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Pain 2022 May 17. Epub 2022 May 17.

Genesis Research Services, Broadmeadow, NSW, Australia.

Abstract: Ambroxol is a multifaceted drug with primarily mucoactive and secretolytic actions, along with anti-inflammatory, antioxidant, and local anaesthetic properties. It has a long history of use in the treatment of respiratory tract diseases and has shown to be efficacious in relieving sore throat. In more recent years, ambroxol has gained interest for its potential usefulness in treating neuropathic pain. Read More

Cochrane Database Syst Rev 2022 05 17;5:CD010853. Epub 2022 May 17.

Department of Health Sciences, Centre for Health and Wellbeing Across the Lifecourse, Brunel University London, Uxbridge, UK.

Background: Complex regional pain syndrome (CRPS) is a painful and disabling condition that usually manifests in response to trauma or surgery and is associated with significant pain and disability. CRPS can be classified into two types: type I (CRPS I) in which a specific nerve lesion has not been identified and type II (CRPS II) where there is an identifiable nerve lesion. Guidelines recommend the inclusion of a variety of physiotherapy interventions as part of the multimodal treatment of people with CRPS. Read More

Rev Neurol (Paris) 2022 May 2. Epub 2022 May 2.

Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia, V6T 1Z3 Vancouver, British Columbia, Canada; GF Strong Rehabilitation Centre, Vancouver, V5Z 2G9 British Columbia, Canada.

Int J Mol Sci 2022 May 6;23(9). Epub 2022 May 6.

Christian Doppler Laboratory for Innovative Immunotherapeutics, Institute of Molecular Biotechnology, Department of Biotechnology, University of Natural Resources and Life Sciences, Vienna (BOKU), Muthgasse 18, 1190 Vienna, Austria.

Inhibition of complement activation via the overexpression of complement-regulatory proteins (CRPs), most notably CD46, CD55 and CD59, is an efficient mechanism of disguise of cancer cells from a host immune system. This phenomenon extends to counteract the potency of therapeutic antibodies that could lyse target cells by eliciting complement cascade. The manifold functions and ubiquitous expression of CRPs preclude their systemic specific inhibition. Read More

Paediatr Neonatal Pain 2021 Dec 14;3(4):163-169. Epub 2021 Nov 14.

Department of Clinical Sciences Malmö, Anesthesiology and Intensive Care Medicine Lund University Lund Sweden.

Pediatric complex regional pain syndrome (pCRPS) is a rare, painful state that often occurs as a complication following physical trauma. Diagnosis and treatment require specialist expertise in a multidisciplinary setting. Treatment is focused on pain reduction and improvement in function, which differs from the treatment of adult CRPS. Read More

J ISAKOS 2022 Feb 4;7(1):27-34. Epub 2021 Oct 4.

Division of Orthopaedic Surgery, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 3Z5, Canada. Electronic address:

Importance: The posterior cruciate ligament (PCL) is involved in almost one-third of all knee injuries. Surgical management of PCL injuries is currently controversial, and no single graft material is determined as superior in primary PCL reconstruction. A growing body of literature has demonstrated the safety and versatility of the quadriceps tendon (QT) autograft in arthroscopic knee ligament reconstruction. Read More

Plast Reconstr Surg 2022 May 10. Epub 2022 May 10.

From private practice.

Background: The clinical features of classic carpal tunnel syndrome are well known. However, some patients who display atypical symptoms and signs of pain and dysesthesias in the hand, worsening of symptoms at night, and above all, inability to make a full fist, respond equally well to carpal tunnel release. This same clinical picture was shared by some patients labeled as having complex regional pain syndrome. Read More

Plast Reconstr Surg 2022 May 10. Epub 2022 May 10.

From the Department of Orthopaedics, University of Pennsylvania; Department of Plastic Surgery, New York University; Division of Plastic Surgery and Department of Orthopaedics and Rehabilitation, Penn State Milton S. Hershey Medical Center; Department of Urology, Albert Einstein College of Medicine; and Department of Health Policy and Administration, The Pennsylvania State University.

