Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Treatment for Acute Stage Complex Regional Pain Syndrome Type II with Polydeoxyribonucleotide Injection

  • Received : 2014.12.10
  • Accepted : 2015.07.03
  • Published : 2016.09.01
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Abstract

Complex regional pain syndrome (CRPS) type II is a syndrome that develops after nerve injury. Symptoms may be severe, and vary depending on the degree of sympathetic nerve involvement. As yet, there is no satisfactory treatment. We report the case of a female patient who had an L5 left transverse process fracture and an S2 body fracture, who developed symptoms of CRPS type II in her left lower leg that were aggravated during ambulation in spite of absolute bed rest for one month after the trauma. Several treatments, including bed rest, medication, and numerous nerve blocks were attempted, but the pain persisted. We finally tried injection of polydeoxyribonucleotide (PDRN) solution at the left L5 transverse process fracture site because we knew of the anti-inflammatory effect of PDRN. One day after this treatment, her symptoms had almost disappeared and three days later, she was discharged. We will also further discuss the possibility of using PDRN solution for the treatment of CRPS.

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References

  1. Altavilla D, Bitto A, Polito F, Marini H, Minutoli L, Di Stefano V, et al. : Polydeoxyribonucleotide (PDRN) : a safe approach to induce therapeutic angiogenesis in peripheral artery occlusive disease and in diabetic foot ulcers. Cardiovasc Hematol Agents Med Chem 7 : 343-321, 2009 https://doi.org/10.2174/187152509789541909
  2. Bitto A, Galeano M, Squadrito F, Minutoli L, Polito F, Dye JF, et al. : Polydeoxyribonucleotide improves angiogenesis and wound healing in experimental thermal injury. Crit Care Med 36 : 1594-1602, 2008 https://doi.org/10.1097/CCM.0b013e318170ab5c
  3. Bitto A, Oteri G, Pisano M, Polito F, Irrera N, Minutoli L, et al. : Adenosine receptor stimulation by polynucleotides (PDRN) reduces inflammation in experimental periodontitis. J Clin Periodontol 40 : 26-32, 2013 https://doi.org/10.1111/jcpe.12010
  4. Bitto A, Polito F, Irrera N, D'Ascola A, Avenoso A, Nastasi G, et al. : Polydeoxyribonucleotide reduces cytokine production and the severity of collagen-induced arthritis by stimulation of adenosine $A(_2A)$ receptor. Arthritis Rheum 63 : 3364-3371, 2011 https://doi.org/10.1002/art.30538
  5. Bruehl S : An update on the pathophysiology of complex regional pain syndrome. Anesthesiology 113 : 713-725, 2010
  6. Carroll I, Curtin CM : Management of chronic pain following nerve injuries/CRPS type II. Hand Clin 29 : 401-408, 2013 https://doi.org/10.1016/j.hcl.2013.04.009
  7. Galeano M, Bitto A, Altavilla D, Minutoli L, Polito F, CaloM, et al. : Polydeoxyribonucleotide stimulates angiogenesis and wound healing in the genetically diabetic mouse. Wound Repair Regen 16 : 208-217, 2008 https://doi.org/10.1111/j.1524-475X.2008.00361.x
  8. Harden RN, Oaklander AL, Burton AW, Perez RS, Richardson K, Swan M, et al. : Complex regional pain syndrome : practical diagnostic and treatment guidelines, 4th edition. Pain Med 14 : 180-229, 2013 https://doi.org/10.1111/pme.12033
  9. Kemler MA, de Vet HC, Barendse GA, van den Wildenberg FA, van Kleef M : Effect of spinal cord stimulation for chronic complex regional pain syndrome Type I : five-year final follow-up of patients in a randomized controlled trial. J Neurosurg 108 : 292-298, 2008 https://doi.org/10.3171/JNS/2008/108/2/0292
  10. Kim WJ, Shin HY, Koo GH, Park HG, Ha YC, Park YH : Ultrasoundguided prolotherapy with polydeoxyribonucleotide sodium in ischiofemoral impingement syndrome. Pain Pract 14 : 649-655, 2014 https://doi.org/10.1111/papr.12215
  11. Maihofner C, Seifert F, Markovic K : Complex regional pain syndromes : new pathophysiological concepts and therapies. Eur J Neurol 17 : 649-660, 2010 https://doi.org/10.1111/j.1468-1331.2010.02947.x
  12. Minutoli L, Arena S, Bonvissuto G, Bitto A, Polito F, Irrera N, et al. : Activation of adenosine A2A receptors by polydeoxyribonucleotide increases vascular endothelial growth factor and protects against testicular damage induced by experimental varicocele in rats. Fertil Steril 95 : 1510-1513, 2011 https://doi.org/10.1016/j.fertnstert.2010.07.1047
  13. Price DD, Long S, Wilsey B, Rafii A : Analysis of peak magnitude and duration of analgesia produced by local anesthetics injected into sympathetic ganglia of complex regional pain syndrome patients. Clin J Pain 14 : 216-226, 1998 https://doi.org/10.1097/00002508-199809000-00008
  14. Taylor RS, Van Buyten JP, Buchser E : Spinal cord stimulation for complex regional pain syndrome : a systematic review of the clinical and cost-effectiveness literature and assessment of prognostic factors. Eur J Pain 10 : 91-101, 2006 https://doi.org/10.1016/j.ejpain.2005.02.004
  15. Vincenzi F, Padovan M, Targa M, Corciulo C, Giacuzzo S, Merighi S, et al. : A(2A) adenosine receptors are differentially modulated by pharmacological treatments in rheumatoid arthritis patients and their stimulation ameliorates adjuvant-induced arthritis in rats. PLoS One 8 : e51495, 2013

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