☆ 4.4 Review

Impact of different CRPS phenotypes and diagnostic criteria on quantitative sensory testing outcomes: systematic review and meta-analysis

PAIN MEDICINE (2023)

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Pain mechanisms in complex regional pain syndrome: a systematic review and meta-analysis of quantitative sensory testing outcomes

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Summary: This review aimed to understand the sensory phenotype of complex regional pain syndrome (CRPS) and guide treatment strategies based on quantitative sensory testing (QST). The results showed that adults with CRPS experience significant loss of thermal, mechanical, and vibration sensations, as well as increased pain thresholds and ratings. Adolescents and children with CRPS have milder sensory abnormalities compared to adults. These findings are important for understanding the pain mechanisms of CRPS and guiding treatment.

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Summary: This study provides clinical evidence that autonomic measures to noxious stimuli can objectively detect sensitization processes along the nociceptive neuraxis in complex regional pain syndrome (CRPS) (e.g. widespread hyperexcitability). Pain-autonomic readouts may represent valuable tools to explore pathophysiological mechanisms in a variety of pain patients and offer novel avenues to help guide mechanism-based therapeutic strategies.

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Substance P Serum Degradation in Complex Regional Pain Syndrome - Another Piece of the Puzzle?

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Summary: This study found that the metabolism of neuropeptide substance P (SP) is reduced in the serum of patients with complex regional pain syndrome (CRPS) and patients with limb trauma, suggesting a potential association between impaired peptide metabolism and the development of CRPS and posttraumatic pain.

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Summary: This systematic review found that patients with carpal tunnel syndrome (CTS) exhibit sensory loss, increased thermal and mechanical pain sensitivity, and impaired conditioned pain modulation. However, the evidence for central sensitization in CTS remains inconclusive.

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Article Clinical Neurology

Cold allodynia is correlated to paroxysmal and evoked mechanical pain in complex regional pain syndrome (CRPS)

Lars Kristian Lunden et al.

Summary: This study aimed to investigate the differences in pain characteristics among subgroups of CRPS patients based on quantitative sensory testing (QST) results. Three subgroups were identified based on thermal thresholds, and the presence of thermal allodynia was associated with a higher prevalence of paroxysmal pain. The study suggests that cold allodynia may be related to hyper-excitability of superficial skin nociceptors, and small fiber degeneration alone may not explain the pain mechanism in CRPS.

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Summary: The study found that in children with CRPS-I, longer pain duration was associated with decreased cold pain sensitivity, higher pain intensity was related to elevated anxiety scores, and anxiety and social stress affected warmth sensitivity on the contralateral-pain site.

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Low mechano-afferent fibers reduce thermal pain but not pain intensity in CRPS

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The Source of Hemisensory Disturbances in Complex Regional Pain Syndrome

Peter D. Drummond et al.

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