complex regional pain syndrome 1/4 Flashcards
what is Complex regional pain syndrome?
Increase sympathetic activity causes release of norepinephrine in periphery and leads to vasoconstriction of blood vessels resulting in pain and increase sensitivity to peripheral stimulation
what are general symptoms of Complex regional pain syndrome?
Intense burning, chronic pain in affected extremity that eventually spreads in proximal direction
Hypersensitivity to light touch, heat and/or cold in region
Warmth, swelling, redness over region
Motor disorders- Tremors, spasms, atrophy
3 stages of progression
Causes of Complex regional pain syndrome?
Occurs after 5% of injuries
Injury to affected extremity causes injured sensory nerve fibers at one somatic level, initiate sympathetic efferent activity at many segmental levels
Exact etiology unknown
Precautions with Complex regional pain syndrome type 1?
Heat or cold modalities
Deep friction massage- increase edema
Interventions for Complex regional pain?
Use involved extremity as tolerated
Patient education, skin care, edema - compression garments
Pain control, Desensitization, Retrograde massage
Range of motion, stretching, Joint mobilization
light exercise, light WB exercise - decrease sympathetic tone, increase circulation, maintain ROM and strength, increase fxnl use of extremities
Functional activity training
TENS
Ice and/or heat
What is the patient population for complex regional pain syndrome? Age, sex?
Affects all ages
Most likely 35 to 60 years old
Females 3x more than males
What are some predisposing factors for complex regional pain syndrome?
Trauma, surgery CVA, TBI Repetitive motion disorders Lower motor neuron and peripheral nerve injuries Women 3x > males
What are symptoms of acute stage, stage 1 early in complex regional pain syndrome?
Level of pain greater than expected based on type of trauma to tissue Discoloration Dryness Edema Stiffness Skin warm
What are symptoms of dysphoric stage, stage 2 in complex regional pain syndrome?
worsening and constant pain
Edema
Trophic skin changes
Xray- bone loss, osteoporosis, subchondral bone erosion in affected extremity
What are symptoms of a trophic stage, stage 3 in complex regional pain syndrome?
Pain spreads proximally Hardened edema Decreased limb temperature Atrophy fingertips or toes X-ray- demineralization and joint ankylosis
What imaging is used for diagnosis Of complex regional pain syndrome?
X-rays, Three phase bone scan
Thermographic studies
Laser Doppler flowmetry
How is complex regional pain syndrome diagnosed?
Physical exam
patients complete medical history with history on course of illness
What is the prognosis of complex regional pain syndrome?
Better prognosis if treatment initiated within the first six months of disease process
Many patients improve and complex regional pain syndrome resolves while others progresses and becomes disabling disorder
-spontaneously resolved
-ongoing symptoms last for years
-pattern of remission and recurring symptoms after subsequent injuries
What medication are used in the management a complex regional pain syndrome?
NSAIDs, corticosteroids – pain relief for early stage
Amitriptyline - sleep
Calcium channel blockers - increase peripheral circulation
Baclofen - long-term use for motor function
Biphosphonate - later stage to combat bone loss
What surgeries are used in the management of complex regional pain syndrome?
Sympathetic blocks or sympathectomy to alleviate pain
