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Trauma-induced Complex Regional Pain Syndrome Type Ⅱ on Upper and Lower Limbs: Case Report and Literature Review
創傷後同時引起上肢和下肢的複雜區域疼痛症候群第二型－個案報告與文獻回顧
摘要
一名四十六歲藥物成癮女性病患；因為創傷後造成右上肢和右下肢的複雜區域疼痛症候群而轉診到疼痛門診治療。她產生上肢和下肢複雜區域疼痛症候群是由於服用過量安眠藥暈倒在浴室，使得右側腋下神經和股神經受到長時間壓迫而引起。她有服用過NSAID和Gabapentine治療均無效。疼痛的表現就如同自主神經的症狀，例如水腫，多汗，皮膚的顏色和溫度改變，而且上下肢均無法正常活動。依據臨床症狀的表現被診斷為複雜區域疼痛症候群第二型，疼痛範圍並不限於受傷神經所支配的區域。疼痛機轉不只是與交感神經系統有關，它與神經重塑性和神經性發炎也有密切關係。因此治療方向是利用局部麻醉藥和類固醇使交感神經系統回復正常。我們重覆給病患施行多次的星狀結節和腰部交感神經叢阻斷術，在這位病患身上獲得良好的效果。
並列摘要
The 46-year-old female patient, a drug addict, was referred to pain clinic with a complex regional pain syndrome (CRPS) of the upper and lower limbs. She developed a CRPS due to an episode of falling down in the bathroom after hypnotic drug overdose, and resulted in long time compression of right brachial plexus and right femoral nerve. She had progressive pain in spite of medical treatment (NSAID, Gabapentin). In addition to pain, she also showed the typical autonomic symptoms like edema, disturbances of skin color and temperature and a severely limited motility of right upper and lower limbs. The clinical symptoms of CRPS type Ⅱ is identical and not restricted to the peripheral nerve distribution. The sympathetic nerve system is not only involved in the pain mechanism with reflectory processes in the segment and with the sympathetic afferent coupling, it also takes part in the neuroplasticity and in the neurogenic inflammation. The logical therapeutic intervention is therefore to normalize the hyperactivity of the sympathetic nerve systems with local anesthetics and steroid. This regulation is done with injections to the stellate ganglion and the lumbar sympathetic trunk. Repeated injections to the stellate ganglion and the lumbar sympathetic trunk caused immediate improvement of pain and allowed the patient to receive early physical therapy and range-of-motion exercises.
延伸閱讀
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