Kompleks Regional Pain
EN: Complex Regional Pain Syndrome (CRPS) er en nervebeskadigende smerte, der undertiden forveksles med gentagne blødt vævs-stamme, en hårfraktbrud, en infektion, en fanget nerve, fascitis eller knoglesporer. Dens symptomer omfatter rødme og hævelse, en pludselig ændring i hudfarve og temperatur fra rødt til køligt blåt, og en konstant forbrænding, der undertiden ledsages af et stød af elektricitet. Denne sygdom indebærer en specifik del af nervesystemet kaldet sympatiske system. Det sympatiske system er ansvarlig for funktioner som hjertefrekvens, sved, ændringer i hudtemperaturen samt blodtryk. Således kan medicin, der styrer blodtrykket, hjælpe med denne type smerte.
CRPS kan være en kameleon, der hurtigt blokerer og dør ned og afslører kun en eller to af dens karakteristiske symptomer i stedet for dets fulde spektrum af symptomer. Hos nogle patienter forårsager sygdommen hårtab langs den berørte lemmer; i andre stimulerer det hårvæksten. På samme måde kan en patients hud være varmere eller køligere end normalt.
Tidlig behandling har den bedste chance for succes med CRPS. Når problemet har længe, ​​er det sjældent, at en enkelt nerveblok kan besejre den. Behandling indebærer ofte en række injektioner, og selv med denne tilgang bliver jeg aldrig overrasket, hvis smerten vender tilbage.
Det sympatiske nervesystem kan beroliges med stoffer, der ofte bruges til at behandle andre tilstande, der involverer disse særlige nerver. Hvis du tager medicin til forhøjet blodtryk, vil du genkende navnene på mange af de lægemidler, der gives til behandling af CRPS. Clonidin er en af ​​de anvendte fælles lægemidler, såvel som de orale former for phenoxybenzamin og propranolol og mange andre lægemidler, der anvendes til hypertension.
Men sådanne lægemidler rejser fordele og ulemper, at patienterne skal veje. De cirkulerer gennem hele kroppen, køler smerter, hvor det blusser, samtidig med at de muligvis producerer bivirkninger som lavt blodtryk, et bremsende eller racerende hjerte, seksuel dysfunktion og diarré.
Hvis du slår det sympatiske nervesystem af med blodtryk, vinder medicinen ikke kampen mod brænding, hævelse og elektriske stød, jeg ser andre steder for sårbare indgreb til at anvende behandling. Jeg behandler smerten ved CRPS som enhver anden form for nerveskade. Da neuropatisk smerte stammer fra kramper eller anfald et sted langs nerveveje, er de bedste våben anti-kramperende eller anti-krampe medicin.
Der er ingen klar forskning endnu for at guide mig om hvilket stof der skal ordineres først, så jeg starter normalt med den sikreste. Neurontin (gabapentin), et relativt nyt epilepsilægemiddel, er et af de første lægemidler, jeg når til, når jeg udvider farmakologisk behandling. Det tolereres godt af de fleste patienter og har mindst muligheden for at reagere dårligt med andre lægemidler.
Mange andre anti-convulsants og anti-arytmi kan anvendes med fordel, herunder mexiletin, generisk navn (Dilantin), topiramat (Topomax), carbamazepin (Tegretol), lamotrigin (Lamictal) sĂĄvel som tricykliske antidepressiva (Elavil, Tofranil, Notriptylin, Desipramin) og andre.
FAQ - 💬
❓ What is complex regional pain?
👉 Complex regional pain syndrome (CRPS) is a broad term describing excess and prolonged pain and inflammation that follows an injury to an arm or leg. CRPS has acute (recent, short-term) and chronic (lasting greater than six months) forms. CRPS used to be known as reflex sympathetic dystrophy (RSD) and causalgia.
❓ What are the 3 stages of complex regional pain syndrome?
👉 The three clinical stages of type 1 complex regional pain syndrome (CRPS 1) are acute, subacute, and chronic. The acute form lasts approximately 3 months. Pain, often burning in nature, is one of the first symptoms that initially limits function.
❓ What causes complex regional pain syndrome?
👉 Many cases of CRPS occur after a forceful trauma to an arm or a leg. This can include a crushing injury or a fracture. Other major and minor traumas — such as surgery, heart attacks, infections and even sprained ankles — also can lead to CRPS .
❓ Can complex regional pain syndrome go away?
👉 How is complex regional pain syndrome treated? This syndrome has no cure. But sometimes the symptoms get better or stop on their own. Some evidence suggests early treatment, particularly with physical therapy, can help limit the disease.
❓ What CRPS feels like?
👉 The pain of CRPS is usually triggered by an injury. But the pain is a lot more severe and long-lasting than would normally be expected. The pain may feel like a mix of burning, stabbing or stinging. There may also be tingling and numbness.
❓ How do you fix CRPS?
👉 There's no known cure for complex regional pain syndrome (CRPS), but a combination of physical treatments, medicine and psychological support can help manage the symptoms. It's estimated around 85% of people with CRPS slowly experience a reduction in their pain and some of their symptoms in the first 2 years.
❓ Does CRPS show up on MRI?
👉 Magnetic resonance imaging (MRI) can also be used to determine if tissue changes typical of CRPS and specialized magnetic resonance neurography can be used to evaluate for specific nerve involvement.
❓ When does CRPS become permanent?
👉 Stage 3 is the chronic phase that can develop a year after initial onset of CRPS and last for years or become permanent during which pain may be constant or intermittent.
❓ How do you prove you have CRPS?
👉 Diagnosis and Tests There's no specific test to diagnose CRPS. Healthcare providers mainly diagnose it through a careful medical history, physical examination and review of your symptoms. Your provider will ask you if you've had a recent injury or surgery.
❓ How do you calm a CRPS flare up?
👉 Anticonvulsants. Anticonvulsants, such as gabapentin (Neurontin), are often used to treat neuropathic pain. These medications have nerve-calming properties that can alleviate symptoms of CRPS.
❓ What happens if CRPS is left untreated?
👉 If left untreated, CRPS can lead to serious problems, such as: Tissue wasting (atrophy). If you won't move his hurt limb because of pain or stiffness, their skin, bones, and muscles will weaken. Muscle tightening (contracture).
❓ What is complex regional pain syndrome?
👉 Complex regional pain syndrome is a multifactorial disorder with clinical features of neurogenic inflammation (swelling in the central nervous system), nociceptive sensitisation (which causes extreme sensitivity or allodynia ), vasomotor dysfunction (blood flow problems which cause swelling and discolouration)...
❓ How is complex regional pain syndrome (CRPS) diagnosed?
👉 There’s no specific test that will confirm you have complex regional pain syndrome (CRPS). Doctors mainly base the diagnosis on your symptoms and a physical examination, although tests may be used – sometimes to rule out other conditions:
❓ How long does it take for complex regional pain syndrome to progress?
👉 It’s difficult to predict how complex regional pain syndrome (CRPS) will progress in any one person, but early diagnosis and treatment are helpful. Many people find their CRPS settles over a few weeks or months with good rehabilitation therapy.
❓ What is the role of ketamine in complex regional pain syndrome?
👉 Ketamine, a dissociative anesthetic, appears promising as a treatment for complex regional pain syndrome. It may be used in low doses if other treatments have not worked. No benefit on either function or depression, however, has been seen.
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