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J Pain 2018 Dec 15. Epub 2018 Dec 15.

Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Event-Lab, Department of Clinical Psychology and Psychobiology, Universitat de Barcelona, Barcelona, Spain; ICREA, Barcelona, Spain; Departamento de Psicología Básica, Universitat de Barcelona, Barcelona, Spain. Electronic address:

Modifying the visual aspect of a virtual arm that is felt as one's own using immersive virtual reality (VR) modifies pain threshold in healthy subjects but does it modify pain ratings in chronic pain patients? Our aim was to investigate whether varying properties of a virtual arm co-located with the real arm modulated pain ratings in patients with chronic arm/hand pain due to complex regional pain syndrome (CRPS) type I (without nerve injury) or peripheral nerve injury (PNI). CRPS (n=9) and PNI (n=10) patients were immersed in VR and the virtual arm was shown at four transparency levels (transparency test) and three sizes (size test). We evaluated pain ratings throughout the conditions and assessed the virtual experience, finding that patients with chronic pain can achieve levels of ownership and agency over a virtual arm similar to healthy participants. Read More

Medicine (Baltimore) 2018 Dec;97(50):e13272

Division of Pain Medicine, Department of Anesthesiology, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York.

Rationale: Continuous epidural infusion of local anesthetic may be an alternative to sympathetic blocks in refractory cases of complex regional pain syndrome (CRPS). Spinal epidural abscess (SEA) is a well-known complication associated with this technique, especially in patients with immune deficiencies. We herewith report a cervical SEA associated with an epidural catheter in a woman with CRPS and selective IgG3 subclass deficiency. Read More

Neurotherapeutics 2018 Dec 12. Epub 2018 Dec 12.

Division of Plastic and Reconstructive Surgery, Washington University in St. Louis, St. Louis, MO, USA.

Pain is a frequent cause of physician visits. Many physicians find these patients challenging because they often have complicated histories, emotional comorbidities, confusing examinations, difficult problems to fix, and the possibility of factitious complaints for attention or narcotic pain medications. As a result, many patients are lumped into the category of chronic, centralized pain and relegated to pain management. Read More

Plast Reconstr Surg Glob Open 2018 Oct 16;6(10):e1847. Epub 2018 Oct 16.

Elite Plastic Surgery, Phoenix, Arizona.

Background: Complex regional pain syndromes (CRPS) is a disease that is poorly understood. It is a chronic pain syndrome characterized by sympathetic disruptions as well as CNS sensitization. Botulinum Toxin-A has been shown to have efficacy in Raynaud's as well as other neuropathic pain disorders. Read More

J Pain Res 2018 13;11:2859-2866. Epub 2018 Nov 13.

Sannoh Orthopedic Clinic, Pain Clinic and Rehabilitation for Musculoskeletal Disorders, Sannoh Hospital, Chiba, Japan,

Background: Complex regional pain syndrome type I (CRPS I) in children is a serious condition disrupting the family and school life of patients with the condition after it fully develops. It has been emphasized that early diagnosis is closely associated with earlier reduction of pain leading to preferable outcomes.

Objectives: To report a case of acute CRPS I in a boy who was found to develop this condition by a routine visual analog scale (VAS) pain monitoring and who recovered from CRPS I at an early phase by prompt pharmacological, physical, and educational therapies. Read More

Neuroreport 2018 Nov 29. Epub 2018 Nov 29.

Emotional Information and Communication Technology Association, Seoul, Republic of Korea.

The aim of this study was to investigate distinct neurometabolites in the right and left thalamus and insula of patients with complex regional pain syndrome (CRPS) compared with healthy controls using proton magnetic resonance spectroscopy. Levels of N-acetylaspartate (NAA), N-acetylaspartylglutamate (NAAG), myo-inositol (ml), glutamine (Gln), glycerophosphocholine (GPC), glutathione (GSH), and alanine (Ala) relative to total creatine (tCr) levels, including creatine and phosphocreatine, were determined in the right and left thalamus and insula in 12 patients with CRPS compared with 11 healthy controls using magnetic resonance spectroscopy. Levels of NAAG/tCr and Ala/tCr were higher in patients with CRPS than in controls in the left thalamus. Read More

Physiother Theory Pract 2018 Nov 30:1-13. Epub 2018 Nov 30.

d Phileo Health , Altoona , WI , USA.

