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Complex Regional Pain Syndrome: Diagnosis, Pathophysiology, and Treatment Approaches.
Cureus
December 2024
Neurosurgery, Fluminense Federal University, Niterói, BRA.
Complex regional pain syndrome (CRPS) is a chronic pain condition characterized by significant sensory, motor, and autonomic dysfunction, often following trauma or nerve injury. Historically known as causalgia and reflex sympathetic dystrophy, CRPS manifests as severe, disproportionate pain, often accompanied by hyperalgesia, allodynia, trophic changes, and motor impairments. Classified into type I (without nerve injury) and type II (associated with nerve damage), CRPS exhibits a complex pathophysiology involving peripheral and central sensitization, neurogenic inflammation, maladaptive brain plasticity, and potential autoimmune and psychological influences.
View Article and Find Full Text PDFSprouting sympathetic fibres release CXCL16 and norepinephrine to synergistically mediate sensory neuronal hyperexcitability in a rodent model of neuropathic pain.
Br J Anaesth
January 2025
Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China. Electronic address:
Background: Chronic neuropathic pain generally has a poor response to treatment with conventional drugs. Sympathectomy can alleviate neuropathic pain in some patients, suggesting that abnormal sympathetic-somatosensory signaling interactions might underlie some forms of neuropathic pain. The molecular mechanisms underlying sympathetic-somatosensory interactions in neuropathic pain remain obscure.
View Article and Find Full Text PDFHodological patterning as an organizing principle in vertebrate motor circuitry.
Front Neuroanat
January 2025
Department of Molecular Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
Hodological patterning refers to developmental mechanisms that link the location of neurons in the brain or spinal cord to specific axonal trajectories that direct connectivity to synaptic targets either within the central nervous system or in the periphery. In vertebrate motor circuits, hodological patterning has been demonstrated at different levels, from the final motor output of somatic and preganglionic autonomic neurons targeting peripheral motoneurons and ganglion cells, to premotor inputs from spinal and brainstem neuron populations targeting the somatic motoneurons and preganglionic autonomic neurons, to cortical neurons that delegate movement commands to the brainstem and spinal neurons. In many cases molecular profiling reveals potential underlying mechanisms whereby selective gene expression creates the link between location and axon trajectory.
View Article and Find Full Text PDFStellate Ganglion Blockade as Rescue Therapy for Recurrent Torsades de Pointes and as a Bridge to Surgical Sympathectomy in a Pediatric Patient: A Case Report.
A A Pract
January 2025
From the Department of Anesthesia and Perioperative Medicine, University of California Los Angeles (UCLA) David Geffen School of Medicine, UCLA Health System, Los Angeles, California.
Management of refractory ventricular fibrillation (VF) in patients with implantable implantable cardioverter defibrillator (ICD) presents a therapeutic challenge. We present a case of pediatric refractory ventricular tachycardia (VT)/Torsade de Pointe managed effectively with bilateral stellate ganglion block (SGB) with a long-acting local anesthetic for 18 days as a bridge to more definitive surgical management.
View Article and Find Full Text PDFThe case of a woman with bilateral Dupuytren's contractures who developed CRPS-1 after fasciectomy with no relapse on subsequent collagenase clostridium histolyticum injection and manipulation of the other hand: Considerations for implementing a Budapest criteria checklist and assessing vasomotor instability by measuring differences in skin temperature.
J Hand Ther
January 2025
Saint Joseph, MI, USA. Electronic address:
Background: For patients who experience atypical neurogenic pain thought to be complex regional pain syndrome (CRPS) after Dupuytren's fasciectomy early recognition has been reported to improve outcomes. Furthermore, given the progressive nature of Dupuytren's, individuals with a history of CRPS have been "at risk" for further surgical intervention.
Purpose: To familiarize therapists with a Budapest criteria (BC) checklist for early diagnosis of CRPS, describe how tracking sudomotor/vasomotor signs alongside differences in skin temperature were used to monitor vasomotor instability and intervention effectiveness for a patient with atypical pain after fasciectomy and to detail management of the same patient with a CRPS history who had collagenase clostridium histolyticum (CCH) injection of her other hand without exacerbating CRPS.
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