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Kompleks bölgesel ağrı sendromunda agresif medikal ve fizik tedavinin iyileşme sürecine etkisi

Year 2021, Volume: 4 Issue: 1, 11 - 17, 24.02.2021

Abstract

Amaç: Kompleks bölgesel ağrı sendromu (KBAS), ağrılı bölgedeki otonom ve inflamatuar değişiklikleri temsil eden belirtilerin varlığı ile diğer kronik ağrı durumlarından ayrılır. Kompleks bölgesel ağrı sendromunun tedavisi farmakolojik tedavi, fizik tedavi, mesleki ve psikolojik tedavilerin kombinasyonunu içeren multidisipliner bir yaklaşım gerektirir. Bu nedenle, bu çalışmanın amacı, Tip 1 KBAS hastalarında agresif medikal ve fizik tedavinin iyileşme sürecine etkisini değerlendirmektir.
Yöntem: Tip 1 KBAS tanısı olan 75 hasta (40 kadın, 35 erkek) retrospektif olarak toplandı. Tüm hastalara medikal ve fizik tedavi verilmişti. Tedavilerden önce, tedavilerden 1 ve 3 ay sonra hastaların sağlık durumu (çok iyi, iyi, orta, kötü, çok kötü) ile görsel analog skala (GAS) değerleri geriye yönelik tıbbi kayıtlardan toplandı.
Bulgular: Hastaların ortalama yaşı 53±11,30 yıl idi. Tedaviden önce, tedaviden 1 ve 3 ay sonraki GAS skorları sırasıyla 8,59 ± 0,50, 0,49±0,50 ve 0,49±0,50 idi. Tedaviden sonra 1. ve 3. aydaki GAS skorları, başlangıçtaki GAS düzeyine kıyasla istatistiksel olarak anlamlı derecede azalmıştı (p<0,001). Tedaviden önce ve tedaviden 3 ay sonraki sağlık durumu arasında da istatistiksel olarak anlamlı fark vardı (p<0,001).
Sonuç: Altta yatan herhangi bir patolojiyi gözden kaçırmamak ve bunları tamamen ortadan kaldırmak için mevcut tedavilerin kombinasyonunun iyi sonuçlar sağlayabileceği görülmektedir. Ayrıca, erken ve uygun tedavi, sendromun çözülmesine ve uzun süreli ağrının, fonksiyon kaybının ve sakatlığın önlenmesine yardımcı olabilir.