Background: Patients with longstanding carpal tunnel symptoms may develop transient and, paradoxically, worsened neuropathic pain immediately following release. The authors have termed this "reawakening phenomenon." The purpose of this study was to compare the characteristics of patients with this phenomenon to those with a standard postoperative course. Read More

Neurol India 2022 Mar-Apr;70(2):491-503

Division of Hand Surgery, Cajuru University Hospital, Curitiba, Brazil Cajuru University Hospital, Curitiba, Brazil.

Background: Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment. One of the most devastating complications is complex regional pain syndrome.

Objectivities: The aim of this study was to systematically analyze available evidence about complex regional pain syndrome after carpal tunnel syndrome surgery (CTSS), its risks, associated factors, and treatments. Read More

Case Reports Plast Surg Hand Surg 2022 27;9(1):123-125. Epub 2022 Apr 27.

Department of Anesthesiology, University of Florida College of Medicine, Jacksonville, FL, USA.

65 year old male with preexisting Complex Regional Pain Syndrome (CRPS) in right dominant hand with sudden onset of right third and fourth digit trigger finger successfully treated with flexor tendon sheath corticosteroid and lidocaine injection resulting in long-term resolution of symptoms without causing widely believed aggravation of CRPS. Read More

Cureus 2022 Mar 30;14(3):e23652. Epub 2022 Mar 30.

Operative Unit of Anaesthesiology, Intensive Care and Pain Medicine, Civil Hospital G. Mazzini, Teramo, ITA.

Obesity poses several challenges for anesthetists. The several comorbidities associated with obesity can result in very complex management, which requires a multimodal and reasoned approach. The possible difficult airways are, certainly, the obstacle that most can put the anesthetist to the test. Read More

Clin Rehabil 2022 May 3:2692155221098733. Epub 2022 May 3.

Stroke Unit, Department of Neurology, 36836CHU Bordeaux, Bordeaux, France.

Objective: To evaluate if positioning the upper-limb promoting abduction, external rotation and flexion of the shoulder reduces the intensity of post-stroke shoulder pain at day-7 compared to usual clinical practice.

Design & Setting: Prospective single-center randomized clinical trial using a superiority design comparing two preventive strategies of post-stroke shoulder pain in a stroke unit.

Subjects: Patients were included within 2 days from a first symptomatic ischemic stroke affecting shoulder motor function. Read More

J Pain 2022 Apr 30. Epub 2022 Apr 30.

IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, Australia.

Movement limitation is a common characteristic of chronic pain such that pain prevents the very movement and activity that is most likely to promote recovery. This is particularly the case for pathological pain states such as complex regional pain syndrome (CRPS). One clinical approach to CRPS that has growing evidence of efficacy involves progressive movement imagery training. Read More

Transl Psychiatry 2022 May 2;12(1):179. Epub 2022 May 2.

Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.

Subanesthetic-dose racemic (R,S)-ketamine (ketamine) produces rapid, robust, and sustained antidepressant effects in major depressive disorder (MDD) and bipolar disorder (BD) and has also been shown to effectively treat neuropathic pain, complex regional pain syndrome, and post-traumatic stress disorder (PTSD). However, to date, its mechanism of action remains unclear. Preclinical studies found that (2 R,6 R;2 S,6 S)-hydroxynorketamine (HNK), a major circulating metabolite of ketamine, elicits antidepressant effects similar to those of ketamine. Read More

Oxid Med Cell Longev 2022 14;2022:8035109. Epub 2022 Feb 14.

Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Hangzhou 310053, China.

Complex regional pain syndrome type-I (CRPS-I) represents a type of neurovascular condition featured by severe pain in affected extremities. Few treatments have proven effective for CRPS-I. Electroacupuncture (EA) is an effective therapy for pain relief. Read More

SAGE Open Med Case Rep 2022 21;10:2050313X221093111. Epub 2022 Apr 21.

Department of Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.

SARS-CoV-2 infection has various manifestations including neurological and musculoskeletal system involvement. COVID-19 infection causes peripheral nerve lesions including small fibre neuropathy. Complex regional pain syndrome is a debilitating neurological condition manifested by predominantly pain associated with other sensory, motor, autonomic and tropic involvement. Read More

Front Immunol 2022 14;13:860165. Epub 2022 Apr 14.

Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.

