• The Korean Journal of Pain
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• v.19 no.2
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• pp.159-163
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• 2006

Background: Despite the enormous amount of basic research on neuropathic pain, there is the lack of an objective diagnostic test for complex regional pain syndrome (CRPS). The aim of this study was to evaluate the usefulness of cold stress thermography in the diagnosis of CRPS. Methods: The study involved 12 patients with CRPS type 1, according to the IASP criteria, who were compared with 15 normal healthy volunteers. All subjects underwent thermographic examination under baseline conditions at $21^{\circ}C$. A cold stress test (CST; $10^{\circ}C$ water for 1 minute) was then applied to both hands below the wrists, immediate, and after 10 and 20 minutes. Results: The temperature asymmetry between the patients with CRPS and the volunteers showed significant discrimination at the baseline and after a 20 minute recovery period from the CST. Among the study subjects having temperature asymmetry of both hands of less than $1^{\circ}C$ (8 out of 12 CRPS patients and 14 out of 15 volunteer), 7 (87.5%) of the 8 CRPS patients and 3 (21%) of the 14 volunteers showed a temperature difference of more than $1^{\circ}C$ after the 20 minute recovery period. The actual temperature values during the four periods did not discriminate between the patients with CRPS and the volunteers. Conclusions: Thermography, under the CST, could be a more objective test for the diagnosis of CRPS. A temperature asymmetry greater than $1^{\circ}C$ during the 20 minute recovery period following CST provides strong diagnostic information about CRPS, with both high sensitivity and specificity.

• The Korean Journal of Pain
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• v.19 no.2
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• pp.152-158
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• 2006

Background: Complex regional pain syndrome (CRPS) is a painful, disabling disorder for which no proven treatment has been established. The purpose of this investigation was to assess the evidence of the efficacy of spinal cord stimulation (SCS) in the management of pain in CRPS patients. Methods: Between March 2004 and June 2006, 11 patients with CRPS were treated with SCS. The visual analog scale (VAS) score for pain (0⁣-10) and pain disability index (PDI) were obtained in all patients prior to treatment, and 1, 3 and 6 months post-implantation. Results: All 11 patients, 5 men and 6 women, with a median age and duration of CRPS of 44 years and 48.8 months, respectively, successfully received a lead implantation for SCS. The mean VAS pain score prior to the treatment was 85.5 out of 100 mm. After SCS implantation, the mean VAS pain scores were 49.5, 57.0 and 56.0 at 1, 3 and 6 months after the procedure, respectively. The mean pain score for allodynia was decreased by 50%, with a significant reduction of the PDI also observed after the treatment. Conclusions: Our current study suggests that SCS implantation is a safe and effective method in the management of CRPS patients.

• The Korean Journal of Pain
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• v.19 no.2
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• pp.223-227
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• 2006

Complex regional pain syndrome (CRPS) is clinically characterized by pain, abnormal regulation of blood flow and sweating, edema of skin and subcutaneous tissues, sensory and motor disturbances, and trophic changes of the skin. A 21-year-old man was suffering from pain and swelling in his right hand and forearm. His arm had been in splints for 3 weeks following an extension injury of the right fingers and wrist, with the pain having developed 2 weeks after the splinting. He was treated with various nerve blocks including continuous epidural infusion, thoracic sympathetic block and peripheral nerve blocks, and squeezing his edematous region under general anesthesia as well as intravenous lidocaine and ketamine infusions. However, all of the performed treatments had no effect on the patient's pain or hand swelling. As a next line therapy, spinal cord stimulation should be considered because of intractable severe pain and swelling to almost all other modalities of therapy. We therefore performed an early intervention of spinal cord stimulation for the patient with refractory CRPS type I 5 months after the onset of pain and have got an excellent result.

• The Korean Journal of Pain
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• v.22 no.1
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• pp.33-38
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• 2009

Background: Complex regional pain syndrome (CRPS) is still difficult to diagnose in the field of chronic pain management. CRPS is diagnosed by purely clinical criteria based on the characteristic signs and symptoms, which have to be differentiated from similar pain conditions like posttraumatic neuropathic pain. Until now, there has been a lack of objective diagnostic tools to confirm the diagnosis of CRPS. The aim of this study was to evaluate the usefulness of a three phase bone scan (TBS) for making the diagnosis of CRPS. Methods: A total of 121 patients who had been diagnosed with CRPS were evaluated. All the patients were examined by performing a TBS as a part of the diagnostic work-up. A diffuse increased tracer uptake on the delayed image (phase III) was defined as a positive finding for CRPS. Results: Forty-one patients (33.9%) out of 121 showed the positive results on the TBS. The patients with a duration of pain of less than 24 months had a significantly higher positive result (43.4%) on the TBS than did the patients with duration of pain longer than 24 months (12.1%). Conclusions: A TBS could give a better objective result for diagnosing CRPS for patients with a shorter duration of pain and a TBS gives little information for the diagnosis of CRPS in patients with a duration of pain longer than 24 months.

• The Korean Journal of Pain
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• v.22 no.1
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• pp.28-32
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• 2009

Background: Complex regional pain syndrome (CRPS) is characterized by severe neuropathic pain and disability, which can result in psychological and behavioral dysfunction. The goal of the present study was to evaluate neurocognitive disability, and to assess the relationship between clinical variables and neuropsychological features in CRPS patients. Methods: We investigated the neuropsychological features of 15 CRPS I patients. The neuropsychological tests that we made comprised of a full intelligence quotient, memory quotient, trail-making test A, trail-making test B (TMT-B), and MMPI (Minnesota multiphasic personality inventory). Results: The results showed severe disability in performance on TMT-B. There was no significant correlation between specific cognitive variables and MMPI scales. Conclusions: Decreased performance on TMT-B which shows mental flexibility in the prefrontal lobe exists independently from depressive disorders in CRPS patients.

