Complex regional pain syndrome

Kompleksni regionalni bolni sindrom (engl. Complex regional pain syndrome- CRPS), poznat i kao Sudeckova distrofija, algodistrofija i kauzalgija, stanje je kronične žareće boli često povezane s autonomnom disfunkcijom. Cilj ovoga preglednog rada je prikazati etiologiju i epidemiologiju bolesti, patofiziološke mehanizme, dijagnozu i metode liječenja simptoma bolesti. Uzrok bolesti nije jasno poznat. Predloženi patofiziološki mehanizmi uključuju disfunkciju perifernoga i središnjeg živčanog sustava, neodgovarajući upalni odgovor i autonomnu disfunkciju. CRPS je obično potaknut traumom i najčešće pogađa jedan ekstremitet, ali se nekada može širiti i na druge dijelove tijela. Razvoj bolesti ne ovisi o jačini traume. U tipu 1 CRPS ne postoji ozljeda živčanog sustava koja bi mogla biti uzrok bolesti. CRPS tip 2 obilježen je prisutnošću ozljede perifernoga živca. Simptomi bolesti variraju od bolesnika do bolesnika. Česti simptomi su: žareća bol, hiperalgezija, alodinija, mišićna slabost, tremor te promjene boje i temperature kože. U svojoj akutnoj fazi CRPS je karakteriziran boli i drugim upalnim simptomima. S vremenom neki bolesnici razviju tkivnu atrofiju i gubitak funkcije zahvaćenoga ekstremiteta. Dijagnoza se uglavnom temelji na procjeni kliničkih znakova i simptoma. U cilju smanjenja boli i drugih simptoma bolesti koriste se brojni načini liječenja uključujući fizikalnu terapiju, farmakološko liječenje i invazivni pristup. Cilj uspješnog liječenja je interdisciplinarni pristup. Rana dijagnoza i liječenje povećavaju mogućnost izlječenja. Potrebna su dodatna istraživanja u cilju boljega razumijevanja uzroka i razvoja bolesti.Complex regional pain syndrome (CRPS), also known as Sudeck's dystrophy, algodystrophy and causalgia, is a state of chronic burning pain often associated with autonomic disfunction. The aim of this review is to present epidemiology and etiology of the disease, pathophysiological mechanisms, diagnostic procedures and methods of treating the symptoms of the disease. The cause of the disease is not clearly understood. Proposed pathophysiological mechanisms include dysfunction of the central and peripheral nervous system, inappropriate inflamatory response and autonomic disfunction. CRPS is mostly initiated by trauma and it usually affects one limb, but it can sometimes spread to other parts of the body. Development does not apear to depend on the magnitude of injury. In CRPS type 1 no damage to the nervous system is found as a cause. CRPS type 2 is characterised by a presence of a nerve injury. The symptoms vary from patient to patient. Common symptoms are burning pain, hyperalgesia, allodynia, muscle weakness, tremor, changes in skin colour and temperature. In its acute phase, CRPS is characterised by regional inflammation and pain. During the course of disease some patients develope tissue atrophy and loss of function of the affected limb. The diagnosis is mostly based on observation of signs and symptoms. Many methods, including physical therapy, pharmacological treatment and invasive approach have been used to reduce the pain intensity and symptoms of the disease. The key to successuful treatment is an interdisciplinary approach. Early diagnosis and treatment increase the likelihood of a successful outcome. More research is needed to understand the causes and development of the disease