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; Булатов Альберт Ренатович; Tatyana A. Kolesnik; Колесник Татьяна Андреевна; Александра A. Boykova; Бойкова Александра Андреевна; Igor' V. Litvinenko; Литвиненко Игорь Вячеславович; Nikolay V. Tsygan; Цыган Николай Васильевич

doi:10.17816/rmmar615774

Problems of diagnosis and treatment of chronic pain syndrome in patients with variants of the structure of peripheral nerves. A series of clinical cases

作者: Bulatov A.R.¹, Kolesnik T.A.¹, Boykova А.A.¹, Litvinenko I.V.¹, Tsygan N.V.²
隶属关系:
1. Military Medical Academy
2. Kirov Military Medical Academy
期: 卷 42, 编号 4 (2023)
页面: 413-420
栏目: Case report
URL: https://ogarev-online.ru/RMMArep/article/view/264752
DOI: https://doi.org/10.17816/rmmar615774
ID: 264752

如何引用文章

全文:

详细
全文:
作者简介
参考
补充文件
统计

详细

AIM: To assess the presence of variants of the structure of peripheral nerves as possible risk factors for chronic pain syndrome on the example of a series of clinical cases.

MATERIALS AND METHODS: The systematization and analysis of data from domestic and foreign literature on pathophysiology, clinic, diagnosis and treatment of complex regional pain syndrome has been carried out. Research method: system analysis, presentation of a series of clinical cases.

RESULTS: A series of clinical cases is presented. The main risk factors for chronic pain syndrome are presented. The conditions and diseases that need to be differentially diagnosed if complex regional pain syndrome is suspected are systematized: tunnel syndromes (carpal tunnel syndrome), diabetic polyneuropathy, HIV polyneuropathy, postherpetic neuralgia, neurogenic claudication/lumbar stenosis, central post-stroke pain, upper thoracic syndrome apertures.

CONCLUSION: Today, practitioners and neurophysiologists are not sufficiently aware of the existence of interneural anastomoses and features, typical electroneuromyographic signs, as a result of which in most cases the obtained electroneuromyographic data are interpreted erroneously. Variants of the structure of nerves can give an incorrect clinical picture of the condition of peripheral nerves and lead to untimely diagnosis and treatment of chronic pain syndrome, complex regional pain syndrome. Improvements in diagnostic methods, as well as widely introduced high-tech examination methods, in particular electroneuromyography, magnetic resonance imaging and ultrasound, are helping to increase the frequency of detection of abnormalities in the structure of peripheral nerves. In the presented clinical cases, patients had structural variants that gave an incorrect clinical picture of the condition of the peripheral nerves and led to untimely diagnosis and treatment — the development of chronic pain syndrome.

关键词

chronic pain, CRPS, ENMG, interneural anastomoses, traumatic neuropathy, ultrasound, variants of nerve structure

全文:

M.D., D.Sc. (Medicine), Professor, Deputy Head of the Department and Clinic of Nervous Diseases

俄罗斯联邦, Saint Petersburg

参考

Mos M, Bruijn AGJ, Huygen FJPM., et al. The incidence of complex regional pain syndrome: a population-based study. Pain. 2007;129(1–2): 12–20. doi: 10.1016/j.pain.2006.09.008
Taha R, Blaise GA. Update on the pathogenesis of complex regional pain syndrome: role of oxidative stress. Can J Anaesth. 2012;59(9):875–881. doi: 10.1007/s12630-012-9748-y
Ott S, Maihöfner C. Signs and symptoms in 1,043 patients with complex regional pain syndrome. J Pain. 2018;19(6):599–611. doi: 10.1016/j.jpain.2018.01.004
Russo M, Georgius P, Santarelli DM. A new hypothesis for the pathophysiology of complex regional pain syndrome. Med Hypotheses. 2018;119:41–53. doi: 10.1016/j.mehy.2018.07.026
Kostopoulos VK, Davis CL, Terzis JK. Effects of acetylo-L-carnitine in end-to-side neurorrhaphy: a pilot study. Microsurgery. 2009;29(6):456–463. doi: 10.1002/micr.20639
Sádaba MC, Martín-Estal I, Puche JE, Castilla-Cortázar I. Insulin-like growth factor 1 (IGF-1) therapy: Mitochondrial dysfunction and diseases. Biochim Biophys Acta. 2016;1862(7):1267–1278. doi: 10.1016/j.bbadis.2016.03.010
Tomassoni D, Di Cesare Mannelli L, Bramanti V, et al. Treatment with acetyl-L-carnitine exerts a neuroprotective effect in the sciatic nerve following loose ligation: a functional and microanatomical study. Neural Regen Res. 2018;13(4):692–698. doi: 10.4103/1673-5374.230297
Tang Z, Cao F, Zhang H, et al. Peripheral pain is enhanced by insulin-like growth factor 1 and its receptors in a mouse model of type 2 diabetes mellitus. J Diabetes. 2019;11(4):309–315. doi: 10.1111/1753-0407.12841
Koryachkin VA. Complex regional pain syndrome. Traumatology and orthopedics of Russia. 2014(3):147–156. (In Russ.)
Harden RN, Bruehl S, Perez RS, et al. Validation of proposed diagnostic criteria (the “Budapest Criteria”) for complex regional pain syndrome. Pain. 2010;150(2):268–274. doi: 10.1016/j.pain.2010.04.030
Lawson EF, Castellanos JP, eds. Complex Regional Pain Syndrome: A Clinical Guide. Springer Cham Publisher; 2021. 348 p. eBook ISBN: 978-3-030-75373-3; DOI: 1007/978-3-030-75373-3
Shostak NA, Pravdyuk NG, Klimenko AA. Complex regional pain syndrome — clinic, diagnosis, treatment. Clinician. 2013;(1):41–46. (In Russ.)
Chang MC, Park D. Algorithm for multimodal medication therapy in patients with complex regional pain syndrome. J Yeungnam Med Sci. 2023 Jul 12. Online ahead of print. doi: 10.12701/jyms.2023.00360
Grishina DA, Suponeva NA, Pavlov EV, Savitskaya NG. Innervation anomalies: variants and typical electroneuromyographic signs. Neuromuscular diseases. 2016;6(2):10–19. (In Russ.)

补充文件

附件文件

动作

1. JATS XML

下载

2. Fig. 1. Treatment tactics for CRPS with modifications [11]

下载 (304KB)

索引源数据

3. Fig. 2. a — ultrasound of the median nerve at the level of the entrance to the carpal tunnel (transverse scanning); b — Ultrasound of the right median nerve with transverse scanning of the median nerve in the carpal tunnel

下载 (165KB)

索引源数据

4. Fig. 3. a — Appearance of the left hand; b — ENMG parameters of electrical impulse conduction along the superficial radial nerve (within the age norm)

下载 (159KB)

索引源数据

5. Fig. 4. Patient B; a — magnetic resonance imaging (MRI) of the hands; b — MRI of the left hand: two portions of the median nerve are highlighted in yellow

下载 (115KB)

索引源数据

用户名
密码
记住我

忘记您的密码?	注册

用户名
密码
记住我

忘记您的密码?	注册