• The Korean Journal of Pain
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• v.22 no.1
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• pp.74-77
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• 2009

Implantable intrathecal pump is one of the therapeutic options for intractable pain. A 24-year-old male with complex regional pain syndrome was suffering from right lower extremity pain. He had all modalities of treatment including spinal cord stimulator. However, his pain had been worse in the past 6 months. His visual analogue pain scale (VAS) was 8-10 and he could not sit or walk. Only opioid was thought to be effective. Then, intrathecal pump was considered. We estimated the minimal effective dose of spinal morphine before implantation. 0.3 mg of morphine was injected intrathecally as a starting dose. Dosage had been increased up to 0.8 mg in 10 days. His VAS score decreased from 8 to 5. He could sleep without pain and walk with crutch. Therefore, intrathecal pump was inserted. He could tolerate to pain. This case suggests that intrathecal morphine delivery can provide effective treatment for intractable non-malignant pain.

• Journal of Physiology & Pathology in Korean Medicine
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• v.23 no.3
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• pp.678-684
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• 2009

It was reported that Dipsaci Radix has decrease pain effect on the Complex Region Pain Syndrome(CRPS). the CRPS was induced by unilateral loose occlusion in 4 part of the sciatic nerve of the rats. For the fingding significantly change on CRPS rats were divided into 4 different experimental groups. and each groups were induced CRPS. Experimental group I (control group; n=15), experimental group II (100 mg/kg Dipsaci Radix dieted rats; n=15), experimental group III (300 mg/kg Dipsaci Radix dieted rats; n=15), and experimental group IV(500 mg/kg Dipsaci Radix dieted rats; n=15). The study of Dipsaci Radix concentration was that foot withdrawal threshold to the thermal stimuli(Hot plate test), foot withdrawal threshold to the mechanical stimuli(von Frey's filament) and immunohistochemistry staining that were substance P. Hot plate test and von Frey Filament were increase in experimental group II, III, IV than group I, especially group III was most significantly change than group II and IV in post-hoc(Duncan's multiple range). and In immunohistochemistry observation; group I showed increase in the group II, III, IV. especially group III had the minimal level of the substance P expression while the experimental group II, III. These results suggested that the Dipsaci Radix dieted made the decrease of pain in CRPS.

• The Korean Journal of Pain
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• v.22 no.2
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• pp.146-150
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• 2009

Background: A skin temperature difference is one of the variables used in the diagnosis of complex regional pain syndrome. However, there have been no reports as to whether the real (${\Delta}T$) or absolute value ($|{\Delta}T|$) of skin temperature differences should be used in the diagnosis of complex regional pain syndrome. This study was conducted to compare the diagnostic validity of ${\Delta}T$ with $|{\Delta}T|$ for complex regional pain syndrome using receiver operating characteristic curves (ROC). Methods: Infrared thermographic images were obtained from the 144 patients who were suspected to have CRPS in a unilateral limb. After ${\Delta}T$ and $|{\Delta}T|$ calculation from the thermographic image, ROCs of ${\Delta}T$ and $|{\Delta}T|$ were developed, and the areas under the curve (AUC) for the ROC curves were compared. Results: AUCs of ${\Delta}T$ and $|{\Delta}T|$ were 0.520 and 0.746 respectively, this difference was statistically significant (P < 0.001). Conclusions: Absolute skin temperature difference shows greater validity in the diagnosis of CRPS than ${\Delta}T$. Therefore, $|{\Delta}T|$ is more useful when comparing the skin temperature of CRPS patients.

• Journal of Korean Medicine Rehabilitation
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• v.21 no.3
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• pp.79-87
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• 2011

Objectives : The aim of this study was to observe the pain relief effect of moxibustion therapy in a patient with complex regional pain syndrome(CRPS). Methods : A male with type I CRPS, 48-year-old, who suffered from severe pain and paresthesia on his legs despite of treatments of oral medications and spinal cord stimulation was treated by indirect moxibustion following Korean medicine dianosis. Total 20 moxibustion treatments(once daily, 5 days a week, for 4 weeks) were given on the 4 acupoints(both side) where known to be effective fro the CRPS. Visual analogue scale(VAS), digital infrared thermal imaging(DITI), Beck depression index(BDI) were evaluated before and after the treatments. Pain relief, thermal changes on affected legs, and improvement of depression scale were observed after the treatments. Results : As for DITI, right thigh showed low temperature compared with left on before the treatments. While after the treatments, DITI showed similar temperature in both legs at discharge day. Conclusions : Though it is a case report, moxibustion therapy might have pain relief effect. Further rigorous case series and controlled trials are warranted.

• The Korean Journal of Pain
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• v.20 no.1
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• pp.66-70
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• 2007

No definitive etiology or risk factors have been identified that predispose individuals to developing complex regional pain syndrome (CRPS). We experienced two cases of CRPS developed after arterial and venous puncture which were done in regular medical work. A 35-years old female patient was suffered from pain and allodynia with swelling at right hand and wrist after radial artery puncture for monitoring of blood pressure during general anesthesia. A 24-years old male patient had pain and swelling with allodynia at the right fingers and arm after median cubital vein puncture for blood sampling. They did not have proper pain management as CRPS patients in the past weeks and months after their pain occurred. They were diagnosed as CRPS and started undergoing various interventional procedures, which led to improve their pain condition. Our cases suggest that CRPS could develop without any proved tissue damage in routine medical practice. In conclusion, health care workers should be educated in knowledge about the uncommon medical condition and proper consultation to pain specialist when it happens.