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BMC Musculoskeletal Disorders

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Open Access 01-12-2022 | Complex Regional Pain Syndrome | Research

Determinants of complex regional pain syndrome type I in patients with scaphoid waist fracture- a multicenter prospective observational study

Authors: Hao Gong, Gang Zhao, Yuzhou Liu, Zhengfeng Lu

Published in: BMC Musculoskeletal Disorders | Issue 1/2022

Abstract

Background

The aim of this prospective study was to assess the incidence of complex regional pain syndrome type I (CRPS I) in patients with scaphoid waist fracture and to explore associated factors.

Methods

This was a multicenter, prospective observational study. Demographic, imaging indicators and clinical data were collected before the conservative treatment of scaphoid waist fracture patients. The occurrence of CRPS I and pain condition were the main outcomes. To explore the factors associated with CRPS I, multivariate logistic regression model was used.

Results

A total of 493 scaphoid waist fracture participants undergoing conservative treatment were recruited for this study. The incidence of CRPS I was 20% (n = 87). The average time between injury and the onset of CRPS I was 6.7 ± 2.1 weeks. Multivariable logistic regression analysis revealed that female sex (odds ratio (OR): 1.669; 95% confidence interval (CI): 1.189–2.338), diabetes mellitus (OR: 3.206; 95% CI: 2.284–4.492), and severe pain condition before treatment (visual analog scale (VAS) score more than 4 cm) (OR: 27.966; 95% CI: 19.924–39.187) were independently associated with CRPS I.

Conclusions

Patients suffering from scaphoid waist fracture may be at a higher risk of CRPS I, especially in women with diabetes mellitus who report severe pain before treatment. Early screening and regular follow up evaluation are recommended in these patients.

de Mos M, de Bruijn AGJ, Huygen FJPM, Dieleman JP, Stricker BHC, Sturkenboom MCJM. The incidence of complex regional pain syndrome: a population-based study. Pain. 2007;129(1–2):12–20. https://doi.org/10.1016/j.pain.2006.09.008.CrossRefPubMed

Sandroni P, Benrud-Larson LM, McClelland RL, Low PA. Complex regional pain syndrome type I: incidence and prevalence in Olmsted county, a population-based study. Pain. 2003;103(1–2):199–207. https://doi.org/10.1016/s0304-3959(03)00065-4.CrossRefPubMed

de Mos M, Sturkenboom MCJM, Huygen FJPM. Current understandings on complex regional pain syndrome. Pain Pract. 2009;9(2):86–99. https://doi.org/10.1111/j.1533-2500.2009.00262.x.CrossRefPubMed

Iolascon G, de Sire A, Moretti A, Gimigliano F. Complex regional pain syndrome (CRPS) type I: historical perspective and critical issues. Clin Cases Miner Bone Metab. 2015;12(Suppl:1. https://doi.org/10.11138/ccmbm/2015.12.3s.004.CrossRef

Varenna M, Crotti C, Ughi N, Zucchi F, Caporali R. Determinants of diagnostic delay in complex regional pain syndrome type 1: an observational study of 180 consecutive new cases. J Clin Rheumatol. 2020. https://doi.org/10.1097/RHU.0000000000001558.

Moretti A, Palomba A, Paoletta M, Liguori S, Toro G, Iolascon G. Complex regional pain syndrome in athletes: scoping review. Medicina. 2021;57(11):1262. https://doi.org/10.3390/medicina57111262.CrossRefPubMedPubMedCentral

Iolascon G, Moretti A. Pharmacotherapeutic options for complex regional pain syndrome. Expert Opin Pharmacother. 2019;20(11):1377–86. https://doi.org/10.1080/14656566.2019.1612367.CrossRefPubMed

Israel D, Delclaux S, André A, Apredoaei C, Rongières M, Bonnevialle P, et al. Peri-lunate dislocation and fracture-dislocation of the wrist: retrospective evaluation of 65 cases. Orthop Traumatol Surg Res. 2016;102(3):351–5. https://doi.org/10.1016/j.otsr.2016.01.004.CrossRefPubMed

Beltsios M, Savvidou OD, Kovanis J, Alexandropoulos P, Mitsiokapa EA, Mavrogenis AF, et al. Surgical outcome of scaphoid nonunions in heavy manual workers. J Surg Orthop Adv. 2010;19(4):209–13.PubMed

10.