Background: Chronic Regional Pain Syndrome (CRPS) is a condition that physical therapists may encounter in an outpatient orthopedic setting. In physical therapy (PT) treatment of CRPS addresses pain and the changes observed in the brain through the use of graded motor imagery (GMI).

Case Description: A 57-year-old female presented to an outpatient PT clinic with CRPS type 1. Read More

Immunol Res 2018 Nov 27. Epub 2018 Nov 27.

Rheumatology Department, National Institute of Cardiology, Mexico City, Mexico.

This article reviews the case series reported from several countries describing patients with suspected severe side effects to the HPV vaccines. The described symptom clusters are remarkably similar and include disabling fatigue, headache, widespread pain, fainting, gastrointestinal dysmotility, limb weakness, memory impairment episodes of altered awareness, and abnormal movements. This constellation of symptoms and signs has been labeled with different diagnoses such as complex regional pain syndrome (CRPS), postural orthostatic tachycardia syndrome (POTS), small fiber neuropathy (SFN), myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), or fibromyalgia. Read More

Front Biosci (Landmark Ed) 2019 01 1;24:48-95. Epub 2019 Jan 1.

Berlin Cures GmbH Berlin, Knesebeckstrasse 59-61, 10719 Berlin, Germany,

In the 1970s, autoantibodies directed against G-protein-coupled receptors (GPCR, GPCR-AAB) were discovered. After receptor binding, GPCR-AAB trigger uncontrolled receptor mediated signal cascades, thus producing pathologies. Diseases associated with such functionally active autoantibody type (functional autoantibodies) can be called "functional autoantibody diseases". Read More

J Bone Miner Metab 2018 Nov 21. Epub 2018 Nov 21.

Department of Orthopaedic Surgery, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.

In the course of complex regional pain syndrome (CRPS), local osteopenia in the subchondral/subcortical areas of the affected limb represents a central manifestation. Mechanistic aspects of CRPS-associated pathologies remain unclear, and knowledge about bone morphology in CRPS-affected areas is rare. The aim of this study was to assess trabecular and cortical bone microstructure in patients with CRPS of the distal tibiae. Read More

Conf Proc IEEE Eng Med Biol Soc 2018 Jul;2018:3782-3787

Working towards improved neuromyoelectric control of dexterous prosthetic hands, we explored how differences in training paradigms affect the subsequent online performance of two different motor-decode algorithms. Participants included two intact subjects and one participant who had undergone a recent transradial amputation after complex regional pain syndrome (CRPS) and multi-year disuse of the affected hand. During algorithm training sessions, participants actively mimicked hand movements appearing on a computer monitor. Read More

J Hand Surg Asian Pac Vol 2018 Dec;23(4):554-561

* Department of Occupational Therapy, The University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.

Background: To investigate the role of psychological factors (anxiety and depression) and pain measured on a visual analogue scale (VAS) in the development of complex regional pain syndrome type I (CRPS I) following the distal radius fracture (DRF).

Methods: A consecutive sample of patients (N=60) with a distal radius fracture was measured for signs of CRPS by Budapest criteria weekly till 8 weeks and then another follow-up one year after injury to determine the incidence and predictors of developing CRPS I in a prospective cohort study and also to discover whether there is difference between pain, depression, and anxiety level in the patients with and without CRPS I. The most of the patients were treated by Pin stabilization. Read More

Pract Neurol 2018 Nov 13. Epub 2018 Nov 13.

Nuffield Orthopaedic Hospital, Oxford Centre for Enablement, Oxford, UK.

