Vom M. Sudeck zum komplexregionalen Schmerzsyndrom

 

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Zusammenfassung

Nach Extremitätentraumata, Läsionen peripherer Nerven oder des zentralen Nervensystems und selten spontan kann es zum Auftreten von charakteristischen Symptomkonstellationen eines komplex-regionalen Schmerzsyndroms (CRPS) kommen. Diese bestehen aus motorischen, sensiblen sowie autonomen Störungen. Nachdem dieser Symptomkomplex in der Vergangenheit mit wechselnden Bezeichnungen (z. B. M. Sudeck, Kausalgie, sympathische Reflexdystrophie) belegt wurde, lautet die von der International Association for the Study of Pain vorgeschlagene und aktuell verwendete Bezeichnung „komplexregionales Schmerzsyndrom“ (complex regional pain syndrome, CRPS). Aufgrund pathophysiologischer Gesichtspunkte erscheint eine Einteilung in Abhängigkeit der Hauttemperatur prinzipiell sinnvoller (primär warmes oder primär kaltes CRPS) als eine Einteilung in Typ I und II, der die Abwesenheit oder das Vorliegen einer einzelnen und eindeutigen peripheren Nervenläsion zugrunde liegt. Eine frühzeitige Diagnosestellung und Beginn einer auf die Symptomatik individuell abgestimmten Therapie unter Einbeziehung nicht medikamentöser und medikamentöser Therapieverfahren sind wichtig, um eine Chronifizierung zu vermeiden und die Funktion der betroffenen Extremität zu erhalten oder wieder herzustellen.

Summary

Sometimes a characteristic constellation of symptoms can be observed following limb trauma, lesions of nerves, central nervous system damage, or even spontaneously. These consist of motor, sensory, and autonomic disturbances. Several terms had been used in the past for these symptoms (e. g. causalgia, sympathetic reflex dystrophy), now, the denomination complex regional pain syndrome (CRPS) has been introduced by the International Association for the Study of Pain. A classification by the initial skin temperature (primary warm or primary cold CRPS) seems more appropriate than the classification as type I or II, depending on the absence or presence of a nerve lesion. Early diagnosis and initiation of an individualized multi-disciplinary therapy with non-medical and medical strategies is essential to avoid chronification of pain and to restore function of the affected extremity.

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