CRPS SIG Newsletter

chris@csa.co.za
By chris@csa.co.za August 16, 2019 06:19
CRPS SIG Newsletter 3

CRPS SIG Officers

Chair: Andreas Goebel

Chair-Elect: Frank Birklein and Janne Gierthmühlen

Past Chair: Candy McCabe

Secretary/Treasurer: Jenny Lewis

Scientific Committee: Lone Knudsen Scientific Committee: Frank Huygen, Norman Harden, Anne Louise Oaklander, Sumitani Masahiko

Communications Liaison: Amanda Stone

Newsletter: Lone Knudsen

Complex Regional Pain Syndrome SIG

 

July 2019 Newsletter

Dear SIG Members,

First, we would like to introduce to you the recently developed logo of the CRPS-SIG. The logo was developed based on input from the SIG-board and members of the Scientific Committee under the CRPS-SIG. The CRPS-SIG changed its name from ‘Pain and Sympathetic Nervous System (PSNS)’ to ‘Complex Regional Pain Syndrome (CRPS)’ a few years ago, and the board felt it was time we have a logo to go with the new name. We hope you like it.

 

CRPS SIG Newsletter 4

2018 CRPS Satellite Symposium

Satellite Symposium: The Cascade from Tissue Injury to CRPS: Beyond ‘Chronification’?, 11 September 2018, Boston, USA

This symposium was held as a joint conference between the CRPS-SIG and the Acute Pain-SIG leading up to the 2018 IASP World Congress on Pain in Boston. The symposium consisted of joint morning sessions and separate SIG afternoon sessions. The aim was to look at the development of CRPS from the acute setting where combining the knowledge of researchers and clinicians from both SIGs might be of benefit. The symposium was well-attended, and there were many fruitful discussions. A number of presentations from the satellite symposium are uploaded on the CRPS SIG Groupsite through IASP and are freely available for all members. Simply login to your IASP account and click on CRPS under “My Group Memberships” to access the Groupsite.

2018 SIG Poster Prizes

CRPS-SIG Poster Prizes awarded for the best poster abstracts on CRPS during the 2018 IASP World Congress on Pain, Boston, USA

When submitting poster abstracts to the 2018 IASP World Congress, submitters had the option of choosing to have their abstract evaluated for best poster abstract on CRPS.

The first prize went to Ms. Ulku Cuhadar from King’s College London, UK. She was awarded a cheque of 200 USD from the CRPS-SIG. Her poster was titled: ‘Passive Transfer of CRPS Pain from Patient to Mouse.’

The second prize of 100 USD was awarded to Lieve Filbrich from Université Catholique de Louvain, Belgium for the poster abstract titled: ‘Visuospatial Biases in Complex Regional Pain Syndrome: Disentangling the Role of Visual vs. Proprioceptive Input.’

Both recipients delivered a 5 minute presentation of their work during the CRPS-SIG business meeting held during the IASP Congress.

The aim of awarding poster prizes was to encourage researchers to conduct and disseminate their work on CRPS. Using an anonymous process, members of the Scientific Committee under the CRPS-SIG evaluated the poster abstracts based on the following criteria: Clarity, originality, scientific merit/clinical merit, methodology, and analysis of the work. Each poster abstract was reviewed independently by two members of the Scientific Committee. A total of 19 abstracts on CRPS underwent review.

2018 Elections

Election Results – 2018

Chair-Elect: Prof. Frank Birklein, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Germany jointly with Dr. Janne Gierthmühlen, Universitätsklinikum Schleswig-Holstein, Kiel, Germany.

 

CRPS at EFIC 2019

The 11th Congress of the European Pain Federation EFIC, 4-7 September 2019, Valencia, Spain

If you are going to EFIC, make sure you attend the workshop on CRPS: ‘New Aspects of Complex Regional Pain Syndrome’ on 5 September 2019 from 10.30 am-12 noon. Prof. Christian Maihöfner will talk about signs and symptoms in CRPS and the complexity of this heterogenous disease, Dr. Andreas Goebel will talk about inflammation and autoimmunity in CRPS, and Prof. Frank Huygen will talk about treatment of CRPS.

Diagnostically relevant subgroups

A group of 17 researchers, clinicians and patient ambassadors from different countries will be meeting over two days leading up to the 2019 EFIC Congress in Valencia to discuss the CRPS diagnostic criteria and how future research may determine and investigate diagnostically relevant subgroups. Participation in the group meeting is by invitation only.

CRPS Standards of Care

CRPS Standards of Care Meeting in Europe

A group of CRPS experts held virtual meetings and discussions, and one face to face meeting in Bergamo, Italy in 2017, and produced a set of standards for the care of patients with CRPS. They defined these standards as ‘minimally acceptable levels of care’, for consideration of adoption for patients with CRPS across the diverse healthcare systems and economies within Europe. A set of 17 standards in eight areas: diagnosis, multidisciplinarity, assessment, care pathways, information and education, pain management, physical rehabilitation and distress management were derived, which were considered achievable for most countries, and aspirational for a minority, dependent on their healthcare structures and resources. The authors stress that these standards are open to change and should be reviewed regularly. Read the full manuscript.

