El síndrome de dolor regional complejo del pie y su gestión mediante la estimulación de la médula espinal

Paul Beeson, Robert Ashford, Jon Raphael


Objetivos: Este artículo describe el dolor neuropático de los pies con especial referencia al síndrome de dolor regional complejo. Proporciona recomendaciones para la evaluación clínica del síndrome de dolor regional complejo y pone de relieve el valor de la estimulación de la médula espinal en su gestión. El objetivo es revisar dolor en el pie neuropático en el síndrome de dolor regional complejo y resumen de su gestión mediante la estimulación de la médula espinal.

Material y métodos: Una revisión de la literatura narrativa se llevó a cabo utilizando bases de datos médicas de idioma Inglés la combinación de estrategias de búsqueda para el síndrome de dolor regional complejo y estimulación de la médula espinal.

Resultados: Estimulación de la médula espinal mejora los síntomas subjetivos del dolor neuropático pies del síndrome de dolor regional complejo, permite la mejora funcional objetivo y reduce el consumo de analgésicos.

Conclusión: Los avances técnicos recientes en la estimulación de la médula espinal han dado lugar a patrones de estimulación mejoradas adaptaciones a las necesidades del paciente. diagnóstico preoperatorio cuidadosa, la selección de pacientes robusto y seguimiento frecuente son vitales para el éxito de este método. Es importante que los podólogos gestión de estos pacientes a tener una comprensión de esta modalidad de tratamiento.


Palabras clave

síndrome de dolor regional complejo; estimulación de la médula espinal; neuralgia; pie; administración

Texto completo:

PDF (English)


O’Hara P. Pain Management for Health Professional, 1st ed. London Chapman & Hall; 1996, p.102-6.

Freynhagen R, Bennett MI. Diagnosis and management of neuropathic pain. BMJ 2009; 339:b3002. doi: 10.1136/bmj.b3002

Raphael J, Mutagi HS, Kapur S. Spinal cord stimulation and its anaesthetic implication. Continuing Education in Anaesthesia Critical Care & Pain 2009; doi:10.1093/bjaceaccp/mkp009.

Treede RD, Jensen TS, Campbell JN et al. Neuropathic pain: redefinition and a grading system for clinical and research purposes. Neurology. 2008;70:1630-5.

Baron R. Mechanisms of disease: neuropathic pain: a clinical perspective. Nat Clin Pract Neurol 2006;2:95-106.

Scholz J, Woolf CJ. The neuropathic pain triad: neurons, immune cells 3 and glia. Nat. Neurosci 2007;10:1361-8.

Turk DC, Okifuji A. Pain terms and taxonomies of pain In: Loeser JD,

Butler SH, Chapman CR, et al, Editors. Bonica’s Management of Pain

rd ed, Baltimore MD Lippincott Williams & Wilkins; 2001, p.17-25.

Hall GC, Carroll D, McQuay H. Primary care incidence and treatment of four neuropathic pain conditions: a descriptive study, 2002-2005. BMC Fam Pract 2008; 9:26.

Freynhagen R, Baron R, Gockel U et al. Pain DETECT: a new screening questionnaire to identify neuropathic components in patients with back pain. Curr Med Res Opin 2006;22:1911-20.

Gustorff B, Dorner T, Likar R, et al. Prevalence of self-reported neuropathic pain and impact on quality of life: a prospective representative survey. Acta Anaesthesiol Scand 2008;52:132-6.

Torrance N, Smith BH, Bennett MI. The epidemiology of chronic pain of predominantly neuropathic origin. Results from a general population study. J Pain 2006;7:281-9.

Bouhassira D, Lanteri-Minet M, Attal N et al. Prevalence of chronic pain with neuropathic characteristics in the general population. Pain 2008;136:380-7.

McDermott AM, Toelle TR, Rowbotham DJ, et al. The burden of neuropathic pain: results from a cross-sectional survey. Eur J Pain. 2006;10:127-135.

Fukushima FB, Bezerra DM, Villas Boas PJD et al. Complex Regional Pain Syndrome, BMJ 2014;349:32-5.

Borchers AT, Gershwin ME. Complex regional pain syndrome: A comprehensive

and critical review, Autoimmunity Reviews 2014; 13:242-265.

Shah A, Kirchner SJ. Complex regional Pain syndrome, Foot and Ankle

Clinics 2011;16:351-366.

Bean DJ, Johnson MH, Kydd RR. The outcome of Complex Regional

Pain Syndrome Type1: A systematic review. Journal of Pain 2014;15:677-690.

Kemler MA, Barendse GA, van Kleef M et al. Spinal cord stimulation in patients

with chronic reflex sympathetic dystrophy. N Engl J Med 2000;24:618-24.

Kemler MA, DeVet HCW, Barendse GAM et al. The effect of spinal cord

stimulation in patients with chronic reflex sympathetic dystrophy: two year

follow-up of the randomized controlled trial. Ann Neurol 2004;55:13-18.

Kemler MA, de Vet H, Barendse G, van den Wildenberg F et al. Spinal cord

stimulation for chronic reflex sympathetic dystrophy: five year follow-up.

N Eng J Med 2006;354:394-6.

