Complex regional pain syndrome

Kompleksni regionalni bolni sindrom (CRPS) predstavlja stanje trajne i često onesposobljavajuće boli, također poznate pod nazivom refleksna simpatička distrofija ili kauzalgija. Cilj ovog preglednog rada je prikazati epidemiologiju i etiologiju bolesti, predložene patofiziološke mehanizme, trenutačno prihvaćeni model dijagnosticiranja stanja te dosad istraživane metode liječenja i olakšavanja posljedica ove bolesti. U slučaju CRPS tipa 1 u podlozi bolnog sindroma ne nalazimo oštećenje središnjeg ili perifernog živčanog sustava. Za razliku , CRPS tipa 2 se može razviti nakon traume ekstremiteta, frakture kosti ili lezije živčanog sustava. Obilježen je trijasom simptoma koji uključuje autonomne (promjene boje i temperature kože, poremećaj znojenja), osjetne (trajna bol, hiperalgezija, alodinija, osjetni deficit) te motoričke (tremor, distonija, slabost). Kronični tijek uzrokuje atrofične promjena tkiva ekstremiteta, gubitka funkcije i radne sposobnosti. Unatoč provedenim istraživanjima, postoje kontradikcije o mehanizmu nastanak bolesti no trenutačno predloženi patofiziološki modeli koji najbolje opisuju bolest su autonomna disfunkcija, neurogena upala te neuroplastične promjene središnjeg živčanog sustava (SŽS) i smatra se kako je njihovo djelovanje prije kompatibilno negoli isključujuće. U svrhu dijagnosticiranja CRPS koristi se detaljan klinički pregled i stupnjevanje kliničke slike prema „Budimpeštanskim kriterijima“. Pristup liječenju traži interdisciplinarnu suradnju liječnika te obuhvaća prilagođenu fizikalnu terapiju, farmakološki pristup te invazivne procedure. Farmakološki pristup je pretežito usmjeren simptomima uključuje korištenje glukokortikoida, baklofena, bisfosfonata te reducensa slobodnih radikala , pogotovo profilaktički vitamina C. Invazivni pristup obuhvaća stimulacije leđne moždine, periferne živčane katetere s anestetikom te u krajnjoj situaciji amputaciju koju pacijenti u teškom stanju rado prihvaćaju. Daljnja istraživanja su potrebna radi boljeg razumijevanje bolesti i učinkovitije terapije.Complex regional pain syndrome (CRPS) represents a state of constant and often disabling pain, also known as reflex sympathetic dystrophy or causalgia. The aim of this review is to present epidemiology and etiology of the disease, proposed patophysiological mechanisms, currently accepted model for diagnosing the condition and previously investigated methods of treating and relieving the consequences of this disease. In case of CRPS type 1 no damage to the central or peripheral nervous system is found as underlying cause. In contrast, CRPS type 2 can develop after limb trauma, bone fractures or lesions of the nervous system. It is marked by a triad of symptoms that include autonomous (changes in skin color and temperature, sweating disorder), sensory (persistent pain, hyperalgesia, allodynia) and motor (tremor, dystonia, weakness). Chronic course of the disease leads to atrophic changes in tissues of the extremities, loss of function and working capacity. Despite the research, there are contradictions regarding mechanism causing the disease, but currently proposed pathophysiological models that best describe the disease are autonomic dysfunction, neurogenic inflammation and neuroplastic changes in the central nervous system and it is considered that their effect is rather compatible than exclusionary. Diagnosis is based on detailed clinical examination with classification of the clinical presentation according to "the Budapest criteria“. Therapy is oriented on interdisciplinary collaboration of physicians and includes a customized physical therapy, pharmacological approach and invasive procedures. Pharmacological approach is mainly symptom oriented and includes the use of glucocorticoids, baclofen, bisphosphonates and free radical scavengers, especially prophylactic vitamin C. Invasive approach includes stimulation of the spinal cord, anesthetic peripheral nerve catheters and in extreme situation amputation that patients in severe condition gladly accept. Further research is needed to better understand the disease and more effective therapies