Although exaggeration or amplification of symptoms is common in all illness, deliberate deception is rare. In settings associated with litigation/disability evaluation, the rate of malingering may be as high as 30%, but its frequency in clinical practice is not known. We describe the main characteristics of deliberate deception (factitious disorders and malingering) and ways that neurologists might detect symptom exaggeration. Read More

Pain Res Manag 2018 17;2018:2894360. Epub 2018 Oct 17.

Department of Anaesthesiology and Intensive Care Medicine, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany.

Background: Complex regional pain syndrome (CRPS) is a multifactorial disorder with complex aetiology and pathogenesis. At the outpatient pain clinic of Magdeburg University Hospital, all patients, without exception, are subject to permanent psychiatric care delivered by a consultation-liaison psychiatrist. In CRPS, psychological stabilization and treatment of the neuropathic aspects are equally important. Read More

Pain Med 2018 Nov 8. Epub 2018 Nov 8.

Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea.

Objective: To evaluate the influence of pain sensitization in the early recovery of distal radius fractures (DRFs) on the occurrence and prognosis of complex regional pain syndrome (CRPS) type I.

Methods: We enrolled 58 patients who were diagnosed with CRPS I based on Budapest criteria within six months after sustaining DRF; they were age- and gender-matched with 58 patients with DRF who did not have CRPS I. We commonly measured patients' pressure pain thresholds (PPTs) in the forearm and administered a Pain Sensitivity Questionnaire (PSQ) when patients complained of pain with numeric rating scale ≥4 at three-month follow-up. Read More

Medicine (Baltimore) 2018 Nov;97(45):e13115

Department of Anesthesia, St. Joseph's Hospital, McMaster University, Hamilton, Ontario, Canada.

Rationale: Ehlers-Danlos syndromes (EDSs) are a heterogeneous group of heritable connective tissue disorders involving defective collagen synthesis. Patients with EDS are prone for chronic myofascial pain, apart from other comorbidities. Although the initial pathology is commonly nociceptive, progression of EDS leads to neuropathies and central sensitization of pain signals. Read More

Med Hypotheses 2018 Dec 29;121:15-20. Epub 2018 Aug 29.

Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB Groningen, The Netherlands.

Deciding for an amputation in case of complex regional pain syndrome type I (CRPS-I) is controversial. Evidence for favorable or adverse effects of an amputation is weak. We therefore follow a careful and well-structured decision making process. Read More

Pain Manag 2018 Nov 5;8(6):427-436. Epub 2018 Nov 5.

Institute for Pain Medicine/Pain Practice Wiesbaden, Germany.

Aim: The secretolytic drug ambroxol may be useful for the treatment of neuropathic pain due to its multiple modes of action. We hypothesized that ambroxol may be a treatment option for complex regional pain syndrome (CRPS).

Methods: Additional to standard therapy, eight CRPS-patients with symptoms of less than 12 months were treated with topical 20% ambroxol cream. Read More

Mol Pain 2018 Jan-Dec;14:1744806918815005. Epub 2018 Nov 5.

1 Department of Anesthesiology, University of California, San Diego, La Jolla, CA, USA.

Complex regional pain syndrome is an extremely painful condition that develops after trauma to a limb. Complex regional pain syndrome exhibits autoimmune features in part mediated by autoantibodies against muscarinic-2 acetylcholine (M2) receptor. The mechanisms underlying the M2 receptor involvement in complex regional pain syndrome remain obscure. Read More

J Clin Apher 2018 Dec 2;33(6):661-665. Epub 2018 Nov 2.

Clinical Ethics, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom.

Background: Complex regional pain syndrome (CRPS) is a severe post-traumatic chronic pain condition affecting distal limbs, for which few effective treatments exist. Complex regional pain syndrome is listed in the 2016 American Society for Apheresis guidelines as an indication for plasma exchange treatment, but patient perspectives are lacking.

Study Design And Methods: We convened a "patient and public consultation exercise. Read More

Pain Pract 2018 Oct 26. Epub 2018 Oct 26.

Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School Boston, MA, USA.

