26. Complex regional pain syndrome Flashcards

1
Q

What do you understand by the term ‘complex regional pain syndrome’?

A

Diagnostic criteria for CRPS

According to the Budapest criteria, there are four criteria that
need to be satisfied for diagnosis.

The first two are:
» At least one symptom in at least three of the four symptom categories.

> > At least one sign in at least two of the four sign categories.

The remaining two criteria are the

> > Continuing pain disproportionate to inciting event.

> > No other diagnosis that can explain symptoms and signs

CRPS II
1. Continuing pain, allodynia or hyperalgesia following a nerve injury, not
necessarily limited to the distribution of the nerve.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the symptoms

A

Sensory:

  • Hyperaesethesia.
  • Allodynia.

Vasomotor:
* Temperature asymmetry.

  • Skin colour changes.
  • Skin colour asymmetry.

Sudomotor/Oedema:
* Oedema.

  • Sweating changes.
  • Sweating asymmetry.

Motor/trophic:
* Decreased range of motion.

  • Motor dysfunction
    (weakness, tremor, dystonia).
  • Trophic changes
    (hair, nail, skin).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

List the signs of complex regional pain syndrome (CRPS)

A

Sensory:
* Hyperalgesia (to pinprick).

  • Allodynia
    (to light touch or deep somatic pressure or joint. movement).

Vasomotor:
* Temperature asymmetry.

  • Skin colour changes.
  • Skin colour asymmetry.

Sudomotor/Oedema:
* Oedema.

  • Sweating changes.
  • Sweating asymmetry.

Motor/trophic:
* Decreased range of motion.

  • Motor dysfunction (weakness, tremor, dystonia).
  • Trophic changes (hair, nail, skin).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Allodynia

A

Pain from a stimulus that does not normally cause pain.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Hyperalgesia

A

A heightened response to a stimulus, which is normally
painful.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Hyperpathia

A

Severe pain in an area of numbness.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the available treatments for CRPS?

A
  1. Patient information and education:
  2. Physical and vocational rehabilitation:
  3. Pain relief (medication and procedures):
  4. Psychological interventions:
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q
  1. Patient information and education:
A

There are four management ‘pillars’; start early and aggressively for best outcome:

Outcome may be improved by full patient education about what
CRPS is and how it is to be managed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q
  1. Physical and vocational rehabilitation:
A
  • Physiotherapy: desensitisation,
    gradual weight bearing, fine motor exercises,
    aerobic conditioning, TENS, hydrotherapy.
  • Oedema control strategies.
  • Occupational therapy:
    pacing prioritising planning, vocational
    support, relaxation techniques.
  • Multidisciplinary pain management.
  • Motor therapy: mirror visual feedback.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q
  1. Pain relief (medication and procedures):
A
  • Start with amitryptiline, move on if not effective or not tolerated to duloxetine, gabapentin or pregabalin.
  • Tramadol for rescue only, not long term.
  • Consider capsacin cream for
    localised neuropathic pain or to avoid
    oral treatments.
  • Bisphosphonates:
    pamidronate 60 mg single intravenous dose for
    patients with CRPS less than six months’ duration to help maintain bone integrity and function.
  • Spinal cord stimulation:
    NICE approved for pain persisting greater
    than six months.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q
  1. Psychological interventions:
A
  • Cognitive behavioural therapy:
    ensure that fear does not reduce
    limb movement and use which
    can exacerbate disuse atrophy.
  • Possible psychiatric issues and
    other life stressors should be
    sought and dealt with.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly