應用疼痛定位法之觀念於CRPS患者作診斷可行嗎？3個病例之分析

Can Pain Mapping Concept be Used in the Diagnosis of Complex Regional Pain Syndrome Type 1 A Discussion of 3 Cases

疼痛定位法可用於診斷背痛之痛源，若在疼痛路徑注射少量局部麻醉劑而病人有90%以上的止痛，疼痛之來源即可查出。我們利用3個複雜性局部疼痛症候群（CRPS）病例，對論疼痛定位法之觀念應用於診斷非交感神經依賴性疼痛（SIP）或交感神經依存性疼痛（SMP）之角色：本文第1、2例中用疼痛定位法之觀念診斷出典型的SIP或SMP，並用於後續治療。然而單純的SIP或SM並不常見。第3例呈現CRPS最常見的表徵。複雜、多面影響因素、無法用單純的神經阻斷術檢查出來。雖然疼痛定位法已被證實對困難背痛（尤其是體源性）之診斷有效，但我們並不建議應用疼痛定位法之觀念應用於交感神經阻斷術，以做為CRPS之診斷方式。

Pain mapping has been used for the precision diagnosis of low back pain. More than 90% of pain relief after application of local anesthetic to pain pathway could be used as a guide to elucidate the source of enigmatic low back pain. In this report, using 3 CRPS cases, we discussed the role of pain mapping concept in the diagnosis of sympathetic mediated pain, or CRPS. Under the new classification, CRPS can be designated as sympathetic independent pain (SIP), sympathetic maintained pain (SMP), or a mix of the SIP and SMP depending on the response to sympathetic block. In cases 1 and 2, the typical SIP or SMP was diagnosed by both the concept of pain mapping and the subsequent therapy. Unfortunately, simple SIP or SMP is uncommon. The case 3 is typical presentation of CRPS in which complicated and multi-factorial features could not be examined by simple blocks. Moreover, the degree of responsiveness to sympathetic block can change over time. Since the pain mapping is proven useful only for the diagnosis of difficult back pain of somatic in nature, the application of pain mapping concept in sympathetic blocks for the diagnosis of CRPS is therefore not recommended.