After producing triple (Gal, H-D and Sd)-KO pigs, hyperacute rejection appeared to no longer be a problem. However, the origin of xeno-rejection continues to be a controversial topic, including small amounts of antibodies and subsequent activation of the graft endothelium, the complement recognition system and the coagulation systems. The complement is activated via the classical pathway by non-Gal/H-D/Sda antigens and by ischemia-reperfusion injury (IRI), via the alternative pathway, especially on islets, and via the lectin pathway. Read More

Anesthesiology 2022 May 2. Epub 2022 May 2.

Center for Translational Pain Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts.

The gut microbiome plays critical roles in human health and disease. Recent studies suggest it may also be associated with chronic pain and postoperative pain outcomes. In animal models, the composition of the gut microbiome changes after general anesthesia and affects the host response to medications, including anesthetics and opioids. Read More

Pain Pract 2022 Apr 29. Epub 2022 Apr 29.

Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Multidisciplinary Pain Center, Hospital Oost-Limburg, Genk, Belgium.

Background: Radiofrequency (RF) treatment of the genicular nerves offers pain relief in patients suffering from chronic knee pain including persistent post-surgical knee pain (PPSP). We present the first case report of the development of complex regional pain syndrome (CRPS) in a chronic knee pain patient after an RF ablation of the genicular nerves that was successfully treated with dorsal root ganglion (DRG) stimulation.

Case Presentation: The patient developed increased pain, sympathetic and dysmorphic changes of the index knee 10 weeks after RF treatment for PPSP. Read More

Orthop Rev (Pavia) 2022 14;14(1):31891. Epub 2022 Feb 14.

Pain Specialists of America, Austin, TX.

Back pain is one of the most common healthcare burdens in the United States and is the number one cause of disability worldwide. Treatment options for back pain usually emphasizes conservative modalities such as reassurance, education, physical therapy, cognitive behavioral therapy, medication management, and interventional pain procedures. Spinal cord stimulation (SCS) is a minimally invasive and reversible therapy used to treat various pain syndromes. Read More

JAMA Surg 2022 Apr 27. Epub 2022 Apr 27.

Gosford and Wyong Hospitals, Gosford, Australia.

Importance: Distal radius fractures are common and are managed with or without surgery. Current evidence indicates surgical treatment is not superior to nonsurgical treatment at 12 months.

Objective: Does surgical treatment for displaced distal radius fractures in patients 60 years or older provide better patient-reported wrist pain and function outcomes than nonsurgical treatment at 24 months?

Design, Setting, And Participants: In this secondary analysis of a combined multicenter randomized clinical trial (RCT) and a parallel observational study, 300 patients were screened from 19 centers in Australia and New Zealand. Read More

J Stroke Cerebrovasc Dis 2022 Jul 23;31(7):106494. Epub 2022 Apr 23.

Innovation, Implementation and Clinical Translation (IIMPACT) in Health, Allied Health and Human Performance, University of South Australia, North Terrace, Adelaide 5000, Australia; Brain Stimulation, Imaging and Cognition Research Group, School of Biomedicine, The University of Adelaide, North Tce, Adelaide 5005, Australia.

Objective: Interhemispheric inhibition is an important cortical mechanism to support motor control. Altered interhemispheric inhibition has been the target of neuromodulation interventions. This systematic review investigated the evidence for altered interhemispheric inhibition in adults with unilateral neurological conditions: stroke, amyotrophic lateral sclerosis, cerebral palsy, complex regional pain syndrome, traumatic brain injury, and cerebral palsy METHODS: We pre-registered the protocol and followed PRISMA guidelines. Read More

J Pain 2022 Apr 22. Epub 2022 Apr 22.

Departments of Physical Medicine and Rehabilitation and Physical Therapy and Human Movement Science, Northwestern University, Chicago, Illinois.

This prospective observational study evaluated preoperative predictors of complex regional pain syndrome (CRPS) outcomes in the 6 months following total knee arthroplasty (TKA). Participants were n = 110 osteoarthritis patients (64.5% female) undergoing unilateral TKA with no prior CRPS history. Read More

Pediatr Emerg Med Pract 2022 May 2;19(5):1-32. Epub 2022 May 2.

Associate Professor of Emergency Medicine, David Geffen School of Medicine at UCLA; Harbor-UCLA Medical Center, Torrance, CA.

