Year 2019 / Volume 26 / Number 1

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Effects of multimodal treatment in patients with complex regional pain syndrome type 1 with, at least, 6 months of evolution: a descriptive study

Rev. Soc. Esp. Dolor. 2019; 26(1): 6-13 / DOI: 10.20986/resed.2018.3651/2018

Andrea Daniela Tabach Apraiz, María Lorena Oyanadel Maldonado, Hector Gutierrez Espinoza, Daniel Bueno Buker


ABSTRACT

Objectives: The main objective of this work is to describe the changes in pain after a multimodal treatment scheme in patients with Complex Regional Pain Syndrome type 1 (CRPS 1), with more than 6 months of evolution, who enter treatment at the Physical Medicine and Rehabilitation Service of the San Borja Arriarán Clinical Hospital.
Material and method: Series of cases of patients with suspicion or diagnosis of CRPS 1 who were admitted for management to the Non-Oncological Chronic Pain Unit, who underwent pain assessments through the Visual Analogue Scale (VAS) and the Chronic Pain Grade Questionnaire, functionality of the upper extremity (UE) with Quick DASH and the Lower Extremity Functional Scale Functional Scale for lower extremities (LE), at the time of admission and in follow-up after two months of multimodal management by an interdisciplinary team.
Results: The sample consisted of 14 patients, 6 had a compromise of UE and 8 of LE, in a greater percentage of women, with an average time for the diagnosis of 14.6 months and average time of evolution at the time of admission of 19.8 months. After the treatment, the VAS showed a statistically and clinically signifi cant decrease (2.2 cm with a DS of 2.1 [p = 0.0018]). The variable Quick DASH showed a reduction of 20.5 points with a DS of 20.2 (p = 0.0558) and the variable LEFS an increase of 13.9 points with a DS of 20.8 (p = 0.1008), both differences are not statistically significant but both with Minimal Clinically Important Difference relevant. Moderate correlation was demonstrated but it is not statistically signifi cant between the time of evolution and the intensity of the pain presented by the patients prior to the start of the multimodal treatment.
Conclusions: The multimodal interventions guided by Physiatrist in an interdisciplinary team in the management of the CRPS allowed to demonstrate, after a period of follow-up, clinically signifi cant changes in pain reduction and improvement in functionality, with a decrease also in aspects of associated disability.



RESUMEN

Objetivos: El objetivo principal del presente trabajo es describir los cambios en el dolor posterior a esquema de tratamiento multimodal en pacientes con síndrome de dolor regional complejo tipo 1 (SDRC 1), con más de seis meses de evolución, que ingresan a control en Servicio de Medicina Física y Rehabilitación del Hospital Clínico San Borja Arriarán.
Material y método: Series de casos de pacientes con sospecha o diagnóstico de SDRC 1 que ingresan para manejo a la Unidad de Dolor Crónico no Oncológico (UCDNO), a los se les realizaron evaluaciones de dolor a través de la Escala Visual Analógica (EVA) y del Cuestionario para la Graduación del Dolor Crónico, funcionalidad de la extremidad superior (EESS) con Quick DASH y la Escala Funcional de la Extremidad Inferior (Lower Extremity Functional Scale [LEFS]) para extremidades inferiores (EEII), al momento del ingreso y en seguimiento a los dos meses de manejo multimodal por equipo interdisciplinario.
Resultados: La muestra se compuso de 14 pacientes: 6 tuvieron compromiso de EESS y 8 de
EEII, en mayor porcentaje fue de mujeres, con un tiempo promedio para el diagnóstico de 14,6 meses y tiempo promedio de evolución al momento del ingreso de 19,8 meses. Posterior al tratamiento la EVA mostró una disminución estadística y clínicamente signifi cativa (2,2 cm con una DS de 2,1 [p = 0,0018]). La variable Quick DASH mostró una reducción de 20,5 puntos con una DS de 20,2 (p = 0,0558) y la variable LEFS un incremento de 13,9 puntos con una DS de 20,8 (p = 0,1008), ambas diferencias no son estadísticamente signifi cativas pero ambas con diferencias clínicas mínimamente importantes relevantes. Se demostró correlación moderada pero que no es estadísticamente signifi cativa entre el tiempo de evolución y la intensidad del dolor que presentan los pacientes al momento de la primera evaluación.
Conclusiones: Las intervenciones multimodales guiadas por Fisiatra en un equipo interdisciplinario en el manejo del SDRC permitieron demostrar, después de un periodo de seguimiento, cambios clínicamente signifi cativos en disminución del dolor y mejoría en funcionalidad, con disminución
también en aspectos de discapacidad asociada.


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Instrucciones para citar

Tabach Apraiz A, Oyanadel Maldonado M, Gutierrez Espinoza H, Bueno Buker D. Effects of multimodal treatment in patients with complex regional pain syndrome type 1 with, at least, 6 months of evolution: a descriptive study. Rev Soc Esp Dolor 2019; 26(1): 6-13 / DOI: 1020986/resed20183651/2018


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Recibido: 12/01/2018

Aceptado: 09/02/2018

Prepublicado: 02/04/2018

Publicado: 07/03/2019

Tiempo de revisión del artículo: 22 días

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