Acta anaesthesiologica Scandinavica
-
Acta Anaesthesiol Scand · Jul 2015
ReviewComplex regional pain syndrome type I: a comprehensive review.
Complex regional pain syndrome type I (CRPS I), formerly known as reflex sympathetic dystrophy (RSD), is a chronic painful disorder that usually develops after a minor injury to a limb. This topical review gives a synopsis of CRPS I and discusses the current concepts of our understanding of CRPS I in adults, the diagnosis, and treatment options based on the limited evidence found in medical literature. CRPS I is a multifactorial disorder. Possible pathophysiological mechanisms of CRPS I are classic and neurogenic inflammation, and maladaptive neuroplasticity. At the level of the central nervous system, it has been suggested that an increased input from peripheral nociceptors alters the central processing mechanisms. ⋯ The pharmacological treatment of CRPS I is empirical and insufficiently effective. Further research is needed regarding the therapeutic modalities discussed in the guidelines. Physical therapy is widely recommended as a first-line treatment. The efficacy of local anesthetic sympathetic blockade as treatment for CRPS I is questionable.
-
Acta Anaesthesiol Scand · Jul 2015
Randomized Controlled TrialHyperbaric oxygen therapy attenuates central sensitization induced by a thermal injury in humans.
Hyperbaric oxygen (HBO2 ) treatment has in animal experiments demonstrated antinociceptive effects. It was hypothesized that these effects would attenuate secondary hyperalgesia areas (SHAs), an expression of central sensitization, after a first-degree thermal injury in humans. ⋯ The results indicate that HBO2 therapy in humans attenuates central sensitization induced by a thermal skin injury, compared with control. These new and original findings in humans corroborate animal experimental data. The thermal injury model may give impetus to future human neurophysiological studies exploring the central effects of hyperbaric oxygen treatment.
-
Acta Anaesthesiol Scand · Jul 2015
Cognitive testing with the Post-Operative Quality of Recovery Scale in pre-surgery cancer patients - a controlled study.
Post-Operative Quality of Recovery Scale (PQRS) has been revised to allow for the normal variation in cognitive performance seen in healthy volunteers. This modification could result in exclusion of test subjects because of poor baseline performance. Our aim was to investigate the impact of severe disease and waiting for cancer surgery on PQRS baseline cognitive performance and exclusion rate, and also on variation in cognitive performance at test re-test. ⋯ Women with breast cancer waiting for surgery expressed a higher level of emotional distress, performed lower at baseline but showed no difference in test re-test variability in cognitive performance according to the PQRS when compared with controls. The considerable exclusion rate among patients waiting for cancer surgery should be acknowledged.