Kompleks Bölgesel Ağrı Sendromunun Yönetiminde Girişimsel Tedaviler
Synopsis
Complex Regional Pain Syndrome (CRPS) is a clinical diagnosis characterized by pain disproportionate to the inciting event, allodynia, hyperalgesia, vasomotor, sudomotor, and motor dysfunctions, categorized into Type 1 and Type 2 based on the presence of major nerve damage. The Budapest criteria are used for diagnosis, while the CRPS Severity Score is employed for clinical monitoring to evaluate symptoms and signs. In CRPS management, interventional pain therapies play a critical role alongside physical therapy, pharmacotherapy, and psychotherapy. In the early stage, Stellate ganglion block is performed for upper extremity and facial involvement, whereas thoracic sympathetic block is preferred in cases of Kuntz nerve anatomical variations, and lumbar sympathetic block is utilized for lower extremity involvement. Adding botulinum toxin to sympathetic blocks or applying radiofrequency neurolysis significantly extends the duration of clinical efficacy. Among neurostimulation options, Dorsal Root Ganglion (DRG) stimulation demonstrates higher success rates in pain relief and quality of life improvement compared to conventional Spinal Cord Stimulation (SCS). Peripheral Nerve Stimulation (PNS) may be applied for symptoms associated with a single major nerve, while intrathecal baclofen infusions can be used in the presence of CRPS-related dystonia. Unlike adults, evidence for sympathetic blocks is low in the pediatric patient population; thus, 10–14 day epidural infusions are recommended early on, and SCS results are considered promising in refractory cases. In summary, early-stage sympathetic blocks and neurostimulation for non-responsive cases constitute the primary interventional steps in adults.
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