Complex regional pain syndrome Flashcards
How is CRPS diagnosed
- noxious event: without overt injury = type 1 and with overt injury = type 2
- pain - hyperalgesia, hyperesthesia, allodynia, hypoesthesia
- disproportionate to original event
common signs of CRPS
- edema, temperature or subomotor abnormalities - current or history
- motor symptomes
- trophic changes
- no other diagnosis
describe how CRPS is a diagnosis of exclusion
- NOT: fibromyalgia, autoimmune disorder, dependent edema
What does CRPS involve
- peripheral nervous system
- central nervous system
- MSK system
- vascular system
- endocrine system
what categories of symptoms must be present for diagnosis of CRPS
need at least 1 symptom in 3/4
- sensation: cloth sensitivity
- vasomotor: blue, red, blotchy limb
- sudomotor/edema: swelling or sweating
- motor: decreased ROM, decreased strength, dystonia, dystrophy
What categories of signs do you need for dx of CRPS
need at least 1 sign in 2/4 categories
- sensation: hyperalgesia, allodynia, deep pain, kinesthetic allodynia
- vasomotor: limb discoloration, temp difference >1.5º C between L and R
- sudomotor/edema: swelling or seating
- motor: decreased ROM, decreased strength, dystonia, dystrophy
What are some other signs of CRPS
- osteopenia
- EMG and NCV: normal in CRPS type 1 can confimr CRPS type 2
What are treatments for CRPS
- increased functional use: prevent weakness, contractures, osteopenia
- encourage them to use painful limb and show that they can move
- pain management
- may include: psychotherapy
meds for CRPS
- cortiosteriods
- gabapentin
- pregabalin
- tricyclic antidepressants
- bisphosphonates
- topical lidocaine
- opioid analgesics
What are some other medications not typically used
- ketamine: NMDA receptor; brain changes that can be positive or negative
- calcitonin to increase CA levels: not better than PT and analgesics for pain
Other chronic pain alternatives
medications
- changes the default mode network psychedelic medications
- DMT
- psilocybin
- cannibis
*DFN is the part of the brain where you day dream, plan or think
What is Spinal cord stimulation
- stimulates DRG to inhibit pain but also blocks all sensation
- used when meds and PT are not adequate
- not first choice of treatment due to requiring surgery and decreased sensation
Other medical treatment techniques for CRPS
medical
- intrathecal pump
- nerve blocks
- stellate ganglion blocks
- permanent sympathetic nerve ablation
- surgical sympathectomy
What can be used to prevent CRPS
- vitamin C: after wrist or ankle fx
- prophylaxis
PT interventions for CRPS
- weight-bearing exercises
- strengthening, stretching
- aerobic training
- balance and coordination
- densitiation
- tens
- yoga
- mirror therapy
- aquatic therapy
Pain exposure PT
- high intensity
- progressive limb loading
- desensitization
- no analgesics, CRPS meds
- 5 visits 1-2 therapist per visit
Pain neuroscience education
what to educate on?
- pt education
- aerobic exercise
- sleep hygiene
- goal setting
- pacing of ADLs
- HIIT/circuits
- weight bearing exercises
- aquatic therapy
- flexibility exercises
virtual mirro therapy and VR training
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- can be used for pain in CRPS
