PDF(Pubmed)
Abstract：
BACKGROUND: Neuroinflammation and maladaptive neuroplasticity play pivotal roles in migraine (MIG), trigeminal autonomic cephalalgias (TAC), and complex regional pain syndrome (CRPS). Notably, CRPS shares connections with calcitonin gene-related peptide (CGRP) in its pathophysiology. This study aims to assess if the documented links between CRPS and MIG/TAC in literature align with clinical phenotypes and disease progressions. This assessment may bolster the hypothesis of shared pathophysiological mechanisms.
METHODS: Patients with CRPS (n = 184) and an age-/gender-matched control group with trauma but without CRPS (n = 148) participated in this case-control study. Participant answered well-established questionnaires for the definition of CRPS symptoms, any headache complaints, headache entity, and clinical management.
RESULTS: Patients with CRPS were significantly more likely to suffer from migraine (OR: 3.23, 95% CI 1.82-5.85), TAC (OR: 8.07, 95% CI 1.33-154.79), or non-classified headaches (OR: 3.68, 95% CI 1.88-7.49) compared to the control group. Patients with MIG/TAC developed CRPS earlier in life (37.2 ± 11.1 vs 46.8 ± 13.5 years), had more often a central CRPS phenotype (60.6% vs. 37.0% overall) and were three times more likely to report allodynia compared to CRPS patients with other types of headaches. Additionally, these patients experienced higher pain levels and more severe CRPS, which intensified with an increasing number of headache days. Patients receiving monoclonal antibody treatment targeting the CGRP pathway for headaches reported positive effects on CRPS symptoms.
CONCLUSIONS: This study identified clinically relevant associations of MIG/TAC and CRPS not explained by chance. Further longitudinal investigations exploring potentially mutual pathomechanisms may improve the clinical management of both CRPS and primary headache disorders.
BACKGROUND: German Clinical Trials Register (DRKS00022961).
METHODS: Patients with CRPS (n = 184) and an age-/gender-matched control group with trauma but without CRPS (n = 148) participated in this case-control study. Participant answered well-established questionnaires for the definition of CRPS symptoms, any headache complaints, headache entity, and clinical management.
RESULTS: Patients with CRPS were significantly more likely to suffer from migraine (OR: 3.23, 95% CI 1.82-5.85), TAC (OR: 8.07, 95% CI 1.33-154.79), or non-classified headaches (OR: 3.68, 95% CI 1.88-7.49) compared to the control group. Patients with MIG/TAC developed CRPS earlier in life (37.2 ± 11.1 vs 46.8 ± 13.5 years), had more often a central CRPS phenotype (60.6% vs. 37.0% overall) and were three times more likely to report allodynia compared to CRPS patients with other types of headaches. Additionally, these patients experienced higher pain levels and more severe CRPS, which intensified with an increasing number of headache days. Patients receiving monoclonal antibody treatment targeting the CGRP pathway for headaches reported positive effects on CRPS symptoms.
CONCLUSIONS: This study identified clinically relevant associations of MIG/TAC and CRPS not explained by chance. Further longitudinal investigations exploring potentially mutual pathomechanisms may improve the clinical management of both CRPS and primary headache disorders.
BACKGROUND: German Clinical Trials Register (DRKS00022961).
摘要：
背景：神经炎症和适应不良的神经可塑性在偏头痛（MIG）中起关键作用，三叉神经自主性头痛（TAC），和复杂的区域疼痛综合征（CRPS）。值得注意的是,CRPS在其病理生理学中与降钙素基因相关肽（CGRP）共享联系。本研究旨在评估文献中记录的CRPS和MIG/TAC之间的联系是否与临床表型和疾病进展一致。此评估可能会支持共享病理生理机制的假设。
方法：患有CRPS的患者（n=184）和年龄/性别匹配的创伤但没有CRPS的对照组（n=148）参加了这项病例对照研究。参与者回答了关于CRPS症状定义的既定问卷，任何头痛的投诉，头痛实体，和临床管理。
结果：患有CRPS的患者更容易患偏头痛（OR：3.23，95％CI1.82-5.85），TAC（OR：8.07，95%CI1.33-154.79），或未分类的头痛（OR：3.68，95％CI1.88-7.49）与对照组相比。MIG/TAC患者在生命早期出现CRPS（37.2±11.1vs46.8±13.5年），更常见的是中央CRPS表型(60.6%vs.总体占37.0％），与其他类型头痛的CRPS患者相比，报告异常性疼痛的可能性要高三倍。此外,这些患者经历了更高的疼痛水平和更严重的CRPS，随着头痛天数的增加而加剧。接受针对CGRP途径的单克隆抗体治疗头痛的患者报告了对CRPS症状的积极影响。
结论：这项研究确定了MIG/TAC和CRPS之间的临床相关关联，但没有偶然的解释。进一步的纵向研究探索潜在的相互病理机制可能会改善CRPS和原发性头痛疾病的临床治疗。
背景：德国临床试验注册（DRKS00022961）。
方法：患有CRPS的患者（n=184）和年龄/性别匹配的创伤但没有CRPS的对照组（n=148）参加了这项病例对照研究。参与者回答了关于CRPS症状定义的既定问卷，任何头痛的投诉，头痛实体，和临床管理。
结果：患有CRPS的患者更容易患偏头痛（OR：3.23，95％CI1.82-5.85），TAC（OR：8.07，95%CI1.33-154.79），或未分类的头痛（OR：3.68，95％CI1.88-7.49）与对照组相比。MIG/TAC患者在生命早期出现CRPS（37.2±11.1vs46.8±13.5年），更常见的是中央CRPS表型(60.6%vs.总体占37.0％），与其他类型头痛的CRPS患者相比，报告异常性疼痛的可能性要高三倍。此外,这些患者经历了更高的疼痛水平和更严重的CRPS，随着头痛天数的增加而加剧。接受针对CGRP途径的单克隆抗体治疗头痛的患者报告了对CRPS症状的积极影响。
结论：这项研究确定了MIG/TAC和CRPS之间的临床相关关联，但没有偶然的解释。进一步的纵向研究探索潜在的相互病理机制可能会改善CRPS和原发性头痛疾病的临床治疗。
背景：德国临床试验注册（DRKS00022961）。
