Post-stroke complex regional pain syndrome and related factors: Experiences from a tertiary rehabilitation center
Introduction
Complex regional pain syndrome (CRPS) is a syndrome that is independent of the severity of the injury, and manifests itself with persistent severe pain with autonomic, sensory and motor abnormalities.1 The condition is classified as Type 1 and 2. Type 1 CRPS accounts for 90% of the cases, and the causative disease or injury is not accompanied by nerve damage. Type 2 CRPS (causalgia), on the other hand, occurs after serious nerve damage.2 Both types exhibit similar clinical symptoms; along with a burning pain, changes in the skin temperature and color, increased sensitivity, disruption of hair and nail growth, swelling affecting the joints, and motor dysfunction may be seen.3
Although the underlying pathophysiology is unclear, it has been reported that sympathetic nervous system dysfunction, which is thought to play an important role, occurs due to a microcirculatory disturbance in the sensory ganglion with peripheral nerves and noradrenergic sympathetic fibers.4 Somatic nervous system dysfunction, neurogenic inflammation, hypoxia and psychological factors are also effective in the progression of the clinical picture.5 The most common causes of CRPS are fractures (45%), followed by sprains and elective surgery. Inflammatory diseases, heart attacks, smoking, hereditary factors, and stroke are less common causes. The condition may develop regardless of a cause in less than 10% of the patients.5–7
Pain of the affected upper extremity is one of the most common complications in patients with stroke.8 Post-stroke CRPS is an important disabling complication in stroke survivors and the incidence was reported to range between 21% and 31%3 The precise pathophysiological mechanisms and predictive factors that underlie post-stroke CRPS remain unknown.9 While the risk factors in CRPS, which develop due to other reasons, have been shown in many studies, there aren't any studies that have identified the risk factors in post-stroke CRPS.6,10 In this study, we aimed to evaluate the risk factors for post-stroke CRPS. We also investigated the relationship between the incidence of CRPS and risk factors.
Section snippets
Participants
The files of the patients who were diagnosed with stroke and hospitalized for rehabilitation between June 1, 2014 and June 1, 2019 at the Ankara Physical Therapy and Rehabilitation Training & Research Hospital of Health Sciences University were retrospectively analyzed. Patients over 18 years of age and with CRPS Type 1, according to the Budapest clinical diagnostic criteria,11 were included in the study. In addition, hemiplegic patients without a CRPS diagnosis were included in the study as a
Results
The sociodemographic and clinical characteristics of the two groups and their comparisons are presented in Table 1. Risk factors of the patients and intergroup comparisons are shown in Table 2. Our multivariate logistic regression analysis showed that in patients with stroke, time of the incident, time to hospitalization, shoulder subluxation, soft tissue lesion, adhesive capsulitis, spasticity, entrapment neuropathy, brachial plexus injury, PEM, LRTI, urinary infection, depression, and CAD
Discussion
In this study, we tried to evaluate the risk factors of CRPS in patients with stroke. Our results have shown that time of the incident, time to hospitalization, shoulder subluxation, soft tissue lesion on the shoulder, adhesive capsulitis, spasticity, entrapment neuropathy, brachial plexus injury, LRTI, urinary infection, depression, PEM, and CAD were independent risk factors.
Although it has been reported that CRPS usually develops within two weeks to three months after the cerebrovascular
Conclusion
In conclusion, post-stroke CRPS is a complicated phenomenon encompassing both nociceptive and neuropathic pain etiologies. It is comprised by a variety of disorders, of which the most common include shoulder subluxation, soft tissue lesion on the shoulder, adhesive capsulitis, spasticity, entrapment neuropathy, brachial plexus injury, LRTI, urinary infection, depression, PEM, and CAD. The management and the treatment of these syndromes include pharmacological, orthotic, biomechanical, and
Declaration of Competing Interest
The authors state that the manuscript has not been published previously, and they have no conflict of interest.
No financial support was received for this project.
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