Journal of Yeungnam Medical Science

Communication

Algorithm for multimodal medication therapy in patients with complex regional pain syndrome: Min Cheol Chang, Donghwi Park; J Yeungnam Med Sci. 2023;40(Suppl):S125-S128. Published online July 12, 2023; DOI: https://doi.org/10.12701/jyms.2023.00360

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Complex regional pain syndrome (CRPS), previously known as reflex sympathetic dystrophy and causalgia, is a clinical entity characterized by classic neuropathic pain, autonomic involvement, motor symptoms, and trophic changes in the skin, nails, and hair. Although various therapeutic modalities are used to control CRPS-related pain, severe pain due to CRPS often persists and progresses to the chronic phase. In this study, we constructed an algorithm for multimodal medication therapy for CRPS based on the established pathology of CRPS. Oral steroid pulse therapy is recommended for initial pain management in patients with CRPS. Oral steroid therapy can reduce peripheral and central neuroinflammation, contributing to the development of neuropathic pain during the acute and chronic phases. If steroid pulse therapy offers poor relief or is ineffective, treatment to control central sensitization in the chronic phase should be initiated. If pain persists despite all drug adjustments, ketamine with midazolam 2 mg before and after ketamine injection can be administered intravenously to inhibit the N-methyl D-aspartate receptor. If this treatment fails to achieve sufficient efficacy, intravenous lidocaine can be administered for 2 weeks. We hope that our proposed drug treatment algorithm to control CRPS pain will help clinicians appropriately treat patients with CRPS. Further clinical studies assessing patients with CRPS are warranted to establish this treatment algorithm in clinical practice.

Citations

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Experience from a single-center study on multimodal medication therapy for patients with complex regional pain syndrome
Donghwi Park, Jin-Woo Choi, Min Cheol Chang
Journal of Back and Musculoskeletal Rehabilitation.2024; 37(3): 687. CrossRef
Problems of diagnosis and treatment of chronic pain syndrome in patients with variants of the structure of peripheral nerves. A series of clinical cases
Al'bert R. Bulatov, Tatyana A. Kolesnik, Александра A. Boykova, Igor' V. Litvinenko, Nikolay V. Tsygan
Russian Military Medical Academy Reports.2023; 42(4): 413. CrossRef

Resident fellow section: Teaching images

A 40-year-old man with neuropathic pain in the entire left foot: Jae Hwa Bae, Mathieu Boudier-Revéret, Min Cheol Chang; J Yeungnam Med Sci. 2023;40(2):223-224. Published online August 30, 2022; DOI: https://doi.org/10.12701/jyms.2022.00486

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Original Article

The Effect of Gabapentin for the Clinical Symptoms in the Traumatic Neuropathic Pain.: Yeung Ki Kim, Yun Woo Cho; Yeungnam Univ J Med. 2004;21(1):82-90. Published online June 30, 2004; DOI: https://doi.org/10.12701/yujm.2004.21.1.82

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Abstract PDF: BACKGROUND
Gabapentin is widely used for the relief of neuropathic pain. But, there is no study of gabapentin in relation to traumatic neuropathic pain. The aim of this study is to assess the efficacy and effectiveness of gabapentin for the various clinical symptoms of traumatic neuropathic pain MATERIALS AND METHODS: 50 patients with traumatic nerve injury were assigned to receive gabapentin, titrated to 900 mg/day over 9 days, followed by further increases to a maximum of 2400 mg/day. Continuous pain, paroxysmal pain, allodynia and thermal evoked pain were measured in mean daily pain scores, based on the 11-point Likert scale. The primary efficacy parameter was compared from the baseline to the final study week. RESULTS: Over the 4.5 week study, this pain score decreased by 2.6 points in the continuous pain, 3.6 points in the paroxysmal pain, 3.1 points in the allodynia, and 2.5 points in the thermal evoked pain. The percentage of patients with over 50% improvement in pain scores was 33% in the continuous pain, 67% in the paroxysmal pain, 53% in the allodynia and 36% in the thermal evoked pain. There was no significant correlation between the effect of gabapentin and the time difference of the onset of symptoms and start of medication. CONCLUSIONS: This study shows that gabapentin reduced neuropathic pain in patients with traumatic peripheral nerve injury. Among the various characteristics of neuropathic pain, the reduction of paroxysmal pain and allodynia was greatest.

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