Subcutaneous 5% glucose injection treatment type 2 complex regional pain syndrome 1 case

Complex regional pain syndrome (COMPLEX regional pain syndrome, CRPS) refers to a spontaneous, regional chronic pain that is aggravatedThe pain area does not conform to the nerve-dominated cortex region, the pain degree is not proportional to the time and severity of the inducing factors, and is accompanied by different degrees of skin changes, autonomic nerve dysfunction, changes in skin sensation, changes in motor function and atrophyTHERE ARE TWO TYPES OF CRPSThe first type is oldly known as reflexive intercourseal sensibility (reflex manostrophy, RSD); Peripheral nerve damage diagnosed with neuroelectrophysiological or physical examination is classified as CRPSIICrPS has complex pathogenesis, including neurogenic inflammation and peripheral sensitivity, spinal back-angle inflammatory response and central sensitivity, oxidative stress response, autoantibody formation, etcin CRPS whether or not accompanied by peripheral nerve damage, are involved in neurogenic inflammatory response, causing the release of inflammatory reaction neuropeptides, leading to the activation of pain receptors, causing CRPS characteristic pain abnormalities and pain sensitivityNonsteroidal anti-inflammatory drugs for peanut tetraoleic acid inflammatory reaction pathway, by inhibiting cyclic oxidase, has a better anti-inflammatory effect, but if at the same time from the source to inhibit the release of inflammatory reaction neuropeptides, should be able to achieve a better anti-inflammatory effecta small number of studies have shown that injections of 5% glucose or right-handed sugar (5% dextrose) under the skin or ultrasound-guided nerves show better therapeutic effect on peripheral nerve pain, which may inhibit the release of neuropeptides that promote inflammatory responsesThis report tried to apply 5% glucose subcutaneous injection to a crPSII patient who was ineffective in long-term treatment, and achieved better therapeutic results, the report analyzed below1Case introductionfemale, 39 years old, in January 2018 due to the fall caused by "right tibia bone fracture", line "right tibia fracture cut to reset intra-fixation surgery." In May 2018, there was a right ring, small finger numbness, line "myoelectromyogram examination prompt: mild damage to the right ruler nerve." The symptoms were further aggravated in July 2018 after a fixed removal in the arm plexus anaesthetic, joint relief, right-hand nerve prosthesis emigrationafter surgery 2 turnover to rehabilitation medical treatment, when transferred to the right hand ruler nerve sensory control area of light tactile needle sting loss, elbow active flexive activity range: 85 degrees - 30 degrees - 0 degreesRehabilitation treatment 1 week later began to appear right elbow extension side and the entire hand pain (VAS 4), accompanied by local swelling, fever, sweating, abnormal skin pain, weak strength symptomsGive 30mg oral tablets, 1 daily, while cold treatment for pain sites, ultrasound and joint exercise therapyAfter 2 and a half months, the patient's symptoms did not improve, and the pain symptoms were further aggravated (VAS-6), and the range of flexive activity of the elbow was further limited: 70 degrees -35 degrees -0 degrees, after signing the informed consent form on September 1, 2018, attempted to give 5% glucose injection (1 to 2 ml/injection point) in the back of the elbow (two third-pointers between the inside and outside) in the back of the elbowThe next day the pain symptoms were reduced to VAS 3, and the symptoms of sweating disappearedAfter 1 week before re-injection VAS 2, hand and elbow extension pain abnormality and weakness loss, elbow and hand swelling fades, elbow active flexion activity range: 85 degrees - 20 degrees - 0 degreesThe symptoms did not recur since two injections, and the range of elbow activity gradually improved2Discussionthe case on the basis of maintaining the original treatment to try the post-cutter 5% glucose injection, hoping to further inhibit the release of inflammatory reaction neuropeptides on the basis of oral nonsteroidal anti-inflammatory drugs, and thus achieve better anti-inflammatory effectResults 50% pain relief was achieved the day after the first injection, and the symptoms of sweating disappearedSubsequently, the patient's symptoms and function sashimi improved further, not repeatedWhen the body is harmed by stimulation, C fiber through axonary reflexes or back root reflexes activate peripheral nerve endings, promote the release of neuropeptides, neuropeptides and immunomodulating cells interaction, resulting in the release of inflammatory cytokines, causing local vascular dilation, protein overflow and other inflammatory reactions, while causing peripheral sensitivity, this process is called "neurogenic inflammation."the nerve surface of the release of neuropeptides has a receptor protein called transient receptor potential vanilla acid receptor I (transient receptor potential vanilloid-Type 1, TPRV1), which, when overactivated, causes the release of the neuropeptide that promotes inflammatory responseTPRV1 is regulated by the pre-synaptic calcium channel, and glucose may achieve the effect of lowering TPRV1 by inhibiting the activation of the pre-synaptic calcium channel5% glucose has no damage to nerves, and injecting it into the peripherals of nerves can theoretically inhibit the neurogenic inflammatory response, thus achieving the goal of reducing painManiquis and others randomly divided 35 non-surgical patients with chronic low back pain into experimental and control groups, which received 10 ml 5% glucose tube injection treatment, and the control group received 10 ml of physiological saline tube injection treatmentThe pain relief level was better in the experimental group at 15min, 2h, 4h and 48h after injection, but there was no significant statistical difference between the two groups at 2 weeksWu and other 49 patients with light to moderate carpaltunnel syndrome were randomly divided into experimental group and control group, each group of 30 wrist joints, the experimental group of patients received 5 ml 5% glucose nerve injection under ultrasound guidance, control group received the same amount of physiological saline injection In the following 1, 3, and 6 months of observation, the experimental group was better than the control group in terms of pain, degree of disability, neuroelectrophysiological examination, and mid-range nerve cross-sectional area Although the exact treatment mechanism for CRPS is not yet clear with 5% glucose subcutaneous injection, inhibiting neurogenic inflammatory responses may be an important part of the process At the same time, its clinical efficacy is still to be further explored However, its operation is simple, low price, and 5% glucose as intravenous drugs in clinical application is very safe, worthy of further clinical research and further promotion in the majority of primary medical institutions