CRPS Globally

CRPS Around the Globe

One of the areas the board of the CRPS-SIG wants to look closer at is the diagnosis and management of CRPS globally. Most of the research conducted and published so far has been from only a few countries as are most of the speakers at scientific conferences. Thus, there is a dearth of knowledge on the clinical picture of CRPS globally and how it is managed. For such reasons, Dr. Kashif Muhammad from Pakistan was asked to deliver a talk on ‘Having CRPS in a developing country’ at the Satellite Symposium in Boston, 2018. We recently learned that Anne Louise Oaklander (member of the CRPS-SIG Scientific Committee) and Max Klein have delivered 8 neuroscience lectures to the International Conference of the Society of Neuroscientists of Africa (SONA) and International Brain Research Organization (IBRO) Neuroscience Schools, which educates globally. In addition to teaching, they learned about challenges to healthcare and to education in Nigeria by touring university medical centers in Ilorin and Lagos. We asked them whether they wanted to share their experiences. Along with Grace Bwala, a Nigerian-trained physician, they share their perspective below.

Pain Treatment in Nigeria

By: Grace S. Bwala, MBBS, MPH National Hospital, Abuja, Nigeria  |  Max M. Klein, PhD, Massachusetts General Hospital, Boston, MA USA  |  Anne Louise Oaklander MD PhD, Massachusetts General Hospital, Boston, MA USA

Nigeria—home to nearly 200 million—is Africa’s most populous country. Nigerians’ family-centered, religious, and traditional values include cheerfulness, respect, and professional achievement. But medical care and research remain hobbled by the poverty of local governments and citizens. Because English education continued after independence from Britain in 1960, many physicians and scientists train and work abroad. Unfortunately, local conditions deter many from returning home to share their knowledge, leading to “brain drain”. As of 2017, only 16% of roads were paved and less than 10% of households had potable water. Malnutrition, pollution, and road accidents remain major health threats along with preventable conditions including pneumonia, influenza, tuberculosis, diarrhea, malaria, yellow fever, diabetes, cardiovascular disease, and HIV. In 2019, mean life expectancy is 55.2 years.

At hospitals, operating theatres are the only areas with constant power. Elsewhere, during the daily outages, hospital staff are prepared to take over for ventilators, intravenous pumps and monitors. Patients are usually fed and nursed by family members who also take up residence.

Science students and teachers generally have to purchase their own reagents, equipment, and experimental animals, which limits science, education, and business. Projects presented in SONA and IBRO workshops and meetings often involved medicinal properties of native flora, or traditional medicine approaches. These experiments are feasible.

Absent health insurance, physicians rely on nonsteroidal anti-inflammatories (aspirin, and ibuprofen) for pain management–all most patients can afford. Tramadol and codeine are affordable, but use is curtailed to avoid dependence and abuse, as in some European and North American countries. More expensive treatment options such as corticosteroid injections, surgical correction, and non-generic drugs are reserved for severe/chronic pain. Pharmaceutical use is further complicated by an unreliable pharmaceutical market. According to a WHO report, around 40% of globally detected cases of counterfeit medical products were found in Africa. Some pharmaceutical players appear to routinely dilute the active agent in all drugs (including antibiotics) or accept impurities in formulations marketed in Africa, leading to lower efficacy, increased morbidity, and sometimes unintended effects. Because of cost, unfamiliarity and unreliability of pharmaceuticals, many people still use cheaper traditional treatments such as botanicals, where efficacy is uncertain and detrimental effects common. Providers must balance affordability with effectiveness. Inexpensive and at least potentially effective non-pharmaceutical treatments for CRPS such as mirror therapy and transcranial direct current stimulation may be new options for treating CRPS in Nigeria.

 

CRPS SIG Newsletter 5

Max Klein demonstrating noninvasive transcranial direct current stimulation of the brain at the School of Neuroscience on Neuroinflammation and Chronic Pain in Lagos. Generators are affordable and powered by one 9v battery. tDCS, which modulates cortical excitability, is being investigated for chronic pain.

