| Abstract | Kompleksni regionalni bolni sindrom (engl. complex regional pain syndrome – CRPS) stanje je trajne i onesposobljavajuće boli koje, zahvaća jednu regiju (najčešće ruku). Često se javlja nakon ozljede koja se težinom ne poklapa s razinom boli. Dijagnoza je poznata i pod nazivima kao što su simpatička distrofija, kauzalgija,Sudeckova atrofija, prolazna osteoporoza i akutna atrofija kostiju. Cilj ovog rada je prikazati epidemiologiju, etiologiju, patofiziološke mehanizme te načine dijagnosticiranja, liječenja, prevencije i smanjenja posljedica ove nedovoljno prepoznate bolesti. Razlikujemo dva oblika CRPS-a; tip 1 i tip 2.Oblik CRPS-a tip 1 (oblik poznat kao i refleksna simpatička distrofija) javlja se u pacijenta koji nema jasnu ozljedu perifernog živca i predstavlja približno 90% kliničkih prezentacija. Oblik CRPS-a tip 2 prije se nazivao i „kauzalgija“ i javlja se u pacijenata kod kojih je prisutna jasna ozljeda perifernih živaca. Patogeneza CRPS-a je nepoznata. Predloženi mehanizmi su promjene perifernog i središnjeg živčanog sustava i uključuju klasičnu i neurogenu upalu i maladaptivne promjene u percepciji boli. Genetski čimbenici također mogu biti uključeni u patogenezu CRPS-a.Studije temeljene na populaciji procjenjuju incidenciju između 5 i 26 na 100 000 godišnje.CRPS se u odraslih češće javlja na gornjim udovima. Zahvaćenost i gornjih i donjih udova kod istog bolesnika je neuobičajena. Međutim, simptomi CRPS-a mogu se proširiti tijekom vremena i zahvatiti susjedna područja zahvaćenog uda ili, povremeno, drugi ipsilateralni ili kontralateralni ud. Glavni klinički simptomi su bol, senzorne promjene, motorička oštećenja, autonomni simptomi i trofičke promjene u zahvaćenom ekstremitetu. Dijagnoza CRPS-a temelji se na kliničkim značajkama utvrđenim anamnezom i fizičkim pregledom. Međutim, neki istraživači tvrde da su određene pretrage korisne za dijagnozu CRPS-a, posebice troetapna scintigrafija kostiju koja pokazuje povećani unos radiofarmaka u zglobove oko mjesta ozljede. Drugi testovi s određenom mogućom korisnošću uključuju usporedne rendgenske snimke (npr. obje ruke snimljene na istom rendgenskom snimku) koje pokazuju točkastu demineralizaciju kostiju i dugotrajna ili ponavljana mjerenja temperature kože koja pokazuju razliku >1°C između zahvaćene i nezahvaćene strane. Liječenje CRPS-a je složeno kao i njegova sama patofiziologija te klinička slika stoga zahtjeva individualni rad i interdisciplinarnu suradnju. Farmakološki pristup jednako je bitan kao i sama fizikalna terapija. Uz današnju napredniju medicinu možemo postići puno veće, brže i bolje rezultate nego prije. |
| Abstract (english) | Complex regional pain syndrome (eng. complex regional pain syndrome - CRPS) is a state of permanent and disabling pain that affects one region (most often the hand). It often occurs after injuries whose severity does not match the level of pain. The diagnosis is also known by names such as sympathetic dystrophy, causalgia, Sudeck's atrophy, transient osteoporosis and acute bone atrophy. The aim of this paper is to present the epidemiology, etiology, pathophysiological mechanisms and methods of diagnosis, treatment, prevention and reduction of the consequences of this insufficiently recognized disease. We distinguish between two forms of CRPS; type 1 and type 2. The type 1 form of CRPS (also known as reflex sympathetic dystrophy) occurs in patients with no clear peripheral nerve injury and accounts for approximately 90% of clinical presentations. The type 2 form of CRPS used to be called "causalgia" and occurs in patients with clear peripheral nerve injury. The pathogenesis of CRPS is unknown.Proposed mechanisms involve both the peripheral and central nervous systems and include classical inflammation, neurogenic inflammation, and maladaptive changes in pain perception.Genetic factors may also be involved in the pathogenesis of CRPS.Population-based studies estimate the incidence to be between 5 and 26 per 100,000 per year. In adults,CRPS occurs more often in the upper limbs. Involvement of both upper and lower limbs in the same patient is unusual. However,CRPS symptoms can spread over time to involve adjacent areas of the affected limb or, occasionally, the other ipsilateral or contralateral limb. The main clinical symptoms are pain, sensory changes, motor impairments, autonomic symptoms and trophic changes in the affected limb.The diagnosis of CRPS is based on clinical features determined by history and physical examination. However, some researchers claim that certain tests are useful for the diagnosis of CRPS, especially triphasic bone scintigraphy, which shows increased uptake of pharmacotracers in the joints around the injury site. Other tests of some possible utility include comparative radiographs (eg, both hands taken on the same radiograph) showing the point of bone decalcification and long-term or repeated skin temperature measurements showing a difference of >1°C for the affected versus the unaffected side. The treatment of CRPS is as complex as its pathophysiology and clinical picture, and therefore requires individual work and interdisciplinary cooperation. The pharmacological approach is just as important as the physical therapy itself.. With today's advanced medicine, we can achieve much bigger, faster and better results than before. |
