• The Korean Journal of Pain
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• v.35 no.2
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• pp.231-232
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• 2022

• The Korean Journal of Pain
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• v.19 no.2
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• pp.218-222
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• 2006

Complex regional pain syndrome (CRPS) is a syndrome of pain and sudomotor or vasomotor instabilities. The perioperative pain management in CRPS patients is very important, as surgery can aggravate preexisting symptoms, especially when performed around the lesion site. Despite the increasing interest in CRPS research, little is known about the optimal perioperative treatment strategy for CRPS patients. Herein, the case of a female CRPS patient, who underwent elective surgery at the lesion site, is reported. As a preemptive analgesia, the patient was satisfactorily managed with two weeks of patient-controlled epidural analgesia, initiated 2 days prior to surgery. The techniques for the prevention of perioperative pain, including preemptive analgesia, as well as its importance, are discussed.

• Journal of Dental Anesthesia and Pain Medicine
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• v.19 no.5
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• pp.295-300
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• 2019

Complex regional pain syndrome (CRPS) is rare, characterized by pain from diverse causes, and presents as extreme pain even with minor irritation. General anesthesia may be required for dental treatment because the pain may not be controlled with local anesthesia. However, treatment under general anesthesia is also challenging. A 38-year-old woman with CRPS arrived for outpatient dental treatment under general anesthesia. At the fourth general anesthesia induction, she experienced severe pain resulting from her right toe touching the dental chair. Anesthesia was induced to calm her and continue the treatment. After 55 minutes of general anesthesia, the patient still complained of extreme toe pain. Subsequently, two administrations for intravenous sedation were performed, and discharge was possible in the recovery room approximately 5 h after the pain onset. The pain was not located at the dental treatment site. Although the major factor causing pain relief was unknown, ketamine may have played a role.

• The Korean Journal of Pain
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• v.10 no.2
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• pp.274-277
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• 1997

The complex regional pain syndrome(CRPS) exhibit symptoms such as: abnormal skin color, temperature change, abnormal pseudomotor activity, edema. If CRPS is not treated appropriately at acute stage, then the affected extremity may become a useless, painful appendage. Treatment of CRPS by sympathetic blockade may be achieved by repeated intravenous regional guanethidine blocks, repeated anesthetic sympathetic blocks, surgical sympathectomy or oral sympatholytic therapy. We treated 29-year-old male patient with CRPS of left upper extremity by continuous cervical epidural blockade. Due to wound infection and dislocation of the epidural catheter, we inserted an implantable port system to inject the mixture of local anesthetics and small amount of morphine. After 10 months of treatment, patient was cured of symptoms and signs of CRPS and was able to resume a normal life.

• The Korean Journal of Pain
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• v.34 no.1
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• pp.94-105
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• 2021

Background: Many patients with complex regional pain syndrome (CRPS) have been known to be at risk of suicide, due to severe pain and its comorbid conditions. The risk of suicide may be associated with affective instability, which is an indicator of emotional dysregulation. Particularly, unstable shifts in negative emotions are difficult to cope with, which may result in individuals feeling uncontrollable, hopeless, and entrapped. This study aimed to examine the role of affective instability in the relationship between pain intensity and suicide risk (suicidal ideation and impulsivity) in patients with CRPS, by employing a daily diary. Methods: Twenty-three patients registered at the CRPS Association in Korea were asked to complete a day-to-day routine for 15 days, followed by a diary composed of pain intensity, suicidal ideation, impulsivity, and positive and negative affects. Results: Results showed that the interactions between negative affective instability and daily pain intensity were statistically significant on daily suicidal ideation (coefficient = 0.41, t (21) = 2.56, P < 0.050) and daily impulsiveness (coefficient = 1.20, t (19) = 3.35, P < 0.010). However, those between positive affective instability and daily pain intensity were not. Conclusions: This study is the first attempt to investigate the role of affective instability on the relationship between daily pain intensity and daily suicide risk in patients with CRPS. Our findings suggest that health professionals pay considerable attention to the instability of negative affects when assessing and managing patients with CRPS at risk of suicide.

• The Korean Journal of Pain
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• v.30 no.3
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• pp.165-175
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• 2017

Nuclear medicine imaging is widely used in pain medicine. Low back pain is commonly encountered by physicians, with its prevalence from 49% to 70%. Computed tomography (CT) or magnetic resonance imaging (MRI) are usually used to evaluate the cause of low back pain, however, these findings from these scans could also be observed in asymptomatic patients. Bone scintigraphy has an additional value in patients with low back pain. Complex regional pain syndrome (CRPS) is defined as a painful disorder of the extremities, which is characterized by sensory, autonomic, vasomotor, and trophic disturbances. To assist the diagnosis of CRPS, three-phase bone scintigraphy is thought to be superior compared to other modalities, and could be used to rule out CRPS due to its high specificity. Studies regarding the effect of bone scintigraphy in patients with extremity pain have not been widely conducted. Ultrasound, CT and MRI are widely used imaging modalities for evaluating extremity pain. However, SPECT/CT has an additional role in assessing pain in the extremities.

• Clinical Pain
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• v.19 no.1
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• pp.23-27
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• 2020

Our objective is to evaluate the applicability of segmental phase angle (PhA) via bioelectrical impedance analysis (BIA) for post-stroke complex regional pain syndrome (CRPS). Due to its noninvasiveness and convenience, various studies have used BIA in clinical conditions. We measured segmental PhA in 4 patients at the time of CRPS diagnosis and repeated 4 weeks after 2 weeks of steroid pulse therapy. In 3 cases, the affected-to-unaffected ratio of the upper limb PhA decreased at the time of diagnosis. In 2 cases with improvement of more than 5 points in the CRPS severity score (CSS), increased ratios were observed. In other 2 cases with improvement of less than 4 points in the CSS, no remarkable changes in the ratios were found. We suggest that the segmental PhA can be helpful in assessment of post-stroke CRPS and its recovery.

• Annals of Clinical Neurophysiology
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• v.14 no.2
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• pp.86-88
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• 2012

• 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.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.