Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20180071
Brazilian Journal of Pain
Case Report

Complex regional pain syndrome in the orofacial region. Case report

Síndrome complexa de dor regional em região orofacial. Relato de caso

Elba Lúcia Wanderley Santos; Igor Santos Sales; Nadja Maria Jorge Asano; Maria das Graças Wanderley de Sales Coriolano

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Abstract

BACKGROUND AND OBJECTIVES: The complex regional pain syndrome is characterized by presenting autonomic, sensory and motor difficult to control changes of the chronic evolution. Its pathophysiology and treatment are not fully defined, and the search for an increasingly effective treatment is a subject of medical concern. The involvement of the orofacial region has an even rarer incidence, and the literature reports only 14 cases in five decades. The objective of this report was to warn physicians and researchers about the importance of a correct diagnosis and to show the possibility of controlling this dysfunction with conservative treatment.

CASE REPORT: A 68-year-old female patient, who after a facial trauma and three subsequent surgical procedures, developed orofacial complex regional pain syndrome. Several therapeutic regimens were performed, and after the last one she became completely asymptomatic: oxcarbazepine (900mg/day), morphine-controlled liberation (120mg/day), fluoxetine (40mg/day) and clonazepam (2mg/day), electrotherapy and oral rehabilitation.

CONCLUSION: The diagnosis criteria for complex regional pain syndrome recommended by the International Association for the Study of Pain, revised in 2007, should be followed. The treatment of this neuropathic syndrome includes anticonvulsants, tricyclics, opioids, electrotherapy and somatic and stellate ganglion block, the latter when the pain is maintained by the sympathetic nervous system. In this report of an orofacial complex regional pain syndrome II, pain control was shown without the need for sympathetic ganglion block, which can be a warning to the medical class to a correct diagnosis and an effective and less invasive treatment.

Keywords

Algodystrophy, Causalgia, Diagnosis, Facial pain, Reflex sympathetic dystrophy, Therapeutics

Resumo

JUSTIFICATIVA E OBJETIVOS: A síndrome complexa de dor regional se caracteriza por apresentar alterações autonômicas, sensitivas e motoras de evolução crônica de difícil controle. Sua fisiopatologia não está totalmente definida e a busca por um tratamento cada vez mais eficaz é objeto de preocupação médica. O comprometimento da região orofacial tem uma incidência ainda mais rara e a literatura relata apenas 14 casos em cinco décadas. O objetivo deste relato foi alertar médicos e pesquisadores para a importância de um diagnóstico correto e mostrar a possibilidade de controle dessa disfunção com o tratamento conservador.

RELATO DO CASO: Paciente do sexo feminino, 68 anos, após trauma facial e três intervenções cirúrgicas posteriores, desenvolveu quadro de síndrome complexa de dor regional orofacial. Foram realizados vários esquemas terapêuticos, o último dos quais tornou-a completamente assintomática: oxcarbazepina (900mg/dia), morfina de liberação controlada (120mg/dia), fluoxetina (40mg/dia) e clonazepam (2mg/dia), eletroterapia e reabilitação oral.

CONCLUSÃO: Os critérios de diagnóstico para a síndrome complexa de dor regional, preconizados pela International Association for the Study of Pain, revisados em 2007, devem ser seguidos. O tratamento desta síndrome neuropática inclui anticonvulsivantes, tricíclicos e opioides, eletroterapia, bloqueio somático e de gânglio estrelado, este último quando a dor for mantida pelo sistema nervoso simpático. Neste relato de uma síndrome complexa de dor regional II orofacial foi mostrado o controle da dor sem a necessidade de bloqueio do gânglio simpático, o que pode alertar a classe médica para um correto diagnóstico e um tratamento eficaz e menos invasivo.

Palavras-chave

Algodistrofia, Causalgia, Diagnóstico, Distrofia simpática reflexa, Dor orofacial, Terapêutica

References

Cândido DK, Winnie A. Reflex Sympathetic Dystrophy on the face. Pain management. 2011:506-13.

Cordon FC, Lemonica L. Complex regional pain syndrome: epidemiology, pathophysiology, clinical manifestations, diagnostic tests and therapeutic proposals. Rev Bras Anestesiol. 2002;52(5):618-27.

Arden RL, Bahu SJ, Zuazu MA, Berguer R. Reflex sympathetic dystrophy of the face: current treatment recommendations. Laryngoscope. 1998;108(3):437-42.

Galler BS, Schwartz L, Allen RJ. Complex regional pain syndromes type I: reflex sympathetic dystrophy, and type ii: causalgia. Bonica's management of pain. 2001:388-411.

Raj PP. Reflex sympathetic dystrophy. Pain Medicine. 1996:466-82.

Hoffmann KD, Matthews MA. Comparison of sympathetic neurons in orofacial and upper extremity nerves: implications for causalgia. J Oral Maxillofac Surg. 1990;48(7):720-7.

Harden RN, Bruel S, Stanton-Hicks M, Wilson PR. Proposed new diagnostic criteria for complex regional pain syndrome. Pain Med. 2007;8(4):326-31.

Harden RN, Bruehl S, Perez RS, BIirklein F, Marinus J, Maihofner C. Validation of proposed diagnostic criteria (the "Budapest Criteria") for Complex Regional Pain Syndrome. Pain. 2010;150(2):268-74.

Stanton-Hicks M. Complex regional pain syndrome. Anesthesiol Clin North America. 2003;21(4):733-44.

Skaer TL. Practice guidelines transdermal opioids in malignant pain. Drugs. 2004;64(23):2629-38.

Baron R, Binder A, Ludwing J, Schattschneider , Wasner GL. Diagnostic tool and evidence-based treatment of complex regional pain syndrome. Update review: refresher course syllabus. 2005:293-306.

Rowbotham MC. Pharmacologic management of complex regional pain syndrome. Clin J Pain. 2006;22(5):425-9.

Krause HL, Sredni S. Systemic drug therapy for neuropathic pain review. Br J Pain. 2016;17(^sSuppl 1):S91-4.

Alrashood ST. Carbamazepine. Profiles Drug Subst Excip Relat Methodol. 2016;41:133-321.

Chen XH, Han JS. Analgesia induced by electroacupuncture of different frequencies is mediated by different types of opioid receptors: another cross-tolerance study. Behav Brain Res. 1992;47(2):143-9.

Lee YH, Lee KM, Kim HG, Kang SK, Auh QS, Hong JP. Orofacial complex regional pain syndrome: pathophysiologic mechanisms and functional MRI. Oral Surg Oral Med Oral Pathol Oral Radiol. 2017;124(2):e164-70.

Heir GM, Nasri-Heir C, Thomas D, Puchimada BP, Khan J, Eliav E. Complex regional pain syndrome following trigeminal nerve injury: report of 2 cases. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;114(6):733-9.

Melis M, Zawawi K, al-Badawi E, Lobo Lobo S, Mehta N. Complex regional pain syndrome in the head and neck: a review of the literature. J Orofac Pain. 2002;16(2):93-104.

Janig W. The puzzle of "reflex sympathetic dystrophy": mechanisms, hypothesis, open questions. Reflex Sympathetic Dystrophy: a reappraisal. 1996:1-24.

Janig W, Baron R. Complex regional pain syndrome: mystery explained?. Lancet Neurol. 2003;2(11):687.

Sakamoto E, Shiiba S, Noma N, Okada-Ogawa A, Shinozaki T, Kobayashi A. A possible case of complex regional pain syndrome in the orofacial region. Pain Med. 2010;11(2):274-80.


Submitted date:
05/16/2018

Accepted date:
08/29/2018

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