複雜區域疼痛症候群 (CRPS) 的症狀、診斷和治療

引言

通常肢體受傷後，我們出現疼楚。隨著傷口癒合，這種痛楚會消失。然而，有些人會持續感到痛楚，甚至可能隨著時間加劇，受影響的肢體甚至會出現腫脹及變色。這些人可能患有複雜區域疼痛症候群（CRPS）。

臨床表現

 通常，CRPS 通常受傷或手術引發，這些受傷可以是十分輕微，例如腳踝扭傷等。在病發初期，受傷肢體會表現出疼痛、腫脹和發紅。隨著疾病的進展，疼痛可能加劇並可能涵蓋整個肢體。除此之外，患肢可能會出現觸痛或發熱、發冷、皮膚變色、僵硬等。疾病還可能導致患肢皮膚萎縮及毛髮減少，以及冇力、活動幅度減少及震顫等。

 診斷

 CRPS的診斷主要依靠身體檢查和對患者病徵的評估。目前，並沒有單一的檢查可以確診CRPS。最被廣泛接受的診斷標準是布達佩斯標準Budapest Criteria。根據這一標準，醫生會評估病人是否表現出異常的感覺、顏色變化、不尋常的腫脹或肢體活動異常。

基礎病理生理學

 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。

保守治療

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。

藥物治療

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。

介入治療

CRPS 的介入治療包括交感神經阻斷、周邊神經阻斷、周邊神經脈沖射頻治療及脊髓刺激器等。交感神經阻斷是最常用的首選介入治療。脈沖射頻治療利用集中的電磁場調節神經。而脊髓刺激器則是利用神經調節技術，在脊髓或背根節放置電極以發送電流來阻斷疼痛信息傳遞和和改善神經系統對疼痛信息的處理。 

總結

複雜區域疼痛症候群（CRPS）是一種令人困惑的疾病，他會為患者帶來持續甚至不斷加劇的痛楚。雖然它的確切原因和潛在機制仍在持續研究之中，但隨著我們對這病不斷增加理解，治療方法會變得更多。這包括物理治、藥物治療和介入治療。在將來，相信我們可以研發出更有效的治療方法。

Complex Regional Pain Syndrome: An In-Depth Look at Symptoms, Diagnosis, and Treatments

Introduction

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).

Clinical Presentation

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.

 Diagnosis

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.

Underlying Pathophysiology

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 Treatment

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 Therapy

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.

Conclusion

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.