Background: High frequency spinal cord stimulation at 10 kHz (HF10-SCS) has been demonstrated to provide enhanced and durable pain relief in patients with chronic back and radiating leg pain. Patients with pain related to complex regional pain syndromes (CRPS) in the chronic stages are commonly challenging to treat and often receive traditional spinal cord stimulation. Very little information is currently available about the therapeutic outcomes following application of high frequency stimulation in this cohort of patients. Read More

Neuromodulation 2018 Oct 25. Epub 2018 Oct 25.

University Hospital Bonn, Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany.

Objectives: Complex regional pain syndrome (CRPS) and associated comorbidities have been linked to a pro-inflammatory state driven by different mediators. Targeted dorsal root ganglion stimulation (DRG ) suppressed pain levels and improved functional capacity in intractable CRPS. However, clinical trials assessing the impact of DRG stimulation on the neuroimmune axis are lacking. Read More

J Neurol Neurosurg Psychiatry 2018 Oct 24. Epub 2018 Oct 24.

Centre for Clinical Brain Sciences, Western General Hospital, NHS Lothian and University of Edinburgh, Edinburgh, UK

There have been many articles highlighting differences and similarities between complex regional pain syndrome (CRPS) and functional neurological disorders (FND) but until now the discussions have often been adversarial with an erroneous focus on malingering and a view of FND as 'all in the mind'. However, understanding of the nature, frequency and treatment of FND has changed dramatically in the last 10-15 years. FND is no longer assumed to be only the result of 'conversion' of psychological conflict but is understood as a complex interplay between physiological stimulus, expectation, learning and attention mediated through a Bayesian framework, with biopsychosocial predisposing, triggering and perpetuating inputs. Read More

J Wrist Surg 2018 Nov 18;7(5):358-365. Epub 2018 Sep 18.

Division of Hand and Upper Extremity Surgery, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York.

 CAGE-DR implant is a novel Food and Drug Administration approved intramedullary fracture fixation device used for distal radius fractures. We examine a series of 22 patients and report the outcomes with this device.  A total of 24 patients with distal radius fractures (8 articular AO type C1/C2; 16 extra-articular AO type A2/A3) underwent open reduction and internal fixation (ORIF) using CAGE-DR implant by a single surgeon. Read More

Br J Pain 2018 Nov 1;12(4):217-219. Epub 2018 Mar 1.

Department of Neurological Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ, USA.

Introduction: High-frequency (HF) spinal cord stimulation (SCS), a relatively new form of spinal cord stimulation, provides stimulation frequencies of up to 10 kHz and allows for paresthesia-free pain relief, an advantage that distinguishes it from traditional stimulation therapy. Without paresthesias, patients with HF SCS do not experience position-dependent painful stimulation and do not have to experience treatment interruption during sleep. Lead migration is a well-known complication of conventional spinal cord stimulation and usually results in a loss of efficacy along with other unpleasant sensory symptoms. Read More

Pain Med 2018 Oct 20. Epub 2018 Oct 20.

Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, USA.

Objectives: The purpose of this study was to conduct classical psychometric evaluation and Rasch analysis on the Neuropathic Qualities subscale of the Short-Form McGill Pain Questionnaire-2 utilizing scores from persons with complex regional pain syndrome to consider reliability and person separation, validity (including unidimensionality), and responsiveness in this population.

Methods: Secondary analysis of longitudinal data from persons with acute complex regional pain syndrome was utilized for analysis of the psychometric properties and fit to the Rasch model of the Neuropathic Qualities subscale. We followed an iterative process of Rasch analysis to evaluate and address data fitting challenges. Read More

Pain Res Manag 2018 24;2018:6375713. Epub 2018 Sep 24.

Department of Pediatrics, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada.