Beerthuizen A, Stronks DL, Van't Spijker A, Yaksh A, Hanraets BM, Klein J, et al. Demographic and medical parameters in the development of complex regional pain syndrome type 1 (CRPS1): prospective study on 596 patients with a fracture. Pain. 2012;153(6):1187–92. https://doi.org/10.1016/j.pain.2012.01.026.CrossRefPubMed

11.

Wells ME, Nicholson TC, Macias RA, Nesti LJ, Dunn JC. Incidence of scaphoid fractures and associated injuries at US trauma centers. J Wrist Surg. 2021;10(2):123–8. https://doi.org/10.1055/s-0040-1720963.CrossRefPubMed

12.

Johnson NA, Dias R, Dias JJ. Scaphoid alignment in dorsally displaced distal radial fracture: a radiographic study. J Hand Surg Eur. 2021;46(6):600–6. https://doi.org/10.1177/1753193420983696.CrossRef

13.

Dias JJ, Wildin CJ, Bhowal B, Thompson JR. Should acute scaphoid fractures be fixed? A randomized controlled trial. J Bone Joint Surg Am. 2005;87(10):2160–8. https://doi.org/10.2106/JBJS.D.02305.CrossRefPubMed

14.

Dias JJ, Brealey SD, Fairhurst C, Amirfeyz R, Bhowal B, Blewitt N, et al. Surgery versus cast immobilisation for adults with a bicortical fracture of the scaphoid waist (SWIFFT): a pragmatic, multicentre, open-label, randomised superiority trial. Lancet. 2020;396(10248):390–401. https://doi.org/10.1016/S0140-6736(20)30931-4.CrossRefPubMed

15.

Satteson ES, Harbour PW, Koman LA, Smith BP, Li Z. The risk of pain syndrome affecting a previously non-painful limb following trauma or surgery in patients with a history of complex regional pain syndrome. Scand J Pain. 2017;14:84–8. https://doi.org/10.1016/j.sjpain.2016.10.005.CrossRefPubMed

16.

Buijze GA, Goslings JC, Rhemrev SJ, Weening AA, Van Dijkman B, Doornberg JN, et al. Cast immobilization with and without immobilization of the thumb for nondisplaced and minimally displaced scaphoid waist fractures: a multicenter, randomized, controlled trial. J Hand Surg Am. 2014;39(4):621–7. https://doi.org/10.1016/j.jhsa.2013.12.039.CrossRefPubMed

17.

Hegazy G, Alshal E, Abdelaal M, Abdelaziz M, Moawad M, Saqr YM, et al. Kirschner wire versus Herbert screw fixation for the treatment of unstable scaphoid waist fracture nonunion using corticocancellous iliac bone graft: randomized clinical trial. Int Orthop. 2020;44(11):2385–93. https://doi.org/10.1007/s00264-020-04730-7.CrossRefPubMed

18.

Harden NR, Bruehl S, Perez RSGM, Birklein F, Marinus J, Maihofner C, et al. Validation of proposed diagnostic criteria (the "Budapest criteria") for complex regional pain syndrome. Pain. 2010;150(2):268–74. https://doi.org/10.1016/j.pain.2010.04.030 Epub 2010 May 20.CrossRefPubMedPubMedCentral

19.

Beaton DE, Wright JG, Katz JN. Development of the QUICKDASH: comparison of three item-reduction approaches. J Bone Joint Surg Am. 2005;87(5):1038. https://doi.org/10.2106/JBJS.D.02060.CrossRefPubMed

20.

