Complex regional pain syndrome.

INTRODUCTION: Complex regional pain syndrome (CRPS) is a chronic pain condition that can occur after a minor trauma or surgery. It is a multifactorial condition with a complex cause and even more complex pathophysiology. There are disturbances and changes in the sympathetic, somatosensory and motor nervous system, resulting in severe pain and disability. Patients with CRPS can have their quality of life and functional ability greatly affected and they need appropriate and interdisciplinary interventions. PURPOSE: This article contributes towards an up-to-date knowledge and an overall view of CRPS, which can contribute to a structured and systematic rehabilitation process for patients. IMPLICATIONS: This Masterclass describes a functional restoration algorithm to assist therapists in the development of a treatment plan based on the available evidence and international guidelines. Early diagnosis and treatment is of great importance as patients (adults and children), can be severely affected in their functional capacity and quality of life.

The role of neuroplasticity in experimental neck pain: a study of potential mechanisms impeding clinical outcomes of training.

Training is a mainstay in the clinical management of neck pain, yet, effects of various training protocols are only small to moderate and improvements are required. Previous investigations of the nervous system indicate a correlation between neuroplastic adaptation to training and functional recovery. The interaction between neck pain and training thus needs further exploration. This was a randomized experimental study of the effects of experimental neck pain and training on corticomotor excitability. Healthy volunteers were randomized to training and experimental neck pain, training and no pain, and pain and no training. Primary endpoints were corticomotor excitability assessed by transcranial magnetic stimulation and electromyography measured as changes in amplitudes and latencies of motor evoked potentials (MEPs), recorded at baseline and after 30 min, 1 h, and 1 week. Additionally, correlations between changes in MEPs and motor learning, effects of pain and concomitant neck training on pain, muscle strength, and fatigue were investigated. Data were analyzed by repeated measurement ANOVA, paired t tests, Grubbs' outlier test and correlation coefficients. Results indicated that neck pain and training significantly enhanced the inhibition of the amplitudes of the MEPs for 1 week. The results indicate that moderate neck pain and training induce long-lasting inhibition of the corticomotor pathways. This inhibition may limit the outcome of neck training in painful conditions in contrast to pain-free training conditions.

Specific neck training induces sustained corticomotor hyperexcitability as assessed by motor evoked potentials.

STUDY DESIGN: Experimental investigation of short-term and long-term corticomotor effects of specific neck training, coordination training, and no training. OBJECTIVE: To determine the effects of different training programs on the motor neurons controlling the neck muscles as well as the effects of training on muscle strength and muscle fatigue, and the correlations between corticomotor control and motor learning. SUMMARY OF BACKGROUND DATA: Training is usually recommended for unspecific neck pain and consists of neck and upper body coordination, strengthening, and endurance exercises. However, it is unclear which type of training is the most effective. No studies have previously investigated the neural effect of neck training and the possible differential effect of specific versus coordination training on corticomotor control. METHODS: Transcranial magnetic stimulation and electromyography were used to elicit and monitor motor evoked potentials (MEPs) from the trapezius and thumb muscles before and 30 minutes, 1 hour, and 7 days after training. Parameters measured were MEP amplitude, MEP latency, strength, learning effects, and muscle fatigue. RESULTS: Only specific neck training yielded a 67% increase in MEP amplitudes for up to 7 days after training compared with baseline (P < 0.001). No significant changes were seen after coordination training, no training, and in the within-subject control muscle. The mean muscle strength increased immediately after specific neck training from 56.6 to 61 kg (P < 0.001). No subjective or objective measures of fatigue were observed. CONCLUSION: Specific neck training induced a sustained hyperexcitability of motor neurons controlling the neck muscles compared with coordination training and controls. These findings may prove valuable in the process of developing more effective clinical training programs for unspecific neck pain.

[Treatment of whiplash-associated disorders]. / Behandling af gener efter whiplash.

Treatment of whiplash-associated disorders starts with a thorough clinical examination, which may be repeated after 1-3 weeks. For optimal results it is essential that the patient receives clear information about the condition and that any pain is treated effectively with analgesics. Risk factors for persistent symptoms can often be identified early and should be addressed adequately. If symptoms persist and conservative treatments are chosen, these should be active and they should focus on sustaining or regaining usual activities.