Abstract

GARRIDO, B. et al. Complex regional pain syndrome type I: Management with sympathetic blockade and other therapies…. Rev. Soc. Esp. Dolor [online]. 2005, vol.12, n.7, pp.417-424. ISSN 1134-8046.

Introduction: Complex Regional Pain Syndrome type 1 (CRPS-I) starts with an acute phase of regional neurogenic inflammation that leads to a chronic phase of neuropathic disorders. The involvement of the sympathetic nervous system in its genesis and maintenance is significant, but not exclusive. Consequently, an early and multi-factorial treatment aimed to physiopathological mechanisms is important. Objectives: To study the use of sympathetic blockade associated to other therapies and drugs for the management of CRPS-I. Material and methods: Sixty eight patients with CRPS-1 attending a Pain Clinic were studied. All of them underwent blockade of the sympathetic cervical and lumbar chain of nodes, depending on the location of the problem. All patients received also hydromassages at home. Co-adjuvant drugs were administered for the management of neuropathic, paroxysmal and burning persistent pain. In patients with bone consolidation disorders, local laser-therapy was applied. In patients with greater functional limitations, TENS and Physiatry techniques were used. A visual analogue scale was used (VAS) to assess the degree of analgesia and a physical examination was conducted to assess autonomic disorders. Joint function was assessed using the scale of Enneking and cols. for patients with amputation, modified by us. Results: Pain was controlled in 33 patients and 28 reduced their VAS score to tolerable pain levels, with a therapeutic effectiveness of 89,70%. Joint function was recovered in 30 patients, with a slight limitation remaining in 20. These two groups that achieved a better response represented 73.52% of all patients. A moderate limitation remained in 11 patients and a severe limitation remained in 7 patients, or 10,29%. Vasomotor disorders disappeared in all the patients with a favorable response. Conclusions: The degree of analgesia and control of autonomic symptoms were satisfactory in most patients. They recovered the joint function and, hence, improved their quality of life. The method was useful for the management of patients with CRPS-1, in combination with other therapies.

Keywords : CRPS type 1; Neuropathic pain; Pathological pain; Sympathetic blockade.

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