Startseite Invasive intervention for “intractable” Complex Regional Pain Syndromes (CRPS)?
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Invasive intervention for “intractable” Complex Regional Pain Syndromes (CRPS)?

  • Harald Breivik EMAIL logo
Veröffentlicht/Copyright: 1. Januar 2017
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Scandinavian Journal of Pain
Aus der Zeitschrift Scandinavian Journal of Pain Band 14 Heft 1

In this issue of the Scandinavian Journal of Pain Hagerdorn and Atallah publish an educational case report on their experience treating highly selected patients suffering from longstanding apparently intractable CRPS with intrathecal pump-administration of morphine and bupivacaine [1]. The patient had failed to obtain pain relief or had intolerable side effects during trial of several oral drugs that are often tried, but are only occasionally effective [2]. She also had a failed spinal cord stimulator trial.

Multimodal, multidisciplinary approach with cognitive behavioural techniques may help some patients cope better. Children with CRPS appear to benefit more often from such approaches, at least compared with adult patients with longstanding CRPS with complicating comorbidities. However, it is increasingly apparent that children, who apparently were cured of their CRPS during multidisciplinary psychosocial care, have recurrent CRPS episodes later in life [3,4,5]. Case-histories of such patients indicate that CRPS patients have lasting changes in their central pain modulating systems. Such pathological changes in the fundamental regulations of the ability to sense and modulate nociceptive impulses appear to be important in the conundrum that intractable CRPS is. These mechanisms, that make most of us benefit from the nociceptive alarm and defence mechanisms of our nervous system, they ensure that we are not left with chronic pain after an acute pain-event.

These defence systems likely depend on multiple mechanisms in our central nervous system. It is a bit naïve to believe that multidisciplinary psychosocial and behavioural approaches can help all patients with CRPS. It is a problem that most invasive interventions, except maybe spinal cord stimulation, have been considered by some authorities to be more or less mal-practice. Striking educational case reports [1,3,4,5] remind us that there still is a place for invasive techniques, and not only for intractable cancer pain in palliative medicine [6,7].Although a variety of drugs can be effective in intrathecal infusions [1], the local anaesthetic and opioid receptor agonist components appear to be essential [1,4,6].

DOI of refers to article: http://dx.doi.org/10.1016/j.sjpain.2016.05.040.

Oslo University Hospital, Department of Pain Management and Research, Pbox 4950 Nydalen, 0424 Oslo, Norway.

References

[1] Hagedorn JM, Atallah G. Intrathecal management of complex regional pain syndrome: a case report and literature. Scand J Pain 2017;14:110–2.Suche in Google Scholar

[2] Bruehl S. Complex regional pain syndrome. BMJ 2015;350:h2730.Suche in Google Scholar

[3] Satteson ES, Jarbpur PW, Koman LA, Smith BP, Li Z. The risk of pain syndrome affecting a previously non-painful limb following trauma or surgery in patients with a history of complex regional pain syndrome. Scand J Pain 2017;14:84–8.Suche in Google Scholar

[4] Rodriguez-Lopez MJ, Fernandez-Baena M, Barroso A, Yánez-Santos JA. Complex regional pain syndrome in children: a multidisciplinary approach and invasive techniques for the management of nonresponders. Pain Pract 2015;15:E81–9.Suche in Google Scholar

[5] Breivik H. Complex Regional Pain Syndrome (CRPS): high risk of CRPS after trauma in another limb in patients who already have CRPS in one hand or foot: lasting changes in neural pain modulating systems? Scand J Pain 2017;14:82–3.Suche in Google Scholar

[6] Breivik H. Terminal cancer pain intractable by conventional pain management can be effectively relieved by intrathecal administration of a local anaesthetic plus an opioid and an alfa2-agonist into the cerebro-spinal-fluid. Scand J Pain 2017;14:71–3.Suche in Google Scholar

[7] Mastenbroek TC, Kramp-Henriks BJ, Kallewaard JW, Vonk JM. Multimodal intrathecal analgesia in refractory cancer pain. Scand J Pain 2017;14:39–43.Suche in Google Scholar
Published Online: 2017-01-01
Published in Print: 2017-01-01