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References

  • 1. Dinçer K. Kompleks bölgesel ağrı sendromu. İçinde: Beyazova M, Kutsal YG, ed. Fiziksel Tıp ve Rehabilitasyon. 2. Baskı. Ankara: Güneş Kitapevi; 2011:2143-2157.
  • 2. Wertli M, Bachmann LM, Weiner SS, Brunner F. Prognostic factors in complex regional pain syndrome 1: A systematic review. J Rehabil Med. 2013;45(3):225-231. doi:10.2340/16501977-1103
  • 3. Hernández-Porras BC, Plancarte-Sánchez R, Alarcón-Barrios S, Sámano-García M. Complex regional pain syndrome: A review. Cir Cir. 2017;85(4):366-374. doi:10.1016/j.circir.2016.11.004
  • 4. Shim H, Rose J, Halle S, Shekane P. Complex regional pain syndrome: a narrative review for the practicing clinician. Br J Anaesth. 2019;123(2):e424-e433. doi:10.1016/j.bja. 2019.03.030
  • 5. Eldufani J, Elahmer N, Blaise G. A medical mystery of complex regional pain syndrome. Heliyon. 2020;6(2): e03329. doi:10.1016/j.heliyon.2020.e03329
  • 6. Bruehl S, Harden RN, Galer BS, et al. External validation of IASP diagnostic criteria for complex regional pain syndrome and proposed research diagnostic criteria. Pain. 1999;81:147-154. doi:10.1016/S0304-3959(99)00011-1
  • 7. Huskisson EC. Measurement of pain. Lancet. 1974;2:1127–1131.
  • 8. Perez RS, Zollinger PE, Dijkstra PU, et al. CRPS I task force. Evidence based guidelines for complex regional pain syndrome type 1. BMC Neurol. 2010;10: 20. doi:10.1186/1471-2377-10-20
  • 9. Bruehl S. Complex regional pain syndrome. BMJ. 2015;351: h2730. doi:10.1136/bmj.h2730
  • 10. Pons T, Shipton E, Williman J, Mulder RT. Potential risk factors for the onset of complex regional pain syndrome type 1: a systematic literature review. Anesthesiol Rest Pract. 2015;(2015):ID 956539. doi:10.1155/2015/956539
  • 11. Fukushima FB, Bezerra DM, Villas Boas PJ, Valle AP, Vidal EI. Complex regional pain syndrome. BMJ. 2014;348:g3683. doi:10.1136/bmj.g3683
  • 12. David Clark J, Tawfik VL, Tajerian M, Kingery WS. Autoinflammatory and autoimmune contributions to complex regional pain syndrome. Mol Pain. 2018;14:1744806918799127. doi:10.1177/17448069187 99127
  • 13. Guo TZ, Wei T, Kingery WS. Glucocorticoid inhibition of vascular abnormalities in a tibia fracture rat model of complex regional pain syndrome type I. Pain. 2006; 121:158-167. doi:10.1016/j.pain.2005.12.022
  • 14. Barbalinardo S, Loer SA, Goebel A, Perez RSGM. The treatment of longstanding complex regional pain syndrome with oral steroids. Pain Med. 2016;17(2):337-343. doi:10.1093/pm/pnv002
  • 15. Van de Vusse AC, Stompe-van den Berg SG, Kessels AH, Weber WE. Randomised controlled trial of gabapentin in complex regional pain syndrome type 1. BMC Neurol. 2004;4:13. doi:10.1186/1471-2377-4-13
  • 16. Millecamps M, Codere TJ. Rats with chronic post-ischemia pain exhibit sensitivity an analgesic profile similar to human patients with complex regional pain syndrome-type 1. Eur J Pharmacol. 2008;583:97-102. doi:10.1016/j.ejphar.2008.01.006
  • 17. Giusti A, Bianchi G. Treatment of complex regional pain syndrome type I with bisphosphonates. RMD Open. 2015;1(Suppl 1):e000056. doi:10.1136/rmdopen-2015-000056
  • 18. Pons T, Shipton EA, Williman J, Mulder RT. Potential risk factors for the onset of complex regional pain syndrome type 1: a systematic literature review. Anesthesiol Res Pract. 2015;2015:956539. doi:10.1155/2015/956539
  • 19. Barnhoorn KJ, van de Meent H, van Dongen RT, et al. Pain exposure physical therapy (PEPT) compared to conventional treatment in complex regional pain syndrome type 1: A randomized controlled trial. BMJ Open. 2015;5(12):e008283. doi:10.1136/bmjopen-2015-008283
  • 20. Bussa M, Mascaro A, Cuffaro L, Rinaldi S. Adult Complex Regional Pain Syndrome Type I: A Narrative Review. PM R. 2017;9(7):707-719. doi:10.1016/j.pmrj.2016.11.006
  • 21. Bilgili A, Çakır T, Doğan ŞK, Erçalık T, Filiz MB, Toraman F. The effectiveness of transcutaneous electrical nevre stimulation in the management of patients with complex regional pain syndrome: A randomized, double-blinded, placebo-controlled prospective study. J Back Musculoskelet Rehabil. 2016;29(4):661-671. doi:10.3233/BMR-160667
  • 22. Devrimsel G, Türkyılmaz AK, Yıldırım M, Beyazal MS. The effects of whirlpool bath and neuromuscular electrical stimulation on complex regional pain syndrome. J Phys Ther Sci. 2015;27(1):27-30. doi:10.1589/jpts.27.27

