복합부위통증증후군 제I형 환자에서 조기 척수자극술이 필요한가? -증례보고-

Is Early Spinal Cord Stimulation in Patients with Complex Regional Pain Syndrome Necessary? -A case report-

  • 민형기 (아주대학교 의과대학 마취통증의학교실) ;
  • 한경림 (아주대학교 의과대학 마취통증의학교실) ;
  • 이상은 (아주대학교 의과대학 마취통증의학교실) ;
  • 김경태 (아주대학교 의과대학 마취통증의학교실) ;
  • 김찬 (아주대학교 의과대학 마취통증의학교실)
  • Min, Hyoung Ki (Pain Clinic, Department of Anesthesiology and Pain Medicine, College of Medicine, Ajou University) ;
  • Han, Kyung Ream (Pain Clinic, Department of Anesthesiology and Pain Medicine, College of Medicine, Ajou University) ;
  • Lee, Sang Eun (Pain Clinic, Department of Anesthesiology and Pain Medicine, College of Medicine, Ajou University) ;
  • Kim, Kyoung Tae (Pain Clinic, Department of Anesthesiology and Pain Medicine, College of Medicine, Ajou University) ;
  • Kim, Chan (Pain Clinic, Department of Anesthesiology and Pain Medicine, College of Medicine, Ajou University)
  • 투고 : 2006.10.10
  • 심사 : 2006.12.01
  • 발행 : 2006.12.30

초록

Complex regional pain syndrome (CRPS) is clinically characterized by pain, abnormal regulation of blood flow and sweating, edema of skin and subcutaneous tissues, sensory and motor disturbances, and trophic changes of the skin. A 21-year-old man was suffering from pain and swelling in his right hand and forearm. His arm had been in splints for 3 weeks following an extension injury of the right fingers and wrist, with the pain having developed 2 weeks after the splinting. He was treated with various nerve blocks including continuous epidural infusion, thoracic sympathetic block and peripheral nerve blocks, and squeezing his edematous region under general anesthesia as well as intravenous lidocaine and ketamine infusions. However, all of the performed treatments had no effect on the patient's pain or hand swelling. As a next line therapy, spinal cord stimulation should be considered because of intractable severe pain and swelling to almost all other modalities of therapy. We therefore performed an early intervention of spinal cord stimulation for the patient with refractory CRPS type I 5 months after the onset of pain and have got an excellent result.

키워드

참고문헌

  1. Finniss DG, Murphy PM, Brooker C, Nicholas MK, Cousins MJ: Complex regional pain syndrome in children and adolescents. Eur J Pain 2006; 10: 767-70 https://doi.org/10.1016/j.ejpain.2005.12.004
  2. Baron R: Complex regional pain syndromes. In: Textbook of pain. 5th ed. Edited by McMahon SB, Koltzenburg M: Edinburgh, Elsevier Churchill Livingstone. 2006, pp 1011-27
  3. Galer BS, Schwartz L, Allen RJ: Complex regional pain syndromes-type I: reflex sympathetic dystrophy, and rype II: causalgia. In: Bonica's management of pain. 3rd ed. Edited by Loeser JD: Philadelphia, Lippincott Williams & Wilkins. 2001, pp 388-411
  4. Stanton-Hicks M: Complex regional pain syndrome: manifestations and the role of neurostimulation in its management. J Pain Symptom Manage 2006; 31: S20-4 https://doi.org/10.1016/j.jpainsymman.2005.12.011
  5. Stanton-Hicks M, Baron R, Boas R, Gordh T, Harden N, Hendler N, et al: Complex regional pain syndromes: guidelines for therapy. Clin J Pain 1998; 14: 155-66 https://doi.org/10.1097/00002508-199806000-00012
  6. Bennett DS, Brookoff D: Complex regional pain syndromes (reflex sympathetic dysttophy and causalgia) and spinal cord stimulation. Pain Med 2006; 7: S64-96 https://doi.org/10.1111/j.1526-4637.2006.00124.x
  7. Nelson DV, Stacey BR: Interventional therapies in the management of complex regional pain syndrome. Clin J Pain 2006; 22: 438-42 https://doi.org/10.1097/01.ajp.0000192515.50955.9f
  8. Stanton-Hicks MD, Burton AW, Bruehl SP, Carr DB, Harden RN, Hassenbusch SJ, et al: An updated interdisciplinary clinical pathway for CRPS: report of an expert panel. Pain Practice 2002; 2: 1-16 https://doi.org/10.1046/j.1533-2500.2002.02009.x
  9. Wasner G, Schattschneider J, Binder A, Baron R: Complex regional pain syndrome - diagnostic, mechanisms, CNS involvement and therapy. Spinal Cord 2003; 41: 61-75 https://doi.org/10.1038/sj.sc.3101404
  10. Krames ES: Spinal cord stimulation and intractable pain: patient selection. In: Interventional pain management. 2nd ed. Edited by Waldman SD: Philadelphia, Saunders Co. 2001, pp 566-70
  11. Simpson BA, Meyerson BA, Linderoth B: Spinal cord and brain stimulation. In: Textbook of pain. 5th ed. Edited by McMahon SB, Koltzenburg M: Edinburgh, Churchill Livingstone Publisher. 2006, pp 563-82
  12. Kemler MA, Barendse GA, Van Kleef M, De Vet HC, Rijks CP, Furnee CA, et al: Spinal cord stimulation in patients with chronic reflex sympathetic dystrophy. N Engl J Med 2000; 343: 618-24 https://doi.org/10.1056/NEJM200008313430904
  13. Oakley JC, Prager JP: Spinal cord stimulation: mechanisms of action. Spine 2002; 27: 2574-83 https://doi.org/10.1097/00007632-200211150-00034
  14. Walker SM, Cousins MJ: Complex regional pain syndromes: including "reflex sympatheric dystrophy" and "causalgia". Anaesth Intensive Care 1997; 25: 113-25
  15. Yoon JW, Moon DE, Lee CW, Ryu KH: Cervical spinal cord stimulation in a patient with complex regional pain syndrome in the upper extremity. Korean J Pain 2004; 17: 243-7 https://doi.org/10.3344/jkps.2004.17.2.243
  16. Taylor Rs, Taylor RJ, Van Buyten JP, Buchser E, North R, Bayliss S: The cost effectiveness of spinal cord stimulation in the treatment of pain: a systemaric review of the literature. J Pain Symptom Manage 2004; 27: 370-8 https://doi.org/10.1016/j.jpainsymman.2003.09.009