© 2016 Scandinavian Association for the Study of Pain

Artikel in diesem Heft

  2. Scandinavian Journal of Pain
  3. Editorial comment
  4. Patients with chronic neck-pain after trauma do not differ in type of symptoms and signs, but suffer more than patients with chronic neck pain without a traumatic onset
  5. Observational study
  6. Chronic neck pain patients with traumatic or non-traumatic onset: Differences in characteristics. A cross-sectional study
  7. Editorial Comment
  8. Re-enforcing therapeutic effect by positive expectations of pain-relief from our interventions
  9. Original experimental
  10. Effect of expectation on pain assessment of lower- and higher-intensity stimuli
  11. Editorial comment
  12. Objective methods for the assessment of the spinal and supraspinal effects of opioids
  13. Topical review
  14. Objective methods for the assessment of the spinal and supraspinal effects of opioids
  15. Editorial Comment
  16. Multi-target treatment of bone cancer pain using synergistic combinations of pharmacological compounds in experimental animals
  17. Original experimental
  18. Synergistic combinations of the dual enkephalinase inhibitor PL265 given orally with various analgesic compounds acting on different targets, in a murine model of cancer-induced bone pain
  19. Editorial comment
  20. Terminal cancer pain intractable by conventional pain management can be effectively relieved by intrathecal administration of a local anaesthetic plus an opioid and an alfa2-agonist into the cerebro-spinal-fluid
  21. Observational study
  22. Multimodal intrathecal analgesia in refractory cancer pain
  23. Editorial comment
  24. Treatment success in neck pain: The added predictive value of psychosocial variables in addition to clinical variables
  25. Observational study
  26. Treatment success in neck pain: The added predictive value of psychosocial variables in addition to clinical variables
  27. Editorial comment
  28. Why are some patients with chronic pain from anterior abdominal nerve entrapment syndrome (ACNES) refractory to peripheral treatment with neurectomy?
  29. Clinical pain research
  30. Treatment response and central pain processing in Anterior Cutaneous Nerve Entrapment Syndrome: An explorative study
  31. Editorial comment
  32. Gain in functions before pain reduction during intensive multidisciplinary paediatric pain rehabilitation programme
  33. Clinical pain research
  34. Physical and occupational therapy outcomes: Adolescents’ change in functional abilities using objective measures and self-report
  35. Editorial comment
  36. Complex Regional Pain Syndrome (CRPS): High risk of CRPS after trauma in another limb in patients who already have CRPS in one hand or foot: Lasting changes in neural pain modulating systems?
  37. Clinical pain research
  38. The risk of pain syndrome affecting a previously non-painful limb following trauma or surgery in patients with a history of complex regional pain syndrome
  39. Editorial Comment
  40. Positive affect could reduce the impact of pain
  41. Original experimental
  42. The buffering role of positive affect on the association between pain intensity and pain related outcomes
  43. Editorial comment
  44. The meaning and consequences of amputation and mastectomy from the perspective of pain and suffering – Lessons to be learned and relearned
  45. Clinical pain research
  46. The meaning and consequences of amputation and mastectomy from the perspective of pain and suffering
  47. Editorial comment
  48. Invasive intervention for “intractable” Complex Regional Pain Syndromes (CRPS)?
  49. Educational case report
  50. Intrathecal management of complex regional pain syndrome: A case report and literature
  51. Observational study
  52. Item response theory analysis of the Pain Self-Efficacy Questionnaire
  53. Announcement
  54. Scandinavian Association for the Study of Pain (SASP): Annual Meeting 2017
https://doi.org/10.1016/j.sjpain.2016.12.006

Artikel in diesem Heft

  2. Scandinavian Journal of Pain
  3. Editorial comment
  4. Patients with chronic neck-pain after trauma do not differ in type of symptoms and signs, but suffer more than patients with chronic neck pain without a traumatic onset
  5. Observational study
  6. Chronic neck pain patients with traumatic or non-traumatic onset: Differences in characteristics. A cross-sectional study
  7. Editorial Comment
  8. Re-enforcing therapeutic effect by positive expectations of pain-relief from our interventions
  9. Original experimental
  10. Effect of expectation on pain assessment of lower- and higher-intensity stimuli
  11. Editorial comment
  12. Objective methods for the assessment of the spinal and supraspinal effects of opioids
  13. Topical review
  14. Objective methods for the assessment of the spinal and supraspinal effects of opioids
  15. Editorial Comment
  16. Multi-target treatment of bone cancer pain using synergistic combinations of pharmacological compounds in experimental animals
  17. Original experimental
  18. Synergistic combinations of the dual enkephalinase inhibitor PL265 given orally with various analgesic compounds acting on different targets, in a murine model of cancer-induced bone pain
  19. Editorial comment
  20. Terminal cancer pain intractable by conventional pain management can be effectively relieved by intrathecal administration of a local anaesthetic plus an opioid and an alfa2-agonist into the cerebro-spinal-fluid
  21. Observational study
  22. Multimodal intrathecal analgesia in refractory cancer pain
  23. Editorial comment
  24. Treatment success in neck pain: The added predictive value of psychosocial variables in addition to clinical variables
  25. Observational study
  26. Treatment success in neck pain: The added predictive value of psychosocial variables in addition to clinical variables
  27. Editorial comment
  28. Why are some patients with chronic pain from anterior abdominal nerve entrapment syndrome (ACNES) refractory to peripheral treatment with neurectomy?
  29. Clinical pain research
  30. Treatment response and central pain processing in Anterior Cutaneous Nerve Entrapment Syndrome: An explorative study
  31. Editorial comment
  32. Gain in functions before pain reduction during intensive multidisciplinary paediatric pain rehabilitation programme
  33. Clinical pain research
  34. Physical and occupational therapy outcomes: Adolescents’ change in functional abilities using objective measures and self-report
  35. Editorial comment
  36. Complex Regional Pain Syndrome (CRPS): High risk of CRPS after trauma in another limb in patients who already have CRPS in one hand or foot: Lasting changes in neural pain modulating systems?
  37. Clinical pain research
  38. The risk of pain syndrome affecting a previously non-painful limb following trauma or surgery in patients with a history of complex regional pain syndrome
  39. Editorial Comment
  40. Positive affect could reduce the impact of pain
  41. Original experimental
  42. The buffering role of positive affect on the association between pain intensity and pain related outcomes
  43. Editorial comment
  44. The meaning and consequences of amputation and mastectomy from the perspective of pain and suffering – Lessons to be learned and relearned
  45. Clinical pain research
  46. The meaning and consequences of amputation and mastectomy from the perspective of pain and suffering
  47. Editorial comment
  48. Invasive intervention for “intractable” Complex Regional Pain Syndromes (CRPS)?
  49. Educational case report
  50. Intrathecal management of complex regional pain syndrome: A case report and literature
  51. Observational study
  52. Item response theory analysis of the Pain Self-Efficacy Questionnaire
  53. Announcement
  54. Scandinavian Association for the Study of Pain (SASP): Annual Meeting 2017
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