Complex Regional Pain Syndrome Flashcards
Define CRPS
pain out of proportion to insult
-autonomic dysfunction, trophic changes and functional impairment
Describe the 2 types of CRPS and a further subtype
CRPS Type 1: without nerve injury
CRPS Type 2: with known nerve injury
Warm or cold types
Describe some of the precipitating events to CRPS
- distal radius fracture
- sprains/strains
- post surgical
- contusion
Describe the clinical presentations of CRPS
unilateral, non-dermatomal
- automic, sensory, motor, psychological, inflammatory response
Describe some of the autonomic presentations of CRPS
- skin color change
- sweating/dryness
- skin temp change
Describe some of the sensory presentations of CRPS
- allodynia
- hyperalgesia
- hyper/hypoesthesia
- hyperpathia
Describe some of the inflammatory presentations of CRPS
- shiny/glossy skin
- nail/hair growth
- hyperkeratosis
- sausage digits
Define allodynia
pain caused by a normally non-painful stimulus
Define hyperalgesia
increased sensitivity to painful stimulus
Define hyperesthesia
increased non-painful sensitivity to non-painful stimulation
Define hyperpathia
exaggerated pain response to painful stimulus
define dyesthesia
unpleasant abnormal sense of touch
Describe causalgia
neuralgic symptoms lingering long after the trace effects of a wound have gone
What may be seen on xray in CRPS
decalcification due to disuse
Describe the epidemiology of CRPS
- mean age 40 at diagnosis
- female 3:1 male
- 80-90% with preceding trauma even as small as an insect bite or needle
What is the mean duration of symptoms prior to a diagnosis of CRPS
30 months
What are the early symptoms of CRPS (1 week - 3 months)
- focal, diffuse, disproportionate pain
- burning, searing, throbbing
- autonomic signs: discoloration
- motor signs: stiffness, weakness, disuse
- inflammatory signs: sweating, edema
What are the middle symptoms of CRPS (3-6 months)
- increased hair growth, shiny skin, cool more so than warm
- stiff, discoloration, disuse, poor sleep
What are some of the late symptoms of CRPS (6-12 months)
- trophic changes
- skin, muscle, SQ, bone atrophy
- contractures, keratosis
- stiffness, discoloration, disuse, poor sleep
What things are associated with poorer prognosis in CRPS
cigarette smoking
delayed diagnosis
What is the timeframe for typical persistent long term morbidity/dysfunction related to CRPS
symptoms persisting past 12 months
What are some of the tests that could be suggested at late stages in CRPS
- x-ray: moth eaten bone
- bone scan: increased activity at site of injury
- thermography, sweat test, stellate ganglion block
typically not sensitive or specific
Describe neurogenic inflammation as it relates to CRPS pathophysiology
cytokines are released after pain signals sent to/from brain and provoke pain, edema, vasodilation, sweating, and other skin/nail changes
Describe the autonomic nervous systems involvement in CRPS pathophysiology
pain becomes independent of sympathetic maintenance rendering useless sympathetic block for treatment
Describe vitamin C involvement in treating/managing CRPS
- 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
Describe some of the primary treatment options for CRPS
- 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
What is one of the most consistently beneficial meds in treating CRPS
calcitonin (thyrocalcitonin) - reduces bone breakdown and pain, as well as some inflammatory cytokines