Objectives: The use of interdisciplinary patient-centered care (PCC) and empathetic behaviour seems to be a promising avenue to address chronic pain management, but their use in this context seems to be suboptimal. Several patient factors can influence the use of PCC and empathy, but little is known about the impact of pain visibility on these behaviours. The objective of this study was to investigate the influence of visible physical signs on caregiver's patient-centered and empathetic behaviours in chronic pain context. Read More

Arch Orthop Trauma Surg 2018 Dec 19;138(12):1773-1782. Epub 2018 Oct 19.

AUVA Trauma Hospital Lorenz Böhler, European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria.

Introduction: Distal radius fractures (DRF) are the most common fractures of the upper extremities. The incidence is expected to continue rising in the next years due to the increased life expectancy. Palmar locking plate stabilizing has since become the standard treatment for dorsally displaced DRF with a complication rate of 8-39% reported in the literature. Read More

Br J Anaesth 2018 Nov 24;121(5):1133-1137. Epub 2018 Aug 24.

Department of Anesthesiology and Pain Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. Electronic address:

Background: Discrepancy between a patient's subjective thermal symptoms and objective measured temperature value is common in complex regional pain syndrome (CRPS) in clinical settings. For that reason, the diagnostic validity of a single temperature measurement method has been criticised. Several studies showed that the perfusion index (PI), which is derived from pulse oximetry, is a more sensitive and earlier indicator of sympathetic blockade than temperature measurement. Read More

Front Pharmacol 2018 2;9:1119. Epub 2018 Oct 2.

Centro de Estudio para las Investigaciones y Evaluaciones Biológicas, Instituto de Farmacia y Alimentos, Universidad de La Habana, Havana, Cuba.

The present study reproduces chronic post-ischemia pain (CPIP), a model of complex regional pain syndrome type I (CRPS-I), in rats to examine the possible transient and long-term anti-allodynic effect of mangiferin (MG); as well as its potential beneficial interactions with some standard analgesic drugs and sympathetic-mediated vasoconstriction and vasodilator agents during the earlier stage of the pathology. A single dose of MG (50 and 100 mg/kg, p.o. Read More

BMJ Case Rep 2018 Oct 16;2018. Epub 2018 Oct 16.

USAT College of Medicine, University of Science, Arts & Technology, Olveston, Montserrat.

A 34-year-old man with a history of gunshot wound (GSW) to the right upper chest developed secondary aortic valve endocarditis (AVE) and was treated with an artificial valve placement (AVP). Three months after, he presented to an outpatient pain management clinic right arm pain and was diagnosed with complex regional pain syndrome type II (CRPS II). The patient underwent a diagnostic sympathetic ganglion block, before undergoing endoscopic thoracic sympathectomy surgery. Read More

N Engl J Med 2018 Oct;379(16):1575-1577

Pain Rep 2018 Sep 11;3(Suppl 1):e681. Epub 2018 Sep 11.

Department of Psychology and Centre for Pain Research, University of Bath, Bath, United Kingdom.

Introduction: Parenting a young person with complex regional pain syndrome (CRPS) is associated with high levels of parental distress and numerous emotional, informational, and practical challenges. To meet these challenges, parents seek others undergoing similar experiences, both in face to face and online forums.

Objectives: The objective of this study was to conduct a qualitative analysis of online forum data to explore the process of parental forum communication regarding parenting a young person with CRPS in online spaces. Read More

Pain Res Treat 2018 13;2018:9091216. Epub 2018 Sep 13.

Department of Anesthesiology, School of Medicine, University of Minnesota, Minneapolis, MN, USA.

Peripheral nerve stimulation has been used in the treatment of several chronic pain conditions including pain due to peripheral nerve dysfunctions, complex regional pain syndrome, and cranial neuralgias. It has been shown to be effective for chronic, intractable pain that is refractory to conventional therapies such as physical therapy, medications, transcutaneous electrical stimulations, and nerve blocks. Recently, a new generation of peripheral nerve stimulation devices has been developed; these allow external pulse generators to transmit impulses wirelessly to the implanted electrode, and their implantation is significantly less invasive. Read More

Am J Phys Med Rehabil 2018 Oct 8. Epub 2018 Oct 8.

