Abstract

NEIRA, F.  and  ORTEGA, J. L.. Complex Regional Pain Syndrome and Evidence-Based Medicine. Rev. Soc. Esp. Dolor [online]. 2007, vol.14, n.2, pp.133-147. ISSN 1134-8046.

The patients with Complex Regional Pain Syndrome (CRPS) have received different treatments with major or less success. In the present review we have achieved a systematic search in Internet, using the terms "Reflex Sympathetic Dystrophy" and "Complex Regional Pain Syndrome". The objective is to assess the diagnostic methods and therapeutics more effectives based on the best available scientific evidence, that allows a suitable control of patients with CRPS. The IASP establish the CRPS as a variety of pain conditions of regional finding, after one injury, with distal prevalence of unusual symptoms, exceeding in magnitude and duration to the clinic course expect of initial incident, producing an important impairment motor, with a variable progression in the time. The difference between CRPS I and CRPS II is in the presence of an injury in a peripheral nerve in the CRPS II. This Syndrome have some main signs and symptoms: strong pain, hyperesthesis, hyperalgesia, allodynia, sensorial deficiency, hyposthesis, tumefaction, changes of colour and temperature anomaly of sudation, changes in the skin: pallor, fibrosis, hyperkeratosis, brilliant and thin skin, trophic and vasomotor changes, muscular and bony atrophy. The diagnosis of CRPS I can be realized by clinic history and exploration [recommendation (R) B]. The diagnosis of CRPS I is based in the severity and duration of signs and symptoms [level of evidence (LE) III]. Some complementary test can assist to the differential diagnostic with other syndromes of chronic pain. We have evaluated different diagnostic approach although there aren’t reasons to recommend one over other (R C). The present guideline a recommend a multidisciplinary treatment with three essential elements: pain treatment, rehabilitation and psychological treatment. Treatment must be individualized according to characteristic of patient and to avoid pain, Joint rigidity, vasomotor reflex, Joint and bone sequel. The last objective must be the functional recovery without pain. Between treatments performed with some effectiveness there are: antiepileptic (LE II), antidepressant (LE III), nasal calcitonina (LE II), block of channel of calcium (LE IV), antiinflamatory nonsteroid, corticosteroid (LE I), patch of clonidina (LE IV), lidocaína intravenous (LE IV), cream of dimetil sulfoxide (LE IV), bifosfonates (LE II), ketamina intravenous (LE IV) and opioids. The regional endovenous block have efficacy: clonidina associated with lidocaína (LE III), bretilio associated with lidocaína (LE II), while guanetidine doesn’t seem effective (LE I). Epidural block is effective: bupivacaína associated to opioids (LE III), clonidina (LE II), Other technical that seems effective are: chirurgical sympathectomy (LE IV), Transcutaneous electrical nerve stimulation (LE IV), medular electric stimulation in CRPS I (R A) and in CRPS II (R D), phisioterapy (LE IV) and occupational therapy (LE IV). Prevention of CRPS can be realized with early hospitalary rehabilitation (RC).

Keywords : Complex Regional Pain Syndrome; Reflex Sympathetic Dystrophy; Evidence-Based Medicine; Pain.

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