Kumar K, Taylor RS, L. Jacques, et al. The effects of spinal cord stimulation in

neuropathic pain are sustained: a 24-month follow-up of the prospective

randomized controlled multicenter trial of the effectiveness of spinal cord

stimulation. Neurosurgery 2008;63:762–770.

Mailis-Gagnon A, Furlan AD, Sandoval JA et al. Spinal cord stimulation for

chronic pain, Cochrane Database of Systematic Reviews 2004, CD003783.

Wolter T. Spinal cord stimulation for neuropathic pain: current perspectives.

J Pain Res 2014;4:651-663.

Sandroni P, Benrud-Larson LM, McClelland RL et al. Complex Regional Pain Syndrome Type I: Incidence and prevalence in Olmsted County, a population-based study. Pain 2003;103:199-207.

Kishner S, Rothaermel JB, Munshi, BS et al. Complex Regional Pain Syndrome, Turkish J Phys Med & Rehab 2011;57: 156-164.

Royal College Physicians. Complex Regional Pain Syndrome in adults: UK

guidelines for diagnosis, referral and management in primary and secondary

care. London. 2012.

Van Rijn MA, Marinus J, Putter H et al. Spreading of Complex Regional

Pain Syndrome: not a random process. J Neural Transm 2011;118:1301- 9.

Marinus J, Moseley LG, Birklein F et al. Clinical features and pathophysiology of

Complex Regional Pain Syndrome. Lancet Neurology 2011;10:637–648.

Rewhorn MJ, Leung AH, Gillespie A et al. Incidence of Complex Regional Pain

Syndrome after foot and ankle surgery. J Foot Ankle Surg 2014;53:256-8.

Littlejohn G. Complex regional pain syndrome. Peri-operative triggers.

Rheumatology 2014;53:1157-8.

Harden RN, Bruehl S, Perez RS et al. Validation of proposed diagnostic criteria

(The ‘Budapest Criteria’) for Complex Regional Pain Syndrome. Pain 2010;150:


Turner-Stokes L, Goebel A. Complex Regional Pain Syndrome in adults:

concise guidance. Clinical Medicine 2011;11:596-600.

Veldman PH, Reyman HM, Arntz IE et al. Signs and symptoms of reflex

sympathetic dystrophy: prospective study of 829 patients. Lancet


McBride A, Atkins R. Complex Regional Pain Syndrome, Current

Orthopaedics 2005;19155–165.

National Institute of Neurological Disorders and Stroke 2014: Accessed at: http://www.ninds.nih.gov/disorders/reflex_sympathetic_dystrophy/detail_reflex_sympathetic_dystrophy.htm

Allen G, Galer BS, Schwartz S. Epidemiology of complex regional pain

syndrome: a retrospective chart review of 134 patients. Pain 1999;80:539-544.

Bacchini M, Vaienti E, Soncini G. Post-traumatic reflex sympathetic dystrophy

in the foot and ankle: a study of 32 cases, Chir Organi Mov 1999;84:189-196.

Harris J, Fallat L, Schwartz S. Characteristic Trends of Lower-Extremity

Complex Regional Pain Syndrome. J Foot & Ankle Surg 2004;43:296-301.

Masahiko S, Hideo Y, Kanji U et al. Perioperative factors affecting the

occurrence of acute Complex Regional Pain Syndrome following limb bone

fracture surgery: data from the Japanese Diagnosis Procedure Combination

database, Rheumatology 2014;53:1186-1193.

McCracken LM, Morley S. The Psychological Flexibility Model: A Basis for

Integration and Progress in Psychological Approaches to Chronic Pain

Management. Journal of Pain 2014;15:221-234.

Myerson BA, Linderoth B. Mechanisms of spinal cord stimulation in neuropathic

pain. Neurological Research 2000;22:285-292.

National Institute for Health and Clinical Excellence. Spinal Cord

Stimulation for Chronic Pain of Neuropathic or Ischaemic Origin. London.

Kavar B, Rosenfeld JV, Hutchinson A. The efficacy of spinal cord stimulation for

chronic pain, J Clin Neuroscience 2000;7:409-13.

Kumar K, Taylor R, Jacques L et al. Spinal cord stimulation versus conventional

medical management for neuropathic pain: a multi-centre randomized

controlled trial in patients with failed back surgery syndrome. Pain 2007;132:


Spinal cord stimulation for the management of pain: recommendations for best

clinical practice, British Pain Society; 2008.

Elliott JA, Norregaard TV. Neuromodulation for pain. In: Warfield CA, Bajwa

ZW, Editors. Principles & Practice of Pain Medicine, 2nd Edn. New York

McGraw-Hill; 2004: stimulation 740–6.

Taylor RS, Van Buyten JP, Buchser E. Spinal cord stimulation for complex

regional pain syndrome: a systematic review of the literature of the clinical

and cost-effectiveness literature and clinical assessment of prognostic factors.

European J Pain 2006;10:91.

Hylands-White N, Duarte RV, Beeson P et al. Electroencephalographic evoked

pain response is suppressed by spinal cord stimulation in complex regional pain

syndrome: a case report. J Clin Monit Comput; 2015; 1-4 10.

DOI: https://doi.org/10.17979/ejpod.2017.3.1.1577

Enlaces refback

  • No hay ningún enlace refback.