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PHTY APPB > Chronic Regional Pain Syndrome > Flashcards

Chronic Regional Pain Syndrome Flashcards

1
Q

What is the main characteristic of CRPS?

A

Severe pain disproportionate to coinciding event

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2
Q

What are the symptoms for CRPS?

A 
Sensory disturbances
Temperature changes
Abnormal sweating patterns
Swelling and oedema 
Reduced ROM 
Movement abnormalities
Trophic changes
Localised OP changes and body perceptions
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3
Q

How do patients with CRPS describe pain?

A

Continuous most severe pain

  • Intensity high
  • Painful response from non-painful stimulus
  • Hyper pain response
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4
Q

How do we diagnose CRPS?

A

Assessment of sensory motor autonomic skin and bone abnormalities in affected limb
History: No correlation between symptoms and cause of injury
Present with mixed pain

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5
Q

Which group is more likely to have CRPS?

A

Women 3-4x more

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6
Q

What happens when a tissue is injured?

A
  • Activate release of neurotransmitter from primary neuron
  • Release from the immune cells of inflammatory mediators
  • Vasodilation response at nerve endings
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7
Q

What is the process that causes pain?

A
  1. Peripheral activation of primary neurons
  2. Sensory signals travel by primary afferent fibres into dorsal horn
  3. Synapses with intrinsic spinal horn neurons - 2nd order neurons
  4. Signals to many areas of the brain
  5. Down modulation of signals
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8
Q

What are the 4 pain mechanisms of CRPS?

A
  • Aberrant (neurogenic) inflammation
  • Vasomotor dysfunction
  • Nociceptive sensitization
  • Maladaptive neuroplasticity
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9
Q

What is Aberrant Inflammation?

A
  • Reduced sympathetic outflow causing vasodilation

- Increased peripheral cytokine and chemokine leading to activation of nociceptive sensory neurons, proinflammatory

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10
Q

What is vasomotor dysfunction?

A
  • Endothelial dysfuncton/damage –> vasoconstriction

- Peripheral cytokine and chemokine

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11
Q

What is nociceptive sensitisation?

A
  • Central and peripheral

- Reduced endogenous pain control –> allodynia, hyperalgesia, motor dysfunction, disruption in perception

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12
Q

Maladaptive neuroplasticity

A
  • Ipsi and contralateral cortical changes

- Neural degeneration of C and A-d fibres –> allodynia, hyperalgesia, motor dysfunction, disruption in perception

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13
Q

What are the immune alterations associated with CRPS?

A
  • Systemic- anti autonomic immunoglobulin G autoantibodies high prevalent
  • Mild pro-inflammatory states in affected skin, muscle, bone and peripheral blood
  • No systemic inflammatory signs (blood)
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14
Q

What are 3 subtypes of CRPS?

- not useful much anymore

A

I - no nerve damage
II - nerve damange
NOS - Not useful, as it is being defined around mechanisms

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15
Q

Cold Vs Warm models

A

Cold: Cold, blue, dry, less oedematous
Warm: Warm, red, sweaty, oedematous

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16
Q

What is the way to measure subsets of CRPS?

A

Severity
CRPS score, clusters in CSS may represent subsets such as autonomic dysfunction subset

Refer to CRPS severity score

17
Q

What are the risk factors?

A

Demographic and trauma RF
- Unusually high level of pain during week of trauma
- Female?
- Fracture, surgery, soft tissue injury
Psychological risk factors
- Alexithymia (differentiation between emotion and bodily sensations
- PTSD

18
Q

What does the subjective assessment for CRPS consist of?

A
  • Same MS questions
  • Chronic pain questions
  • Budapest criteria
  • Questioning regarding body schema e.g. body perception
19
Q

What makes up the physical examination for CRPS?

A

Budapest criteria
Clinical sensory testing
Balance, coordination, gait, weightbearing
Body schema testing

20
Q

Category 1: sensory

What are the signs and symptoms and clinical diagnosis?

A

Symptoms: Hyperaesthesia, allodynia
Signs: Hyperalgesia to pinprick, allodynia to light touch, deep somatic pressure or joint movement

Clinical diagnosis: 1+ symptoms in 3 categories, 1+ signs in 2 categories

21
Q

Category 2: Vasomotor

What are the signs and symptoms and clinical diagnosis?

A

Symptoms/signs:

  • skin temperature asymmetries
  • skin colour changes
  • skin colour asymmetry

Clinical diagnosis same as sensory

22
Q

Category 3: Sudomotor or Oedema

What are the signs and symptoms and clinical diagnosis?

A

Symptoms/signs

  • Oedema
  • Sweating changes
  • Sweating asymmetry

Same clinical diagnosis numbers

23
Q

Category 4: Motor or Trophic

What are the signs and symptoms and clinical diagnosis?

A

Symptoms/signs

  • Decreased ROM
  • Motor dysfunction: weakness, tremor, dystonia
  • Trophc: hair, nails, skin
24
Q

What are differences in S/s of CRPS vs non CRPS?

A

Allodynia: 83% vs 44%
Pinprick hyperalgesia: 89% vs 37%
1.5deg temp diff: 59% vs 15%

25
Q

What are questions that are helpful for differential diagnosis?

A
  • Has extent of primary pathology been recognized and managed (carpal instability following Colles fracture)
  • Secondary pathology present?
  • Psychological/psychiatric symptoms present?
26
Q

What are the 5 stages to multidisciplinary treatment?

A 
Engagement
Education
Activation
Body perception
Psychological practice
27
Q

What are the factors of early diagnosis?

A 
Pain reduction
Oedema reduction
Fear reduction
Sensory motor reintegration
Address impairments
28
Q

What makes up education in treatment for CRPS?

A 
Suited to person
Multimodal
Analogies
Reassurance
Realistic journey
29
Q

What makes up activation in treatment for CRPS?

A

Graded exposure
Pacing
Patient led
Specific –> Functional

30
Q

What makes up body perception in treatment for CRPS?

A

Graded motor imagery: laterality, imagine movements, mirror therapy
Mindful movement
Movement with relaxation
Desesnitisation

31
Q

What makes up body perception in treatment for CRPS?

A

Graded motor imagery: laterality, imagine movements, mirror therapy
Mindful movement
Movement with relaxation
Desesnitisation

32
Q

How to conduct psychological practice for CRPS?

A
  • Communication and language
  • Address fear avoidance/catastrophising
  • Belief system
  • CBT
  • motivational interviewing
  • Patient led goals
  • Sense of self

PHTY APPB (10 decks)

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