Kompleks Bölgesel Ağrı Sendromunda Fizyoterapi ve Rehabilitasyon
Özet
Kompleks bölgesel ağrı sendromu (KBAS), kronik seyirli, inflamatuar yanıt ve otonom disfonksiyonla karakterize bir hastalıktır. Bu sendromun en belirgin özelliklerinden biri sempatik hiperaktivasyona bağlı gelişen otonom disfonksiyondur ve bu durum ağrı yönetiminin tedavi prognozundaki önemini artırır. Yıllık KBAS prevalansı yüz binde 5.46–26.2 arasında değişmekte olup kadınlarda üç kat daha sık görülür; en sık 46–53 yaş aralığında ortaya çıkar. KBAS’ın patofizyolojisi tam olarak aydınlatılamamış olup mevcut teoriler ağrının ısrarcı doğasına odaklanmaktadır. Literatürde farmakolojik ajanlardan nöraksiyal tedavilere, spinal kord ve dorsal kök ganglion stimülasyonundan sempatik blokajlara kadar çok sayıda tedavi seçeneği bildirilmiştir. Fizyoterapi, iş uğraşı terapisi, TENS ve ayna terapisi KBAS tedavisinde en sık tartışılan konservatif yöntemlerdir. Germe ve güçlendirme egzersizleri, ödem drenajı, kontrast banyo ve termoterapi gibi uygulamalar farklı klinik serilerde yer almaktadır. Bununla birlikte, KBAS için evrensel olarak etkili bir tedavi henüz bulunmamaktadır ve fizik tedavi girişimlerinin etkinliğini destekleyen kanıtlar sınırlıdır. Tüm kısıtlılıklara rağmen fizyoterapi, multidisipliner yaklaşımlarla beraber uygulandığında bu sendromda yararlı bir tamamlayıcı tedavi seçeneği olarak değerlendirilmektedir.
Referanslar
Giostri GS, Souza CDA. Síndrome da dor complexa regional. Revista Brasileira de Ortopedia. 2024;59:497-503.
Harden RN, McCabe CS, Goebel A, Massey M, Suvar T, Grieve S, et al. Complex regional pain syndrome: practical diagnostic and treatment guidelines. Pain medicine. 2022;23(Supplement_1):S1-S53.
Nagasako EM, Oaklander AL, Dworkin RH. Congenital insensitivity to pain: an update. Pain. 2003;101(3):213-9.
Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain. 2020;161(9):1976-82.
Çalι A, Özden AV, Ceylan İ. Effects of a single session of noninvasive auricular vagus nerve stimulation on sports performance in elite athletes: an open-label randomized controlled trial. Expert Review of Medical Devices. 2024;21(3):231-7.
Kubale V. Laocoön and His Sons. 2015.
Chang C, McDonnell P, Gershwin ME. Complex regional pain syndrome–false hopes and miscommunications. Autoimmunity reviews. 2019;18(3):270-8.
Duong S, Bravo D, Todd KJ, Finlayson RJ, Tran DQ. Treatment of complex regional pain syndrome: an updated systematic review and narrative synthesis. Canadian Journal of Anesthesia/Journal canadien d'anesthésie. 2018;65(6):658-84.
Urits I, Shen AH, Jones MR, Viswanath O, Kaye AD. Complex regional pain syndrome, current concepts and treatment options. Current pain and headache reports. 2018;22(2):10.
Shim H, Rose J, Halle S, Shekane P. Complex regional pain syndrome: a narrative review for the practising clinician. British journal of anaesthesia. 2019;123(2):e424-e33.
Bruehl S. Complex regional pain syndrome. Bmj. 2015;351.
Green DP. Operative hand surgery. Operative hand surgery1988. p. xxv, 811-xxv, .
Sousa LHA, Costa CdO, Novak EM, Giostri GS. Complex regional pain syndrome after carpal tunnel syndrome surgery: A systematic review. Neurology India. 2022;70(2):491-503.
Neumeister MW, Romanelli MR. Complex regional pain syndrome. Clinics in plastic surgery. 2020;47(2):305-10.
Vittersø AD, Halicka M, Buckingham G, Proulx MJ, Bultitude JH. The sensorimotor theory of pathological pain revisited. Neuroscience & Biobehavioral Reviews. 2022;139:104735.