Gummesson C, Ward MM, Atroshi I. The shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH): validity and reliability based on responses within the full-length DASH. Bmc Musculoskelet Disord. 7(1):44–0. https://doi.org/10.1186/1471-2474-7-44.

21.

Cooney WP, Bussey R, Dobyns JH, Linscheid RL. Difficult wrist fractures. Perilunate fracture-dislocations of the wrist. Clin Orthop Relat Res. 1987;214:136–47.CrossRef

22.

Fan ZJ, Smith CK, Silverstein BA. Assessing validity of the QuickDASH and SF-12 as surveillance tools among workers with neck or upper extremity musculoskeletal disorders. J Hand Ther. 2008;21(4):354–65. https://doi.org/10.1197/j.jht.2008.02.001.CrossRefPubMed

23.

Julian LJ. Measures of anxiety: state-trait anxiety inventory (STAI), Beck anxiety inventory (BAI), and hospital anxiety and depression scale-anxiety (HADS-A). Arthritis Care Res. 2011;63(Suppl 11):S467–72. https://doi.org/10.1002/acr.20561.CrossRef

24.

van Smeden M, Moons KG, de Groot JA, Collins GS, Altman DG, Eijkemans MJ, et al. Sample size for binary logistic prediction models: beyond events per variable criteria. Stat Methods Med Res. 2019;28(8):2455–74. https://doi.org/10.1177/0962280218784726.CrossRefPubMed

25.

Ten Brink AF, Bultitude JH. Predictors of self-reported neglect-like symptoms and involuntary movements in complex regional pain syndrome compared to other chronic limb pain conditions. Pain Med. 2021;22(10):2337–49. https://doi.org/10.1093/pm/pnab226.CrossRefPubMedPubMedCentral

26.

Jellad A, Salah S, Frih BS, Z. Complex regional pain syndrome type I: incidence and risk factors in patients with fracture of the distal radius. Arch Phys Med Rehabil. 2014;95(3):487–92. https://doi.org/10.1016/j.apmr.2013.09.012.CrossRefPubMed

27.

Harden NR, Bruehl S, Stanos S, Brander V, Chung OY, Saltz S, et al. Prospective examination of pain-related and psychological predictors of CRPS-like phenomena following total knee arthroplasty: a preliminary study. Pain. 2003;106(3):393–400. https://doi.org/10.1016/j.pain.2003.08.009.CrossRefPubMed

28.

Ott S, Maihöfner C. Signs and symptoms in 1,043 patients with complex regional pain syndrome. J Pain. 2018;19(6):599–611. https://doi.org/10.1016/j.jpain.2018.01.004.CrossRefPubMed

29.

Jo Y-H, Kim K, Lee B-G, Kim J-H, Lee C-H, Lee K-H. Incidence of and risk factors for complex regional pain syndrome type 1 after surgery for distal radius fractures: a population-based study. Sci Rep. 2019;9(1):4871. https://doi.org/10.1038/s41598-019-41152-x.CrossRefPubMedPubMedCentral

30.

Elsharydah A, Loo NH, Minhajuddin A, Kandil ES. Complex regional pain syndrome type 1 predictors - epidemiological perspective from a national database analysis. J Clin Anesth. 2017;39:34–7. https://doi.org/10.1016/j.jclinane.2017.03.027.CrossRefPubMed

31.

Elsamadicy AA, Yang S, Sergesketter AR, Ashraf B, Charalambous L, Kemeny H, et al. Prevalence and cost analysis of complex regional pain syndrome (CRPS): a role for Neuromodulation. Neuromodulation. 2018;21(5):423–30. https://doi.org/10.1111/ner.12691.CrossRefPubMed

32.

Lee S-U, Na K-T, Lee Y-M, Park JH, Joo SY. Low vitamin D levels in post-menopausal women are associated with complex regional pain syndrome type I in surgically treated distal radius fractures. J Orthop Surg Res. 2020;15(1):328. https://doi.org/10.1186/s13018-020-01859-4.CrossRefPubMedPubMedCentral

33.

