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Aktuelle Neurologie 2013; 40(09): 478-485
DOI: 10.1055/s-0033-1357177
Neues in der Neurologie
© Georg Thieme Verlag KG Stuttgart · New York

Neues aus der Forschung zum Komplexen Regionalen Schmerzsyndrom (CRPS)

Recent Research on Complex Regional Pain Syndrome (CRPS)
E. Krumova
1   Neurologische Klinik und Poliklinik, BG-Universitätsklinikum Bergmannsheil, Ruhr-Universität, Bochum
,
C. Maier
2   Abteilung für Schmerzmedizin, BG-Universitätsklinikum Bergmannsheil, Ruhr-Universität, Bochum
,
M. Tegenthoff
1   Neurologische Klinik und Poliklinik, BG-Universitätsklinikum Bergmannsheil, Ruhr-Universität, Bochum
› Author Affiliations
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Publication History

Publication Date:
15 October 2013 (online)

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Zusammenfassung

Das komplexe regionale Schmerzsyndrom (complex regional pain syndrome; CRPS) entwickelt sich typischerweise nach Extremitätenverletzungen, manifestiert sich generalisiert im distalen Bereich einer Extremität und ist durch Störungen der Sensorik und Motorik, der Vaso- und Sudomotorik, der Trophik und durch Gelenkveränderungen charakterisiert. Die Fälle ohne Nervenläsion werden als Typ I bezeichnet, diejenigen mit einer Nervenläsion – als Typ II. Die Diagnosestellung erfolgt primär aufgrund des klinischen Bildes anhand der aktuellen sog. Budapest-Kriterien. Bedeutsam für die Diagnose ist neben definierten klinischen Parametern der weitreichende Ausschluss anderweitiger Ursachen für die anamnestisch berichteten Symptome und die nachweisbare klinische Symptomatik. Für die Früh- und Differenzialdiagnose ist die Dreiphasenskelettszintigrafie hilfreich, da diese eine hohe Spezifität (98%) aufweist, während die Sensitivität im Verlauf der Erkrankung abnimmt. Im Akutstadium der Erkrankung scheinen proinflammatorische Faktoren primär an der Pathogenese beteiligt zu sein, sodass sich ein möglicher Therapieansatz ergeben kann. Im Verlauf nimmt ihre Bedeutung unabhängig vom klinischen Schweregrad ab. Chronische Stadien werden vor allem durch zentralnervöse Veränderungen mit Verminderung der kortikalen Repräsentation der betroffenen Extremität, Störungen des Körperschemas, Neglect-ähnlichen Symptomen sowie dystone Fehlstellungen bestimmt. Das häufigste pathologische sensorische Symptom ist die Druckhyperalgesie über der Muskulatur, erklärbar vermutlich als Folge einer überwiegend peripheren Sensibilisierung. Zusätzlich zu den klinisch nachweisbaren fokalen autonomen Störungen finden sich beim CRPS auch generalisierte Störungen autonomer Funktionen. Dystone Symptome sind hinsichtlich ihrer Pathogenese weiterhin schlecht verstanden und somit häufig schwer therapeutisch erreichbar. Die Therapie des CRPS sollte multimodal im interdisziplinären Setting erfolgen, angepasst an das Schmerzniveau. Invasive Maßnahmen sollten spezialisierten Zentren unter strenger Indikationsstellung überlassen werden.

Abstract

Complex regional pain syndrome (CRPS) typically develops following extremity injuries and is characterised by distally generalised sensory, motor, trophic, vaso- and sudomotor dysfunctions, as well as joint affliction. CRPS cases with­out nerve lesions are defined as type I – those involving nerve damage as type II. The diagnosis is primarily based on the clinical presentation using the so called ‘Budapest criteria’. Important for the diagnosis is the exclusion of other potential conditions which could account for the pa­tient-reported symptoms and demonstrable clinical signs. Triple-phase bone scans are helpful for the early and differential diagnosis due to their high specificity (98%), although their sensitivity decreases as the disease progresses. In the acute stage of the disease, pro-inflammatory factors seem to play an important role, allowing for a potential therapeutic approach. As the disease progresses, however, they are unrelated to the clinical severity. Chronic stages are primarily determined by central nervous system changes including a reduced cortical representation of the affected limb, changes in body scheme, neglect-like symptoms, as well as dystonic deformities. The most common sensory abnormality is pressure hyperalgesia over muscles, most likely a result of peripheral sensitisation. In addition to the clinically detectable focal autonomic disorders, more generalised autonomic dysfunction is also found. The pathogenesis of dystonic symptoms, however, remains poorly understood, making therapeutic treatment more difficult. Treatment of CRPS should be multimodal and take place in a multi-disciplinary setting, adapted to the level of pain. Invasive interventions should be limited to strict indications and specialised centres.

Schlüsselwörter

CRPS - komplexes regionales Schmerzsyndrom - Morbus Sudeck

Keywords

CRPS - complex regional pain syndrome - Sudeck’s atrophy
 

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