPubMedSearch in Google Scholar
  • 67 Sigtermans MJ. et al. Ketamine produces effective and long-term pain relief in patients with Complex Regional Pain Syndrome Type 1. Pain 2009; 145 (Suppl. 03) 304-11.
    CrossrefPubMedSearch in Google Scholar
  • 68 Schwartzman RJ. et al. Outpatient intravenous keta-mine for the treatment of complex regional pain syndrome: a double-blind placebo controlled study. Pain 2009; 147 1–3 107-15.
    CrossrefPubMedSearch in Google Scholar
  • 69 Cordivari C, Misra VP, Catania S, Lees AJ. Treatment of dystonic clenched fist with botulinum toxin. Mov Disord 2001; 16 (Suppl. 05) 907-13.
    CrossrefPubMedSearch in Google Scholar
  • 70 van Hilten BJ. et al. Intrathecal baclofen for the treatment of dystonia in patients with reflex sympathetic dystrophy. N Engl J Med 2000; 343 (Suppl. 09) 625-30.
    CrossrefPubMedSearch in Google Scholar
  • 71 Price DD, Long S, Wilsey B, Rafii A. Analysis of peak magnitude and duration of analgesia produced by local anesthetics injected into sympathetic ganglia of complex regional pain syndrome patients. Clin J Pain 1998; 14 (Suppl. 03) 216-26.
    CrossrefPubMedSearch in Google Scholar
  • 72 Kemler MA. et al. Pain relief in complex regional pain syndrome due to spinal cord stimulation does not depend on vasodilation. Anesthesiology 2000; 92 (Suppl. 06) 1653-60.
    CrossrefPubMedSearch in Google Scholar