Hacettepe University Medical School, Department of Physical and Rehabilitation Medicine Ankara, Turkey.

Pain Med 2018 Oct;19(10):2021-2030

Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark.

Objective: Findings regarding small nerve fiber damage in complex regional pain syndrome type I (CRPS-I) are not uniform, and studies have not included a matched healthy control group. The aim was to assess intraepidermal nerve fiber density (IENFD) in relation to thermal sensitivity of the same skin areas in CRPS-I patients and a gender- and age-matched healthy control group.

Methods: IENFD was investigated in skin biopsies from the CRPS-affected and contralateral limbs of eight CRPS-I patients and from an equivalent site in eight gender- and age-matched healthy controls (HCs). Read More

Acta Chir Orthop Traumatol Cech 2018 ;85(2):125-129

Ortopedické oddělení Nemocnice v Chomutově, Krajská zdravotní, a.s., Chomutov.

PURPOSE OF THE STUDY The aim of the study was to present the surgical technique combining the interposition and suspension arthroplasty using the TIE-IN implant as a treatment option for advanced symptomatic to final stage rhizarthrosis. MATERIAL AND METHODS Since 2015 we have performed the interposition arthroplasty combined with suspension arthroplasty using the TIE-IN implant in 12 patients, mostly indicated for stage IV rhizarthrosis. In two cases stage III rhizarthrosis with concomitant trapezium destruction was present. Read More

Eur J Pain 2018 Oct 5. Epub 2018 Oct 5.

Department of Neurology, Fürth General Hospital, Fürth, Germany.

Background: In complex regional pain syndrome (CRPS), altered perception of the affected hand and neglect-like symptoms of the affected body side are common features. In this study, we presented tactile stimuli to the affected hands in CRPS patients and matched healthy controls.

Methods: The participants' task was to point at the perceived positions of the stimuli using a tracking device. Read More

Eur J Pain 2018 Oct 5. Epub 2018 Oct 5.

Royal United Hospitals NHS Foundation Trust, Bath, UK.

Background: Sensorimotor conflicts are well known to induce sensory disturbances. However, explanations as to why patients with chronic pain are more sensitive to sensorimotor conflicts remain elusive. The main objectives of this study were (a) to assess and compare the sensory disturbances induced by sensorimotor conflict in complex regional pain syndrome (n = 38), fibromyalgia (n = 36), arthritis (n = 34) as well as in healthy volunteers (HV) (n = 32); (b) to assess whether these disturbances were related to the intensity and duration of pain, or to other clinical variables assessed using questionnaires (abnormalities in sensory perception, depression and anxiety); and (c) to categorize different subgroups of conflict-induced sensory disturbances. Read More

Pain Pract 2018 Sep 30. Epub 2018 Sep 30.

Department of Pain Medicine, BG University Hospital Bergmannsheil GmbH, Ruhr University, Bochum, Germany.

Background: The early phase of complex regional pain syndrome (CRPS) is characterized by an inflammatory state and therefore often treated with anti-inflammatory acting glucocorticoids. Recently, we demonstrated that remote ischemic conditioning (RIC), a cyclic application of nondamaging ischemia on a remote extremity, reduces blood flow and increases oxygen extraction in the CRPS-affected extremity.

Aim: The aim of the presented study was to analyze the effect of short-term pain treatment including glucocorticoid pulse treatment on the RIC-induced perfusion parameters. Read More

J Plast Reconstr Aesthet Surg 2018 Sep 6. Epub 2018 Sep 6.

Department of Plastic and Reconstructive Surgery Southmead Hospital, Bristol BS10 5NB, United Kingdom. Electronic address:

A multidisciplinary team representing 28 professional bodies has updated the guidelines for the management of complex regional pain syndrome (CRPS), published by the Royal College of Physicians (RCP) of England, 2018. The author represented the British Association of Plastic, Reconstructive and Aesthetic Surgeons in this process and is an author of the guidelines. This article summarises the updated guidelines and highlights aspects relevant to plastic and reconstructive surgery. Read More

Med Sci (Basel) 2018 Sep 21;6(4). Epub 2018 Sep 21.