Yesil H, Sungur U, Akdeniz S, Gurer G, Yalcın B, Dundar U. Association between serum vitamin D levels and neuropathic pain in rheumatoid arthritis patients: a cross-sectional study. Int J Rheum Dis. 2018;21(2):431–9. https://doi.org/10.1111/1756-185X.13160.CrossRefPubMed

34.

Marshall AT, Crisp AJ. Reflex sympathetic dystrophy. Rheumatology (Oxford). 2000;39(7):692–5. https://doi.org/10.1093/rheumatology/39.7.692.CrossRef

35.

Kim RP. The musculoskeletal complications of diabetes. Curr Diab Rep. 2002;2(1):49–52. https://doi.org/10.1007/s11892-002-0057-7.CrossRefPubMed

36.

Huygen FJPM, Ramdhani N, van Toorenenbergen A, Klein J, Zijlstra FJ. Mast cells are involved in inflammatory reactions during complex regional pain syndrome type 1. Immunol Lett. 2004;91(2–3):147–54. https://doi.org/10.1016/j.imlet.2003.11.013.CrossRefPubMed

37.

Groeneweg JG, Huygen FJPM, Heijmans-Antonissen C, Niehof S, Zijlstra FJ. Increased endothelin-1 and diminished nitric oxide levels in blister fluids of patients with intermediate cold type complex regional pain syndrome type 1. BMC Musculoskelet Disord. 2006;7:91. https://doi.org/10.1186/1471-2474-7-91.CrossRefPubMedPubMedCentral

38.

Liu J, Zuo Q, Li Z, Chen J, Liu F. Trelagliptin ameliorates IL-1β-impaired chondrocyte function via the AMPK/SOX-9 pathway. Mol Immunol. 2021;140:70–6. https://doi.org/10.1016/j.molimm.2021.09.009.CrossRefPubMed

39.

Choi JH, Yu KP, Yoon Y-S, Kim ES, Jeon JH. Relationship between HbA1c and complex regional pain syndrome in stroke patients with type 2 diabetes mellitus. Ann Rehabil Med. 2016;40(5):779–85. https://doi.org/10.5535/arm.2016.40.5.779.CrossRefPubMedPubMedCentral

40.

Moretti A, Gimigliano F, Paoletta M, Liguori S, Toro G, Aulicino M, et al. Efficacy and effectiveness of physica1 agent moda1ities in comp1eicregiona1 pain syndrome type i a scoping review. Appl Sci. 1857;2021:11.

41.

Hastie BA, Riley JL, Robinson ME, Glover T, Campbell CM, Staud R, et al. Cluster analysis of multiple experimental pain modalities. Pain. 2005;116(3):227–37. https://doi.org/10.1016/j.pain.2005.04.016.CrossRefPubMed

42.

Perez RS, Zollinger PE, Dijkstra PU, Thomassen-Hilgersom IL, Zuurmond WW, Rosenbrand KC, et al. Evidence based guidelines for complex regional pain syndrome type 1. BMC Neurol. 2010;10:20. https://doi.org/10.1186/1471-2377-10-20.CrossRefPubMedPubMedCentral

43.

Martini ML, Caridi JM, Zeldin L, Neifert SN, Nistal DA, Kim JD, et al. Perioperative outcomes of spinal cord stimulator placement in patients with complex regional pain syndrome compared with patients without complex regional pain syndrome. World Neurosurg. 2020;137:e106–17. https://doi.org/10.1016/j.wneu.2020.01.061.CrossRefPubMed

Title: Determinants of complex regional pain syndrome type I in patients with scaphoid waist fracture- a multicenter prospective observational study
Authors: Hao Gong
Gang Zhao
Yuzhou Liu
Zhengfeng Lu
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Complex Regional Pain Syndrome
Complex Regional Pain Syndrome
Diabetes
Published in: BMC Musculoskeletal Disorders / Issue 1/2022
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-021-04977-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Determinants of complex regional pain syndrome type I in patients with scaphoid waist fracture- a multicenter prospective observational study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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