Complex Regional Pain Syndrome Flashcards
1
Q
Description
A
- Type of chronic pain syndrome in which ANS is not under voluntary control
- Any diagnosis can turn into CRPS
- Injury can result in sympathetic overflow
- Progress is progressive without intervention
2
Q
Prevalence/risk factors
A
- Women 3-4x more likely
- Smokers
- Ages 30-55 (average age 40)
- Hx of distal radius fracture or peripheral nerve injury
- Other inflammatory disorders
- UE more common than LE in adults
- 90% of cases have some kind of trauma
3
Q
Symptoms
A
- Vary widely
- Prolonged or excessive pain out of proportion to injury
- Heaviness or stiffness of limb
- Sensitivity to heat or cold
- Swelling
- Changes in skin temperature or texture
- Hypertrichosis: abnormal hair growth that occurs in response to irritated cutaneous nerve
- Atrophy
- Osteopenia
- Insomnia/emotional disturbances
- Dystonia/motor planning difficulty
4
Q
Pain terms related to CRPS
A
- Hyperpathia: abnormal painful reactions to a stimulus (umbrella term)
- Allodynia: pain in specific dermatome distribution from a stimulus that is not normally painful
- Hyperalgesia: increased sensitivity to pain; may be caused by damage to nociceptors or peripheral nerves; more extreme pain than allodynia
- Hyperesthesia: a condition that involves an abnormal increase in sensitive stimuli of the senses
5
Q
Autonomic terms related to CRPS
A
- Vasomotor: dilation and constriction of blood vessels
- Sudomotor: autonomic function associated with sweat glands
- Trophic: changes in tissue due to loss/reduction of nerve and/or blood supply
6
Q
Types of CRPS
A
- Type 1: occurs after an illness or injury that did not directly damage peripheral nerves of affected limb
- Type 2: there is an identifiable peripheral nerve injury
7
Q
Diagnostic testing
A
- Bone scan
- X-rays
- Thermography
8
Q
Stages of CRPS
A
- Stage 1: up to 3 months (increased hair & nail growth, changes in sweating, increased pain, skin becomes thin and dry, color change to red and warm but may quickly become cold, can have swelling)
- Stage 2: 3-6 months (decreased hair growth, swelling could spread, stiffness, muscle atrophy, fingers become pointy)
- Stage 3: 6 months onward (changes are irreversible, severely limited mobility of affected area)
9
Q
Conservative treatment
A
- Modalities (no extreme temps.)
- Exercise (multiple short stints throughout day)
- Edema control
- Desensitization
- Imagery and relaxation
- Mirror box
- Sensory discrimination
- Neural mobilization techniques (if tolerable)
10
Q
MCP squeeze test
A
- Grasp MCP & lightly squeeze
- Positive if patient pulls away
11
Q
Drop & swipe test
A
- Part 1: open alcohol swab package and squeeze until alcohol drops on affected limb; positive for thermal hyperalgesia if pain is dramatically increased in 10-60 sec
- Part 2: swipe alcohol pad lightly over affected area; positive for mechanical hyperalgesia if pain is dramatically increased or patient pulls away
12
Q
Contraindicated treatments
A
- PROM (until able to tolerate without pain)
- Joint mobilization
- Splinting and casting to immobilize
13
Q
Watson Carlson stress loading treatment
A
- Scrub (compression): use towel or sponge to weight-bear into table and move back and forth
- Carry (distraction): carry 1-2 lb object with arm straight
- Complete these exercises 3x/day, starting with 3 min and increasing to 10-15
14
Q
Graded motor imagery
A
- Phase 1: establish laterality (left/right discrimination), diaphragmatic breathing, meditation, biofeedback
- Phase 2: imagery (imagine the extremity performing motion–static, dynamic, doing a task)
- Phase 3: mirror therapy
15
Q
Pharmacological treatment
A
- Almost always combined with therapy
- Anticonvulsants
- Calcium channel blockers
- Systemic corticosteroids
- Antidepressants/SSRIs
- Anti-inflammatories and analgesics
- Adrenergic