The Effect of Aggressive Medical and Physical Therapy on The Healing Process in Complex Regional Pain Syndrome

Year 2021, Volume: 4 Issue: 1, 11 - 17, 24.02.2021

Abstract

Objective: Complex regional pain syndrome (CRPS) differs from other chronic pain situations together by the presence of symptoms representing inflammatory and autonomic alterations in the painful area. The treatment of CRPS requires a multidisciplinary approach that includes a combination of pharmacological, physical, occupational, and psychological therapies. Therefore, the aim of the study is to evaluate the effect of aggressive medical and physical therapy on the recovery process in patients with CRPS type 1.
Methods: Seventy five patients (40 female, 35 male) with CRPS type 1 were retrospectively analyzed. All patients were treated with medical and physical therapy. The state of health (very good, good, moderate, bad, very bad) and visual analog scale (VAS) scores before the treatments, 1 and 3 months after the treatments were collected from medical records.
Results: In the study, the average age of patients was 53±11.30 years. The VAS scores in the baseline, 1, and 3 months after the treatments were 8.59±0.50, 0.49±0.50, and 0.49±0.50, respectively. The VAS scores in the 1 th and 3 th month following the therapies statistically significantly reduced according to the baseline (p<0.001). There a was statistically significant difference between the state of health scores before the treatments and after the treatments at the 3th month (p<0.001).
Conclusion: It is seemed that a combination of the current treatments may provide good results in order not to miss any underlying pathology and to eliminate them completely. Moreover, early and appropriate treatment can help resolve the syndrome and prevent prolonged pain, loss of function, and disability.