Section of Pain Medicine, Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH 03756, USA.

Naltrexone and naloxone are classical opioid antagonists. In substantially lower than standard doses, they exert different pharmacodynamics. Low-dose naltrexone (LDN), considered in a daily dose of 1 to 5 mg, has been shown to reduce glial inflammatory response by modulating Toll-like receptor 4 signaling in addition to systemically upregulating endogenous opioid signaling by transient opioid-receptor blockade. Read More

Neuromodulation 2018 Sep 24. Epub 2018 Sep 24.

Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.

Objective: The physiological mechanisms behind the therapeutic effects of spinal cord stimulation (SCS) are only partially understood. Our aim was to perform a literature review of studies that used objective measures to characterize mechanisms of action of SCS in neuropathic pain patients.

Materials And Methods: We searched the PubMed data base to identify clinical studies that used objective measures to assess the effects of SCS in neuropathic pain. Read More

Neuromodulation 2018 Sep 24. Epub 2018 Sep 24.

Evidence-Based Pain Management Research and Education, Cleveland Clinic, Cleveland, OH, USA.

Introduction: The Neuromodulation Appropriateness Consensus Committee (NACC) is dedicated to improving the safety and efficacy of neuromodulation and thus improving the lives of patients undergoing neuromodulation therapies. With continued innovations in neuromodulation comes the need for evolving reviews of best practices. Dorsal root ganglion (DRG) stimulation has significantly improved the treatment of complex regional pain syndrome (CRPS), among other conditions. Read More

J Pain Res 2018 4;11:1729-1741. Epub 2018 Sep 4.

Department of Rehabilitation Medicine, Daegu Fatima Hospital, Daegu, Republic of Korea,

Background: To date, there has been no study on the effects of interleukin-10 (IL-10) on complex regional pain syndrome (CRPS) rodent models, despite the anti-allodynic effect of IL-10 in previous studies. Thus, the aim of this study was to investigate the effect of IL-10 in a CRPS mouse model and find whether early inhibition of neuro-inflammation by IL-10 administration, which is considered to be one of the important mechanisms in the generation of central sensitization, could prevent the transition from the acute stage to the chronic stage of CRPS.

Method: A mouse model of CRPS (n=6/group) involving tibia fracture/cast immobilization to test the efficacy of intrathecal IL-10 (0. Read More

J Pain 2018 Sep 14. Epub 2018 Sep 14.

Neuroscience Research Australia, Randwick, Sydney, Australia.; University of South Australia, Adelaide, Australia. Electronic address:

Complex regional pain syndrome (CRPS) is associated with deficits in sensorimotor control. Herein we have used a novel finger illusion to investigate whether CRPS is associated with reduced weighting of bimanual hand representations. The illusion normally induces a compelling feeling that the hands are close together when in fact they are 12 cm apart. Read More

Unfallchirurg 2018 Sep 14. Epub 2018 Sep 14.

Abteilung für Unfall‑, Hand- & Wiederherstellungschirurgie, Klinik und Poliklinik für Chirurgie, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Deutschland.

Complex regional pain syndrome (CRPS) is not a very common yet typical complication of extremity trauma in the daily practice of a trauma surgeon. The pathophysiology of this puzzling disease is still not completely understood and its impact on the patient cannot be overestimated. However, advantages have been made in diagnostics and therapy. Read More

Musculoskelet Sci Pract 2018 12 5;38:15-22. Epub 2018 Sep 5.

Department of Psychological Medicine, University of Otago, Christchurch, Corner of Riccarton and Hagley Avenues, Christchurch 8042, New Zealand. Electronic address:

There are no validated clinical models to show a reliable pathway of guaranteeing an effective recovery for Complex Regional Pain Syndrome (CRPS) with physiotherapy management. An array of medical, psychological and physiotherapy intervention methods show weak benefit. Spearman correlations, with significance p < 0. Read More