CRPS 的確切病理生理學仍然未被完全理解。從前它被認為是來自交感神經系統的疾病，但目前的醫生證據顯示CRPS 也涉及中樞神經的病變。目前的研究發現患者出現異常炎症、血管調節障礙和中樞神經系統內的異常的神經連接。這些因素共同引起了CRPS的臨床症狀。
CRPS 的保守治療包含物理治療。除了一般能改善活動能力的物理治療外，治療CRPS 還可利用一特定的治療。其中一種治療方法是Graded Motor Imagery (GMI)。GMI 是一種治療方案，它訓練或者左右判斷能力、也會透過想像動作和鏡子治療達到治療效果。
CRPS 的藥物治療包括利用治療神經疼痛或抑制發炎的藥物。這些包括抗憂鬱劑、抗癲癇劑、加巴班丁類、類固醇、非類固醇消炎止痛藥、防骨質流失藥物、維生素 C，以及靜脈注射的氯胺酮。
Complex Regional Pain Syndrome: An In-Depth Look at Symptoms, Diagnosis, and Treatments
Normally, after surgery or an injury to a limb, we expect to experience pain. As the injury heals, this pain typically subsides. However, some individuals continue to experience persistent pain, which may even intensify over time. In certain cases, the affected limb can even appear visibly distressed. These individuals may be suffering from Complex Regional Pain Syndrome (CRPS).
Typically, a CRPS patient presents symptoms after a minor or moderate tissue injury, such as a sprained ankle. During the acute phase, the injured limb displays pain, swelling, and redness. As the condition progresses, the pain can intensify and may encompass the entire limb. Other symptoms may include sensitivity to touch or cold, changes in skin color and temperature, and stiffness. The condition can also lead to trophic changes in the skin, hair, and nails, as well as altered motor function, which can manifest as a loss of strength, reduced active range of motion, and tremors.
The diagnosis of CRPS primarily relies on a physical exam and an assessment of the patient's medical history. Currently, there isn't a single test that can conclusively diagnose CRPS. The Budapest Criteria is the most widely accepted diagnostic criterion. According to this criteria, doctors assess whether patients exhibit abnormal sensations, color changes, unusual swelling, or impaired movement.
The exact pathophysiology of CRPS is still not fully understood. While it was once believed to stem solely from disorders within the sympathetic nervous system, current evidence suggests significant involvement of the central nervous system. Current research highlights biological pathways associated with abnormal inflammation, impaired blood vessel regulation, and the emergence of atypical neural connections within the central nervous system. Together, these factors play a pivotal role in the clinical presentations of CRPS.
Conservative treatments for CRPS encompass physical therapy. Apart from general physical therapy which aids in mobility improvement, there are specific treatments that can benefit CRPS patients. One such treatment is Graded Motor Imagery (GMI). GMI is a rehabilitation program that utilizes left/right judgments, imagined movements, and mirror therapy.
Pharmacological treatments for CRPS include medications to alleviate neuropathic pain and control inflammation. These may consist of antidepressants, anticonvulsants, gabapentinoids, corticosteroids, non-steroidal anti-inflammatories, bone-loss medications, vitamin C, and intravenous ketamine.
Interventional treatments for CRPS include sympathetic nerve blocks, peripheral nerve blocks, pulsed radiofrequency of nerves, and spinal cord stimulation. Sympathetic nerve blocks are considered the first line interventional treatment for CRPS. Spinal cord stimulation employs neuromodulation techniques wherein electrodes are placed in the spinal cord or dorsal root ganglion to deliver electrical impulses that disrupt pain signals and modify pain signal transmission. Meanwhile, pulsed radiofrequency ablation uses localized electromagnetic fields to modulate the nervous system responsible for transmitting pain signals.
Complex Regional Pain Syndrome (CRPS) is a perplexing condition characterised by persistent and often escalating pain. While its exact causes and underlying mechanisms remain a topic of ongoing research, our understanding of the syndrome has grown, leading to a broader range of treatment options. From conservative methods like physical therapy to pharmacological treatment and interventional procedures. As awareness and knowledge about CRPS expand, we remain hopeful for even more effective treatments in the future.
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