Absent health insurance, physicians rely on nonsteroidal anti-inflammatories (aspirin, and ibuprofen) for pain management–all most patients can afford. Tramadol and codeine are affordable, but use is curtailed to avoid dependence and abuse, as in some European and North American countries. More expensive treatment options such as corticosteroid injections, surgical correction, and non-generic drugs are reserved for severe/chronic pain. Pharmaceutical use is further complicated by an unreliable pharmaceutical market. According to a WHO report, around 40% of globally detected cases of counterfeit medical products were found in Africa. Some pharmaceutical players appear to routinely dilute the active agent in all drugs (including antibiotics) or accept impurities in formulations marketed in Africa, leading to lower efficacy, increased morbidity, and sometimes unintended effects. Because of cost, unfamiliarity and unreliability of pharmaceuticals, many people still use cheaper traditional treatments such as botanicals, where efficacy is uncertain and detrimental effects common. Providers must balance affordability with effectiveness. Inexpensive and at least potentially effective non-pharmaceutical treatments for CRPS such as mirror therapy and transcranial direct current stimulation may be new options for treating CRPS in Nigeria.

CRPS Satellite Symposium 2020

Future Meetings  

A proposal for a satellite symposium on ‘Global CRPS,’ to be held during the IASP 2020 World Congress on Pain in Amsterdam, Netherlands, has been submitted to the IASP Scientific Committee. We are currently awaiting feedback. 

CRPS-Related Publications

Recent Publications of Interest

 

A PubMed search revealed a total of 147 publications on CRPS-related issues since January 2019. Here are some relevant articles on CRPS published in May and June 2019.

 

  1. Antony AB, Schultheis BC, Jolly SM, Bates D, Hunter CW, Levy RM. Neuromodulation of the dorsal root ganglion for chronic postsurgical pain. Pain Med 2019;20 (Supplement 1):S41-S46. 
  2. Bazika-Gerasch B, Maier C, Kumowski N, Fiege C, Kaisler M, Vollert J, Dietrich JW. Compared to limb pain of other origin, ultrasonographic osteodensitometry reveals loss of bone density in complex regional pain syndrome. Pain 2019;160:1261-69. 
  3. Bruehl S, Gamazon ER, Van de Ven T, Buchheit T, Walsh CG, Mishra P, Ramanujan K, Shaw A. DNA methylation profiles are associated with complex regional pain syndrome following traumatic injury. Pain 2019; doi: 10.1097/j.pain.0000000000001624. [Epub ahead of print]
  4. Cropper HC, Johnson EM, Haight E, Cordonnier SA, Chaney AM, Forman TE, Biswal A, Stevens MY, James ML, Tawfik VL. Longitudinal TSPO-PET imaging of peripheral and central myeloid cells in a mouse model of complex regional pain syndrome. Pain 2019; doi: 10.1097/j.pain.0000000000001607. [Epub ahead of print] 
  5. Dietz C, Müller M, Reinhold AK, Karch L, Schwab B, Forer L, Vlckova E, Brede EM, Jakubietz R, Üceyler N, Meffert R, Bednarik J, Kress M, Sommer C, Dimova V, Birklein F, Rittner HL. What is normal trauma healling, what is complex regional pain syndrome I? An analysis of clinical and experimental biomarkers. Pain 2019; doi: 10.1097/j.pain.0000000000001617. [Epub ahead of print] 
  6. Drummond PD, Morellini N, Visser E, Finch PM. Expression of cutaneous beta-2 adrenoceptors is similar in patients with complex regional pain syndrome and pain-free controls. Pain Med 2019; doi: 10.1093/pm/pnz110. [Epub ahead of print]
  7. Helyes Z, Tekus V, Szentes N, Pohoczky K, Botz B, Kiss T, Kemeny A, Koenyei Z, Toth K, Lenart N, Abraham H, Pinteaux, E, Francis S, Sensi S, Denis A, Goebel A. Transfer of Complex Regional Pain Syndrome to Mice via human autoantibodies is mediated by interleukin-1-induced mechanisms. PNAS 2019; doi: 10.1073/pnas.1820168116 (e-pub).
  8. Kersten C, Cameron MG, Bailey AG, Fallon MT, Laird BJ, Paterson V, Mitchell R, Fleetwood-Walker SM, Daly F, Mjåland S. Relief of neuropathic pain through epidermal growth factor receptor inhibition: a randomized proof-of-concept trial. Pain Med 2019; doi: 10.1093/pm/pnz101. [Epub ahead of print] 
  9. Knudsen LF, Terkelsen AJ, Drummond PD, Birklein F. Complex regional pain syndrome: a focus on the autonomic nervous system. Clin Auton Res 2019; doi: 10.1007/s10286-019-00612-0. [Epub ahead of print]
  10. König S, Bayer M, Dimova V, Hermberger M, Escolano-Lozano F, Bednarik J, Vlckova E, Rittner H, Schlereth T, Birklein F. The serum protease network- one key to understand complex regional pain syndrome pathophysiology. Pain 2019;160:1402-09.
  11. Verfaille C, Filbrich L, Cordova Bulens D, Lefévre P, Berquin A, Barbier O, Libouton X, Fraselle V, Mouraux D, Legrain V. Robot-assisted line bisection in patients with complex regional pain syndrome. PloS One 2019;14:e0213732.
chris@csa.co.za
By chris@csa.co.za August 16, 2019 06:19

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