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Neuro > Complex Regional Pain Syndrome > Flashcards

Complex Regional Pain Syndrome Flashcards

1
Q

Define CRPS

A

pain out of proportion to insult

-autonomic dysfunction, trophic changes and functional impairment

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2
Q

Describe the 2 types of CRPS and a further subtype

A

CRPS Type 1: without nerve injury

CRPS Type 2: with known nerve injury

Warm or cold types

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3
Q

Describe some of the precipitating events to CRPS

A
  • distal radius fracture
  • sprains/strains
  • post surgical
  • contusion
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4
Q

Describe the clinical presentations of CRPS

A

unilateral, non-dermatomal
- automic, sensory, motor, psychological, inflammatory response

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5
Q

Describe some of the autonomic presentations of CRPS

A
  • skin color change
  • sweating/dryness
  • skin temp change
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6
Q

Describe some of the sensory presentations of CRPS

A
  • allodynia
  • hyperalgesia
  • hyper/hypoesthesia
  • hyperpathia
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7
Q

Describe some of the inflammatory presentations of CRPS

A
  • shiny/glossy skin
  • nail/hair growth
  • hyperkeratosis
  • sausage digits
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8
Q

Define allodynia

A

pain caused by a normally non-painful stimulus

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9
Q

Define hyperalgesia

A

increased sensitivity to painful stimulus

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10
Q

Define hyperesthesia

A

increased non-painful sensitivity to non-painful stimulation

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11
Q

Define hyperpathia

A

exaggerated pain response to painful stimulus

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12
Q

define dyesthesia

A

unpleasant abnormal sense of touch

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13
Q

Describe causalgia

A

neuralgic symptoms lingering long after the trace effects of a wound have gone

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14
Q

What may be seen on xray in CRPS

A

decalcification due to disuse

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15
Q

Describe the epidemiology of CRPS

A
  • mean age 40 at diagnosis
  • female 3:1 male
  • 80-90% with preceding trauma even as small as an insect bite or needle
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16
Q

What is the mean duration of symptoms prior to a diagnosis of CRPS

A

30 months

17
Q

What are the early symptoms of CRPS (1 week - 3 months)

A
  • focal, diffuse, disproportionate pain
  • burning, searing, throbbing
  • autonomic signs: discoloration
  • motor signs: stiffness, weakness, disuse
  • inflammatory signs: sweating, edema
18
Q

What are the middle symptoms of CRPS (3-6 months)

A
  • increased hair growth, shiny skin, cool more so than warm
  • stiff, discoloration, disuse, poor sleep
19
Q

What are some of the late symptoms of CRPS (6-12 months)

A
  • trophic changes
  • skin, muscle, SQ, bone atrophy
  • contractures, keratosis
  • stiffness, discoloration, disuse, poor sleep
20
Q

What things are associated with poorer prognosis in CRPS

A

cigarette smoking

delayed diagnosis

21
Q

What is the timeframe for typical persistent long term morbidity/dysfunction related to CRPS

A

symptoms persisting past 12 months

22
Q

What are some of the tests that could be suggested at late stages in CRPS

A
  • x-ray: moth eaten bone
  • bone scan: increased activity at site of injury
  • thermography, sweat test, stellate ganglion block

typically not sensitive or specific

23
Q

Describe neurogenic inflammation as it relates to CRPS pathophysiology

A

cytokines are released after pain signals sent to/from brain and provoke pain, edema, vasodilation, sweating, and other skin/nail changes

24
Q

Describe the autonomic nervous systems involvement in CRPS pathophysiology

A

pain becomes independent of sympathetic maintenance rendering useless sympathetic block for treatment

25
Q

Describe vitamin C involvement in treating/managing CRPS

A
  • 500mg QD x50 days reduces CRPS incidence after distal radius fracture
  • can be taken after traumatic injury (distal radius fracture) or surgery for 2 mos as precaution
26
Q

Describe some of the primary treatment options for CRPS

A
  • early PT/OT (active>passive)
  • mirror box therapy
  • NSAIDs, narcotics (also gabapentin, SSRI, TCA, steroids, local anesthetics)
  • muscle relaxers/anti-spasmodics for spasms and dystonia
  • surgical as last resort
27
Q

What is one of the most consistently beneficial meds in treating CRPS

A

calcitonin (thyrocalcitonin) - reduces bone breakdown and pain, as well as some inflammatory cytokines

Neuro (22 decks)

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