Aktuelles zur Pathophysiologie und Therapie des komplex-regionalen Schmerzsyndroms (CRPS)

Zusammenfassung

Bei etwa 2% der Patienten kommt es, meist nach einem Trauma einer Extremität, einer Läsion eines periphereren Nervs oder des zentralen Nervensystems, zum Auftreten charakteristischer Symptomkonstellationen mit schmerzhafter Funktionseinschränkung, die als „komplex-regionales Schmerzsyndrom“ (CRPS) bezeichnet werden. Die Symptome bestehen aus Störungen der Sensibilität (z. B. Taubheitsgefühle, Schmerzen, Hyperalgesie), der Motorik (z. B. Kraftminderung, Tremor, Dystonie), des autonomen Nervensystems (z. B. Änderungen der Hauttemperatur, des Schwitzens sowie Verfärbung der Haut) und der Trophik (z. B. verändertes Wachstum von Haaren, Finger-/Fußnägeln). Komplex-regionale Schmerzsyndrome werden in Anhängigkeit des Nachweises einer Nervenläsion unterteilt in Typ I ohne Läsion und Typ II mit Nervenläsion. Jedoch erscheint zudem eine Einteilung nach der Hauttemperatur zu Beginn der Erkrankung sinnvoll, da dies auch pathophysiologische Aspekte berücksichtigt („primär warmes“ bzw. „primär kaltes CRPS“). Dank intensiver Forschungen der letzten Jahre konnten die Mechanismen des CRPS zunehmend besser erklärt werden. Die unterschiedlichen beteiligten pathophysiologischen Prozesse sind in der vorliegenden Übersichtsarbeit dargestellt. Um eine Chronifizierung und bleibende Funktionseinschränkung zu vermeiden bzw. eine gute Extremtitätenfunktion wiederherzustellen, ist möglichst frühzeitig eine individuell angepasste, multi-disziplinäre Therapie unter Einbeziehung medikamentöser und nicht-medikamentöser Verfahren anzustreben. Die zur Verfügung stehenden Optionen werden in dieser Arbeit ebenfalls vorgestellt.

Abstract

Some patients (approx. 2%) develop a characteristic constellation of symptoms with a painful reduction of extremity function following limb trauma or lesions of the peripheral or central nervous system. This extraordinary painful condition is denominated as „complex regional pain syndrome“ (CRPS). Symptoms regularly observed are motor (e. g., paresis, tremor, dystonia), sensory (e. g., hypaesthesia, pain), and autonomic disturbances (e. g., differences of skin temperature, altered sweating, change of skin colour) as well as trophic alterations (e. g., altered growth of hair or nails). Complex regional pain syndromes (CRPS) are subclassified depending on a clinically obvious nerve lesion. CRPS I is diagnosed in the absence of a nerve lesion, CRPS II in the presence of one. However, a classification considering differences of skin temperature at onset of the disease seems also appealing as it rather reflects pathophysiological aspects („primary warm“ or, respectively, „primary cold CRPS“). Intensive research during the last years has improved our understanding of the mechanisms leading to CRPS. These pathophysiological processes are presented in this review. An early multi-disciplinary therapeutic approach with medical and non-medical treatment is required to avoid chronification and persisting impairment of function of the affected extremity. Effective treatment options are also highlighted in this article.

Schlüsselwörter

M. Sudeck - Kausalgie - sympathische Reflexdystrophie - sympathisch unterhaltener Schmerz

Key words

Sudeck‘s dystrophy - causalgia - sympathetic reflex dystrophia - sympathetic maintained pain

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