Komplexe regionale Schmerzsyndrome

ZUSAMMENFASSUNG

Das komplexe regionale Schmerzsyndrom (CRPS) ist gekennzeichnet durch sensorische (Spontanschmerzen, Hypästhesie, Hypo- oder Hyperalgesie, Allodynie), motorische (v. a. eingeschränkter Bewegungsumfang und Feinmotorik, fehlender Faustschluss, fehlende Abrollbewegung des Fußes, mitunter auch Tremor oder Dystonie) und autonome (Veränderungen des Haut-, Haar- und Nagelwachstums, des Hautkolorits und der -temperatur, der Schweißsekretion, Ödem) Symptome, die sich hinsichtlich Ausmaß und Auftreten individuell unterscheiden. Typisch ist jedoch eine distale Generalisierung der Symptomatik mit Ausdehnung in Hände und Füße, häufig mit handschuh- bzw. strumpfförmigem Verteilungsmuster. Die Diagnose wird klinisch anhand der Budapest-Kriterien gestellt, bei denen sowohl Symptome (Beobachtungen des Patienten) als auch Befunde (Erhebung des Arztes) berücksichtigt werden. Zur Unterstützung der Diagnose ist als einziges bildgebendes Verfahren die 3-Phasen-Skelettszintigrafie geeignet, die in der Spätphase im ersten Jahr der Erkrankung häufig ein typisches bandförmiges Verteilungsmuster mit erhöhtem Knochenstoffwechsel der kleinen Finger- bzw. Zehengelenke zeigt. Die Therapie ist multimodal und beinhaltet je nach Schweregrad bzw. Symptomatik sowohl eine topische als auch systemische Pharmakotherapie, interventionelle Verfahren, eine temporäre Kortisontherapie, Lymphdrainage, Physio-, Ergo- und Psychotherapie. Bei frühzeitiger und adäquater Behandlung ist die Prognose gut, jedoch ist der Verlauf häufig langwierig.

ABSTRACT

Complex regional pain syndrome (CRPS) is characterized by sensory (spontaneous pain, hypesthesia, hypo- or hyperalgesia, allodynia), motor (esp. limited range of motion and fine motor skills, lack of fist closure, lack of rolling motion of the foot, sometimes also tremor or dystonia) and autonomic (changes in skin, hair and nail growth, skin color and temperature, sweat secretion, edema) symptoms, which vary individually in extent and occurrence. However, a distal generalization of the symptomatology with extension into the hands and feet, often with a glove- or stocking-shaped distribution pattern, is typical. The diagnosis is made clinically using the Budapest criteria, which take into account both symptoms (observations by the patient) and findings by the physician. To support the diagnosis, the only imaging technique suitable is three-phase skeletal scintigraphy, which often shows a typical band-shaped distribution pattern with increased bone metabolism of the small finger and toe joints in the late phase in the first year of the disease. Therapy is multimodal and includes both topical and systemic pharmacotherapy, interventional procedures, temporary cortisone therapy, lymphatic drainage, physical therapy, occupational therapy, and psychotherapy, depending on severity or symptoms present. With early and adequate treatment, the prognosis is good, but the course is often protracted.

Schlüsselwörter

CRPS Typ 1 - CRPS Typ 2 - multimodale Schmerztherapie - Budapest-Kriterien

Key words

CRPS type 1 - CRPS type 2 - multimodal pain therapy - Budapest criteria

Publikationsverlauf

Artikel online veröffentlicht:
09. März 2021

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