References

  • 1. Dinçer K. Kompleks bölgesel ağrı sendromu. İçinde: Beyazova M, Kutsal YG, ed. Fiziksel Tıp ve Rehabilitasyon. 2. Baskı. Ankara: Güneş Kitapevi; 2011:2143-2157.
  • 2. Wertli M, Bachmann LM, Weiner SS, Brunner F. Prognostic factors in complex regional pain syndrome 1: A systematic review. J Rehabil Med. 2013;45(3):225-231. doi:10.2340/16501977-1103
  • 3. Hernández-Porras BC, Plancarte-Sánchez R, Alarcón-Barrios S, Sámano-García M. Complex regional pain syndrome: A review. Cir Cir. 2017;85(4):366-374. doi:10.1016/j.circir.2016.11.004
  • 4. Shim H, Rose J, Halle S, Shekane P. Complex regional pain syndrome: a narrative review for the practicing clinician. Br J Anaesth. 2019;123(2):e424-e433. doi:10.1016/j.bja. 2019.03.030
  • 5. Eldufani J, Elahmer N, Blaise G. A medical mystery of complex regional pain syndrome. Heliyon. 2020;6(2): e03329. doi:10.1016/j.heliyon.2020.e03329
  • 6. Bruehl S, Harden RN, Galer BS, et al. External validation of IASP diagnostic criteria for complex regional pain syndrome and proposed research diagnostic criteria. Pain. 1999;81:147-154. doi:10.1016/S0304-3959(99)00011-1
  • 7. Huskisson EC. Measurement of pain. Lancet. 1974;2:1127–1131.
  • 8. Perez RS, Zollinger PE, Dijkstra PU, et al. CRPS I task force. Evidence based guidelines for complex regional pain syndrome type 1. BMC Neurol. 2010;10: 20. doi:10.1186/1471-2377-10-20
  • 9. Bruehl S. Complex regional pain syndrome. BMJ. 2015;351: h2730. doi:10.1136/bmj.h2730
  • 10. Pons T, Shipton E, Williman J, Mulder RT. Potential risk factors for the onset of complex regional pain syndrome type 1: a systematic literature review. Anesthesiol Rest Pract. 2015;(2015):ID 956539. doi:10.1155/2015/956539
  • 11. Fukushima FB, Bezerra DM, Villas Boas PJ, Valle AP, Vidal EI. Complex regional pain syndrome. BMJ. 2014;348:g3683. doi:10.1136/bmj.g3683
  • 12. David Clark J, Tawfik VL, Tajerian M, Kingery WS. Autoinflammatory and autoimmune contributions to complex regional pain syndrome. Mol Pain. 2018;14:1744806918799127. doi:10.1177/17448069187 99127
  • 13. Guo TZ, Wei T, Kingery WS. Glucocorticoid inhibition of vascular abnormalities in a tibia fracture rat model of complex regional pain syndrome type I. Pain. 2006; 121:158-167. doi:10.1016/j.pain.2005.12.022
  • 14. Barbalinardo S, Loer SA, Goebel A, Perez RSGM. The treatment of longstanding complex regional pain syndrome with oral steroids. Pain Med. 2016;17(2):337-343. doi:10.1093/pm/pnv002
  • 15. Van de Vusse AC, Stompe-van den Berg SG, Kessels AH, Weber WE. Randomised controlled trial of gabapentin in complex regional pain syndrome type 1. BMC Neurol. 2004;4:13. doi:10.1186/1471-2377-4-13
  • 16. Millecamps M, Codere TJ. Rats with chronic post-ischemia pain exhibit sensitivity an analgesic profile similar to human patients with complex regional pain syndrome-type 1. Eur J Pharmacol. 2008;583:97-102. doi:10.1016/j.ejphar.2008.01.006
  • 17. Giusti A, Bianchi G. Treatment of complex regional pain syndrome type I with bisphosphonates. RMD Open. 2015;1(Suppl 1):e000056. doi:10.1136/rmdopen-2015-000056
  • 18. Pons T, Shipton EA, Williman J, Mulder RT. Potential risk factors for the onset of complex regional pain syndrome type 1: a systematic literature review. Anesthesiol Res Pract. 2015;2015:956539. doi:10.1155/2015/956539
  • 19. Barnhoorn KJ, van de Meent H, van Dongen RT, et al. Pain exposure physical therapy (PEPT) compared to conventional treatment in complex regional pain syndrome type 1: A randomized controlled trial. BMJ Open. 2015;5(12):e008283. doi:10.1136/bmjopen-2015-008283
  • 20. Bussa M, Mascaro A, Cuffaro L, Rinaldi S. Adult Complex Regional Pain Syndrome Type I: A Narrative Review. PM R. 2017;9(7):707-719. doi:10.1016/j.pmrj.2016.11.006
  • 21. Bilgili A, Çakır T, Doğan ŞK, Erçalık T, Filiz MB, Toraman F. The effectiveness of transcutaneous electrical nevre stimulation in the management of patients with complex regional pain syndrome: A randomized, double-blinded, placebo-controlled prospective study. J Back Musculoskelet Rehabil. 2016;29(4):661-671. doi:10.3233/BMR-160667
  • 22. Devrimsel G, Türkyılmaz AK, Yıldırım M, Beyazal MS. The effects of whirlpool bath and neuromuscular electrical stimulation on complex regional pain syndrome. J Phys Ther Sci. 2015;27(1):27-30. doi:10.1589/jpts.27.27
There are 22 citations in total.

Details

Primary Language Turkish
Subjects Rehabilitation
Journal Section Research Articles
Authors

Ebru Yılmaz 0000-0003-2172-2742

Publication Date February 24, 2021
Submission Date November 11, 2020
Acceptance Date January 13, 2021
Published in Issue Year 2021 Volume: 4 Issue: 1

Cite

AMA Yılmaz E. Kompleks bölgesel ağrı sendromunda agresif medikal ve fizik tedavinin iyileşme sürecine etkisi. Acta Med Nicomedia. February 2021;4(1):11-17.

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