Regional Pain

Regional pain syndrome may develop as a consequence of limb trauma without nerve damage or reflex sympathetic dystrophy or without obvious nerve injury-cauzalgia. This syndrome is relatively common in the population. Has an unknown disease. Complex Regional Pain is a variable that is determined probably symptomatic of multiple causes through different pathophysiological mechanisms. Changes in peripheral and central somatosensory, motor and autonomous interaction and associated pathological sympathetic systems are described as basic mechanisms.The condition can occur at any age, but the average diagnosis is 42 years. It affects men and women, but is three times more common in women.
Regional affected patient experience pain, tremors and muscle weakness, trophic changes of skin coloration and the affected segment, limb movement disorders, depression, anxiety, chronic edema, recurrent infection of the limb, hipoestezii. 20-70% of patients with hemiplegia will suffer from this syndrome.
Hospitalization is usually necessary for patients with regional pain syndrome, but it depends on the invasiveness of treatment for pain and severity of the case. Sometimes a short period of hospitalization is required for persons who require continuous nerve blocks. These patients may be controlled by other conditions orthopedic surgery.Physical therapy in combination with the Occupational play an important role in restoring function. It aims to increase strength and flexibility gradually. These patients have co miofasciala pain can be treated with relaxation techniques and massage miofasciala.
Strategies include improving the pharmacological treatment of pain, sympatholytic interventions and rehabilitation.Evolution of patients can be good if treatment is begun early, ideally within the first 3 months after onset. If treatment is delayed condition is rapidly expanding to the entire member and changes in bone, skin and nerves become irreversible. Member may suffer muscle atrophy, loss of function and amputation.
For patients who can not be treated with narcotic analgesia practice of neural blockade, although neuropathic pain can be very resistant to standard analgesics. All treatments have to follow the restoration of function. The use of drugs, sympathetic blocks, and psychotherapy help to control pain. Early medical intervention is important for its success. The duration between the onset of treatment and clinical improvement varies from several days to several years.
Pathogenesis
There are several hypotheses to the mechanism of sympathetic mediated pain and describes the central and peripheral components. It was demonstrated early loss of peripheral vasoconstrictor activity-autonomous dysfunction deriving from the central nervous system. Case vadculare abnormalities is unknown.The old concept of regional peripheral exaggerated inflammatory response is supported by new data indicating the accumulation of immunoglobulin G region.Electronic Studies of skeletal muscle biopsies showed reduced mitochondrial enzyme activity, mitochondrial veziculizarea, miofibrilelor decay, abnormal deposits lipofuscina, swelling and thickening of basement membrane layers encoteliale-signs of oxidative stress. Oxygen consumption is reduced in the affected limbs and regional pain syndrome has been described to reduce pain after taking oral avasodilatatoare.After a partial nerve injury, excessive activation of C fibers antidromica unaffected and the release of neuropeptides lead to active vasodilation in the territory innervated by the nerve affected.
Regional pain syndrome is divided into two types depending on the presence of nerve injury after injury:I-type known as reflex sympathetic dystrophy, Sudeck atrophy, reflex neurovascular dystrophy without evidence of nerve damageCauzalgia-type II or with nerve damage.
Causes and risk factors:Various injuries can lead to regional pain syndrome:-Trauma, dislocations, fractures, surgery, burns, bruises-Neurological disorders, stroke, tumor, siringomelieHerpes-zoster infection-Myocardial infarction, musculoskeletal disorders-Neoplasia, causes spontaneous / idiopathic.