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What is CRPS?
Complex regional pain syndrome (CRPS) is a
debilitating painful
disorder of the extremities that comprises
pain, autonomic dysfunction, edema, dystrophy, atrophy, and
movement disorder. It frequently begins following an injury,
surgery, or vascular event (myocardial infarction or stroke),
but also may occur without an obvious previous
event.
The pain is of a severity greater than that expected from the
inciting injury.
The name CRPS
was created at an international consensus conference of the
International Association for the Study of Pain (IASP) in 1994,
to head a group of disorders: reflex
sympathetic dystrophy, algodystrophy, shoulder-hand syndrome,
shoulder-hand syndrome variant, Sudeck's atrophy, transient
osteoporosis, acute atrophy of bone, and causalgia.
Two types of CRPS
have been recognized: CRPS type I, where no specific nerve
injury can be identified, and CRPS type II, where a definable
nerve lesion is present.
CRPS is a tremendous problem
for both patients and physicians, with functional disability and
severe pain challenging present therapeutic resources. Numerous
treatment modalities have been proposed for the management of
CRPS. These include pharmacologic therapies, physiotherapy,
behavioral modification and psychotherapy, neuromodulation, and
miscellaneous complementary and alternative therapies. When the
patients do not respond to any of these above treatments, Dr.
Duarte and Dr. Kux have indicated Endoscopic Thoracic
Sympathicotomy (ETS) surgery using their own approach.
What is ETS?
The endoscopic
access to the neurovegetative nervous system was first made by
Dr. E. Kux in Davos (Switzerland) in 1937 to treat pulmonary
tuberculosis. After that, he spread the indications for a vast
series of illnesses. The majority of these indications
disappeared either because the treatment didnt work or there
was a better understanding of the pathophysiology of the disease
and the development of specific pharmacologic therapy. However,
some specific diseases have the ETS as the best solution so far,
for example, hyperhidrosis, blushing, and CRPS. In 1970 Dr.
Peter Kux published a series of 61 patients who had CRPS and
were successfully treated with ETS. In a recent review of the
last 5 years of CRPS patients operated on with video-ETS,
partners Dr. Joćo Bosco Vieira Duarte and Dr. Peter Kux
confirmed that the ETS surgery, like they performed, is a
low-cost and efficient treatment to relieved pain, change the
functional status and improve the quality of life in patients
with CRPS, stages II and III.
The surgery allowed the patients to reduce or stop taking all
the medicine that they were using to combat pain, and
immediately start physiotherapeutic care to improve the strength
and motor function of the limb. They were able to resume
activities that were not possible before the surgery.
What is the Recovery Time?
With the Duarte-Kux
technique, the surgery is usually performed on an outpatient
basis. The pain usually disappears during rest in patients
operated on, allowing the return to physiotherapeutic care. Some
patients report pain after a few minutes during repeated
movement of the limb affected, but the intensity is lower than
before surgery. Analgesics usually are not necessary.
Hyperesthesia, allodynia, vasomotor changes, temperature
abnormalities, sweating abnormalities, and skin color
alterations usually disappear after the surgery.
Patients after the
surgery report an improvement in their overall mood, performance
of daily activities, and a return to activities that were
impossible before the treatment. They also report an improvement
in their physical conditions, which obviously reflect a better
quality of life.
About The
Surgeon:
 |
Belo
Horizonte, Brazil
Joćo
B. V. Duarte
M.D.
Since 1990, Dr. Joćo B.
V. Duarte has been the partner of Dr. Peter Kux,
and they have performed more than 7,000 ETS surgeries. Dr.
Kux is a celebrated pioneer in the field who began
performing the ETS surgical technique in 1947 and has been
further developing ETS in Brazil since 1954. His technique
is now being used by other ETS surgeons around the world.
In recent
years, Dr. Duarte and Dr. Kux have developed a specific and
successful technique to diminish the incidence of
compensatory sweating. With their new technique, performed
on an outpatient basis, they have treated palmar, axillar,
and facial hyperhidrosis, with a chance to reduce plantar
hyperhidrosis in 94% of the patients operated on, when it is
associated with the other conditions. Facial Blushing,
Complex Regional Pain Syndrome, and Chronic non-infectious
rhinitis can also be treated successfully with this new
method. Usually, patients are able to return to their normal
activities the day after the surgery. You can now have
surgery in Brazil by one of the world's most experienced ETS
surgeons.
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