Complex Regional Pain Syndrome
Terms
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- What is the difference between causalgia and RSD?
- Causalgia is a sustained burning pain associated with a nerve injury combined with vasomotor, sudomotor, and late trophic changes. RSD is a latent pain syndrome unrelated to nerve damage.
- What are the different types of CRPS?
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Type 1 (RSD)
Type 2 (Causalgia)
Type 3 (NOS) - What is allodynia?
- Nonpainful stimulus provokes pain.
- What is hyperalgesia?
- Increased response to painful stimulus.
- What is hyperpathia?
- Increased response to painful stimulus that continues after the stimulus is withdrawn.
- What is dyesthesia?
- An unpleasant abnormal sensation.
- What are the main symptoms of neuropathic pain?
- Continous, spontaneous, deep cramping, aching, or throbbing, superficial burning, pinching, or stabbing, and radiating or referred pain.
- Is there one accepted mechanism for CRPS?
- No- there is no one accepted theory. The etiology is poorly understood. It is thought that the pain is unrelated to the SNS.
- What is the incidence of CRPS?
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Female>male
UE>LE
Trauma usually involved
Identifiable lesion >50%
Rare in children/adolescents - What are the prognostication values for the classical clinical presentation of CRPS?
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Stage 1- 3 mos
Stage 2- 3-9 mos
Stage 3- 9 mos or more - What diagnostic criterion factors are used for CRPS?
- Symptoms and Signs (sensory changes, vasomotor changes, sudomotor changes, and motor/trophic changes)
- What is the difference between symptoms and signs?
- Symptoms are what a patient relays to you while signs are what is found when the patient is observed and evaluated.
- What are the symptoms/signs for CRPS?
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Sensory: hyperesthesia/allodynia
Vasomotor: temperature/skin asymmetry and skin color changes
Sudomotor: edema, hyperhydrosis, sweating
Motor/Trophic: decreased ROM - What are the clinical diagnosis criteria for CRPS?
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Disproportionate pain
Symptom factors (3 of 4)
Sign factors (2 or more)
No other diagnosis that explains sx's
Sensitivity of 0.85 and specificity of 0.69 - What diagnostic tests can be used to diagnose CRPS?
- There is no gold standard as far as tests are concerned. Radiology, thermography, plethysmography, and triple phase bone scans can be utilized.
- What are the most common drugs used to treat this disorder?
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Alpha/beta blockers
Sympatholytics
Tricyclic antidepressants
Anticonvulsants
Last two are the most commong ones. - What is the purpose of a Stellate Ganglion nerve block?
- It is attempting to shut off the SNS to help stabalize the system. Used in more chronic pain states when the pain is actually maintained sympathetically.
- What are some treatments utilized for CRPS?
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Nerve blocks
TENS
Edema management
AROM
Functional activities
Splinting
Stretching - What do the different types of TENS do when treating CRPS?
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Conventional- modulates pain
Burst- creates vasodilation
Brief Intense- creates vasoconstriction - Where should electrodes be placed when performing TENS on a patient with CRPS?
- Proximal to the pain- do not place electrodes over spots that are hypersensitive!
- What is important to remember when performing lymphatic drainage or retrograde massage on patients with CRPS?
- It should not be cyclical in nature and one needs to be careful over areas that are hypersensitive.
- Define dystonia.
- Sustained contraction with twisting/repetition/posturing.
- Define myoclonus.
- Involuntary, brief, jerky movements.
- Define tremor.
- Rhythmic contractions at 4-12 Hz
- How is dystonia treated?
- An "external set" (external targeting) and EMG biofeedback are used to get the patient to use the extremity.
- How is allodynia/hypersensitivity treated?
- Desensitization (should be peripheral to cental, fine to coarse, etc.) Should be performed for a minimum of 20 min. and a maximum of 45 min. For the treatment to be effective a total of an hour and a half of treatment should be performed in one 24 hr. period.
- How is vasomotor instability treated when vasoconsticition is present?
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Massage
Heat modalities
Brief Intense TENS
Want to cause vasodilation - How is vasomotor instability treated when vasodilation is present?
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Cryotherapy
Cold immersion (18 degrees for 10-15 min.)
Burst TENS
Want to cause vasoconstriction