Patterson RW, Li Z, Smith BP, Smith TL, Koman LA. Complex regional pain syndrome of the upper extremity. The Journal of hand surgery. 2011;36(9):1553-62.
Weissmann R, Uziel Y. Pediatric complex regional pain syndrome: a review. Pediatric Rheumatology. 2016;14(1):29.
Del Piñal F. Outcomes of carpal tunnel release in complex regional pain syndrome/reflex sympathetic dystrophy/Sudeck disease patients. Plastic and Reconstructive Surgery. 2022;150(1):93-101.
Bilgili A, Çakır T, Doğan ŞK, Erçalık T, Filiz MB, Toraman F. The effectiveness of transcutaneous electrical nerve stimulation in the management of patients with complex regional pain syndrome: a randomized, double-blinded, placebo-controlled prospective study. Journal of back and musculoskeletal rehabilitation. 2016;29(4):661-71.
Barnhoorn KJ, van de Meent H, van Dongen RT, Klomp FP, Groenewoud H, Samwel H, et al. Pain exposure physical therapy (PEPT) compared to conventional treatment in complex regional pain syndrome type 1: a randomised controlled trial. BMJ open. 2015;5(12):e008283.
Oerlemans HM, Oostendorp RA, de Boo T, van der Laan L, Severens JL, Goris RJA. Adjuvant physical therapy versus occupational therapy in patients with reflex sympathetic dystrophy/complex regional pain syndrome type I. Archives of physical medicine and rehabilitation. 2000;81(1):49-56.
Tran DQ, Duong S, Bertini P, Finlayson RJ. Treatment of complex regional pain syndrome: a review of the evidence. Canadian Journal of Anesthesia/Journal canadien d'anesthésie. 2010;57(2):149-66.
Moseley GL. Is successful rehabilitation of complex regional pain syndrome due to sustained attention to the affected limb? A randomised clinical trial. Pain. 2005;114(1-2):54-61.
Cacchio A, De Blasis E, De Blasis V, Santilli V, Spacca G. Mirror therapy in complex regional pain syndrome type 1 of the upper limb in stroke patients. Neurorehabilitation and neural repair. 2009;23(8):792-9.
Jeon B, Cho S, Lee J-H. Application of virtual body swapping to patients with complex regional pain syndrome: a pilot study. Cyberpsychology, Behavior, and Social Networking. 2014;17(6):366-70.
Topcuoglu A, Gokkaya NKO, Ucan H, Karakuş D. The effect of upper-extremity aerobic exercise on complex regional pain syndrome type I: a randomized controlled study on subacute stroke. Topics in stroke rehabilitation. 2015;22(4):253-61.
Vural SP, Yuzer GFN, Ozcan DS, Ozbudak SD, Ozgirgin N. Effects of mirror therapy in stroke patients with complex regional pain syndrome type 1: a randomized controlled study. Archives of physical medicine and rehabilitation. 2016;97(4):575-81.
Oerlemans HM, Oostendorp RA, de Boo T, Goris RJA. Pain and reduced mobility in complex regional pain syndrome I: outcome of a prospective randomised controlled clinical trial of adjuvant physical therapy versus occupational therapy. Pain. 1999;83(1):77-83.
Crombez G, Vlaeyen JW, Heuts PH, Lysens R. Pain-related fear is more disabling than pain itself: evidence on the role of pain-related fear in chronic back pain disability. Pain. 1999;80(1-2):329-39.
Vlaeyen J, Crombez G. Fear of movement/(re) injury, avoidance and pain disability in chronic low back pain patients. Manual therapy. 1999;4(4):187-95.
Eccleston C, Crombez G, Aldrich S, Stannard C. Worry and chronic pain patients: a description and analysis of individual differences. European Journal of Pain. 2001;5(3):309-18.
Stutts JT, Kasdan ML, Hickey SE, Bruner A. Reflex sympathetic dystrophy: misdiagnosis in patients with dysfunctional postures of the upper extremity. The Journal of hand surgery. 2000;25(6):1152-6.
Thacker M, Gifford L. A review of physiotherapy management of complex regional pain syndrome. Topical issues in pain. 2013;3:119-41.
