Abstract
Objectives: The precise causes of Complex Regional Pain Syndrome (CRPS) are as yet not well known. Some consider CRPS type 1 without apparent nerve injury to arise due to a prolonged inflammatory state after initial trauma and its underlying pathophysiology indicates Nociceptive/Inflammatory Pain (NocP) components. Yet others have shown clear direct evidence of nerve injury in CRPS type 1-affected limbs, and they consider CRPS type 1to be Neuropathic Pain (NeP). The McGill Pain Questionnaire (MPQ) has the potential to diagnose pain disorders as well as suggest the underlying pathophysiology. Methods: We investigated pain characteristics of 165 NeP and 66 NocP patients, by using the 78 words of the MPQ, and thereby developed a discriminant function which efficiently discriminates NocP from NeP. We then applied this function to 36 CRPS type 1 patients’ complaints and classified their pain into either NocP or NeP. Results: The discriminant probability of the function was 81.0% (chi-square, p=0.24) and this function revealed 47.2% of CRPS type 1 patients’ complaints were classified as NocP and 52.8% as NeP. These subgroups showed almost comparable demographic data. Considerations: Our results indicate that CRPS type 1 cannot be classified as NeP or NocP dichotomously according to pain descriptions. This raises the possibility that CRPS type 1 represents a “mixed” pain mechanism comprised of both NeP and NocP.
Highlights
Considerations: Our results indicate that Complex Regional Pain Syndrome (CRPS) type 1 cannot be classified as Neuropathic Pain (NeP) or Nociceptive/Inflammatory Pain (NocP) dichotomously according to pain descriptions
Some researchers have suggested that CRPS type 1 is nociceptive and inflammatory pain, based on the following concepts and observations: the axonal reflex and retrograde secretion of neurotransmitters from peripheral nerve endings into peripheral tissues can induce dilation and hyper permeability of small vessels, resulting in skin erythema, edema and temperature elevation, and peripheral nerve sensitization results in allodynia, hyperalgesia and severe pain inappropriate to the initiating event [11]
Other researchers have suggested that CRPS type 1 is neuropathic pain based on direct evidence of nerve injury
Summary
To understand another people’s pai, we must accurately interpret what others say or show by their behaviors. The MPQ consists of 78 pain descriptors, which are classified into 20 sub-groups. The 20 sub-groups can be scored and assessed in view of four major dimensions of pain: sensory, affective, evaluative and miscellaneous pain. Some investigations have suggested that the MPQ is clinically useful for diagnosing the pain complaints of patients on the basis of the nature of their pain descriptions [2,3,4]. The nature of pain is useful for suggesting underlying the pathophysiological mechanism(s), and the MPQ has the potential to diagnose pain disorders and reveal the causative pathophysiology
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