Complex regional pain syndrome: evidence for warm and cold subtypes in a large prospective clinical sample
Complex regional pain syndrome: evidence for warm and cold subtypes in a large prospective clinical sample
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DOI：
10.1097/j.pain.0000000000000569
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发表时间：
2016-08-01
期刊：
影响因子：
7.4
通讯作者：
Harden, R. Norman
中科院分区：
文献类型：
--
作者：
Bruehl, Stephen;Maihoefner, Christian;Harden, R. Norman
有限的研究表明，可能有温暖复杂的区域疼痛综合征（CRPS）和冷CRPS亚型，炎症机制对前者的贡献最大。这项研究首次使用无偏统计模式识别技术来评估是否可以在临床人群中识别出不同的温型与冷型CRPS亚型。采用标准化程序进行了一项国际多中心研究，以评估基线时152例临床CRPS患者的体征和症状，并对其中112例患者进行了3个月的随访评估。使用自动聚类选择的两步聚类分析将2聚类解决方案确定为最佳。结果显示，一个温暖的CRPS患者集群的特点是温暖，红色，水肿，和出汗的肢体和冷CRPS患者集群的特点是冷，蓝色，水肿较少的肢体。中位疼痛持续时间在温暖CRPS（4.7个月）中显著（P < 0.001）短于冷CRPS亚型（20个月），疼痛强度相当。在基线时，温CRPS组（与冷CRPS组相比）的总炎症评分显著升高（P < 0.001），但在随访期间显著降低（P < 0.001），而冷CRPS组的该评分没有降低（时间X亚型相互作用：P < 0.001）。结果支持存在一种常见于急性（
Limited research suggests that there may be Warm complex regional pain syndrome (CRPS) and Cold CRPS subtypes, with inflammatory mechanisms contributing most strongly to the former. This study for the first time used an unbiased statistical pattern recognition technique to evaluate whether distinct Warm vs Cold CRPS subtypes can be discerned in the clinical population. An international, multisite study was conducted using standardized procedures to evaluate signs and symptoms in 152 patients with clinical CRPS at baseline, with 3-month follow-up evaluations in 112 of these patients. Two-step cluster analysis using automated cluster selection identified a 2-cluster solution as optimal. Results revealed a Warm CRPS patient cluster characterized by a warm, red, edematous, and sweaty extremity and a Cold CRPS patient cluster characterized by a cold, blue, and less edematous extremity. Median pain duration was significantly (P < 0.001) shorter in the Warm CRPS (4.7 months) than in the Cold CRPS subtype (20 months), with pain intensity comparable. A derived total inflammatory score was significantly (P < 0.001) elevated in the Warm CRPS group (compared with Cold CRPS) at baseline but diminished significantly (P < 0.001) over the follow-up period, whereas this score did not diminish in the Cold CRPS group (time X subtype interaction: P < 0.001). Results support the existence of a Warm CRPS subtype common in patients with acute (