Analgesia in pediatric patients is critical for minimizing discomfort and maximizing satisfaction for both the patients and their caregivers. In the last decade, ultrasound has been shown to be effective in improving the safety and efficacy of regional anesthesia. This issue discusses materials, methods, and monitoring for pediatric patients undergoing nerve blocks in the emergency department, including both ultrasound-guided and landmark approaches. Read More

J Vasc Access 2022 Apr 23:11297298221091766. Epub 2022 Apr 23.

Department of Surgery, Sundaram Hospital, Puthur, Trichy, Tamil Nadu, India.

Pain and swelling of a limb following creation of arterio-venous fistula (AVF) are often attributable to vascular disorders like venous hypertension or limb ischaemia. Here we report the case of a 70-years old man who developed pain and swelling of upper limb distal to the AVF during second post-operative week due to a complex regional pain syndrome (CRPS). CRPS is characterized by pain that is disproportionate to the invoking injury, autonomic dysfunction, trophic changes and functional impairment of affected limb. Read More

Muscle Nerve 2022 Apr 24. Epub 2022 Apr 24.

H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA.

Musculoskeletal mimics of cervical radiculopathy will be explored in this AANEM monograph. A review of the literature and textbooks was conducted. Musculoskeletal cervical radiculopathy mimics include: (1) head/neck pain, such as neck tension, cervicogenic headache, and temporomandibular disorder; (2) referred pain from shoulder pathology, such as rotator cuff tears/impingement; (3) elbow region abnormalities, including medial/lateral epicondylitis; (4) wrist/hand conditions, such as DeQuervain's tenosynovitis and intersection syndrome; (5) muscle connective tissue disorders, including myofascial trigger points; (6) conditions that have decreased range of motion, including frozen shoulder and rounded shoulders with tight pectoral/scalene muscles; (7) conditions with joint hyperlaxity and instability, as seen in post-stroke shoulder subluxation; (8) vascular conditions, such as thoracic outlet syndrome; and (9) autonomic controlled soft tissue changes associated with complex regional pain syndrome. Read More

J Neurosci Res 2022 Jul 20;100(7):1487-1505. Epub 2022 Apr 20.

School of Medical Sciences and Brain and Mind Centre, University of Sydney, Camperdown, New South Wales, Australia.

Complex regional pain syndrome (CRPS) is a painful condition commonly accompanied by movement disturbances and often affects the upper limbs. The basal ganglia motor loop is central to movement, however, non-motor basal ganglia loops are involved in pain, sensory integration, visual processing, cognition, and emotion. Systematic evaluation of each basal ganglia functional loop and its relation to motor and non-motor disturbances in CRPS has not been investigated. Read More

Eur J Pain 2022 Apr 18. Epub 2022 Apr 18.

Walton Centre NHS Foundation Trust, Liverpool, UK.

Background And Objective: To improve CRPS treatment, it is imperative to understand the nature, degree and relative importance of ongoing problems associated with CRPS. The objective of this systematic review was to summarize the published data concerning measures of function and impact including occupational parameters, of CRPS at 12 months from symptom onset and beyond.

Databases And Data Treatment: MEDLINE, EmBase and PsychINFO were searched (inception to May 2021). Read More

Front Integr Neurosci 2022 30;16:840249. Epub 2022 Mar 30.

Experimental Neuroscience Laboratory (LaNEx), Postgraduate Program in Health Sciences, University of Southern Santa Catarina - UNISUL, Palhoça, Brazil.

Complex regional pain syndrome type I (CRPS-I) is a condition that responds poorly to treatments. The role of omega-3 fatty acids in the treatment of inflammatory disorders is well described in the literature; however, few studies have evaluated its therapeutic benefits in different types of pain. We evaluated the potential antihyperalgesic and anti-inflammatory effects of preventive omega-3 supplementation in an animal model of CRPS-I. Read More

Scand J Pain 2022 Apr 18. Epub 2022 Apr 18.

Section of Clinical Neurophysiology, Department of Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.

Objectives: Mechanisms of complex regional pain syndrome (CRPS) are still debated. Identifying subgroups of patients have been attempted in the hope of linking clinical findings to possible mechanisms. The aim of the present study was to investigate whether subgroups of CRPS (based on quantitative sensory testing (QST)-results) differed with respect to different characteristics of pain like spontaneous ongoing or paroxysmal pain and mechanical dynamic allodynia. Read More