CRPS: Complex Regional Pain Syndrome Flashcards
CRPS: What is it?
- Formerly RSD
- Regional, post-traumatic, neuropathic pain prob that most often affects 1 or more limbs
- *Challenging to treat BUT better prognosis when dx’d EARLY ON
CRPS in Children called______
AMPS
Amplified MSK Pain Syndrome
*usually involves entire body
CRPS
Clinical Features:
- spontaneous pain
- edema
- hypERalgesia
- temp or sudomotor changes
- motor function abnorms
- autonomic changes**
CRPS is ______
COMPLICATED!
not easy to understand
Pathophysiology of CRPS
- Not well understood
-
Multiple Mechanisms such as:
- Altered cutaneous nerve innervation after injury
- Neurogenic inflammation
- Central Sensitization* (explained on other card)
- Peripheral Sensitization* (explained on other card)
Pathophysiology of CRPS
Central Sensitization
Explain further
- Persistent or intense noxious input resulting from tissue damage or nerve injury triggers inc’d excitability of nociceptive neurons in the SC
Central Sensitization is mediated by:
Central Sensitization is mediated by the nociception-induced release of neuropeptides
Central Sensitization results in:
Results in exaggerated responses to nociceptive stimuli (hyperalgesia) and permits normally nonpainful stimuli such as light touch or cold to activate nociceptive pathways
Peripheral Sensitization
Explain further
Initial tissue trauma itself also elicits local peripheral sensitization
Type I CRPS
occurs AFTER injury or illness that did not directly affect nerve
*Accts for 90% of CRPS cases
Type II CRPS
Occurs after DISTINCT nerve injury
*very localized
Risk Factors for developing CRPS:
6:
- Crush injury*→ common
- Fx*→ common
- TBI
- CVA
- Post-op
- AFter LMN injury* (Type II’s)
Generally ______ stages of CRPS
3
Prognosis of CRPS is BETTER when found in this stage
Stage 1
*usually 1-3mos
Stage 1 CRPS
*usually 1-3mos
*usually 1-3mos
- Severe burning or aching pain that INCs w/ even a very slight touch or breeze
- Fluctuations in skin temp bw hot/cold
- Rapid hair and nail growth initially
- Mm spasms and jt pain
- Changes in skin’s color, appearance, texture
- pale, red, purple, mottled, and appears thin and shiny*** see pics
- Inc’d sweating
- in a particular limb
Stage 2 CRPS
*typ 3-6mos
*typ 3-6mos
- Skin cont’s to change and the nails become brittle and cracked
- Lvl of pain INC’s
- Hair growth SLOWS DOWN**
- Jts stiffen and muscles weaken
Stage 3 CRPS
*diff/too painful to move affected limb
- If CRPS remains untreated to this point→ diff or too painful to move affected limb
- Mm’s and tendons waste (atrophy) and contract→ contractures (see pics) of hand/foot affected
- These changes can become permanent
Medical Mgmt of CRPS:
- pain relievers
- antidepressants & anticonvulsants
-
tx nerve pain
- Ex. Gabapentin (common)
-
tx nerve pain
- Corticosteroids to reduce inflammation
- *Esp stage I
- Bone loss meds bc atrophy
- Sympathetic nerve blocking meds
- Esp severe cases
- Intravenous ketamine*
- to reset NS
PT Interventions for CRPS
-
Stress loading for Jt approximation
- want mechanoreceptors to fire
- Biofeedback to allow for improved body awareness (more on this in other card)
-
Graded Motor Imagery
-
Laterality cards for L & R Discrimination
- flashcards
- ID L&R limbs
- reteaches brain
- ID L&R limbs
- flashcards
-
Mirror Tx
- affected side into mirror box→ non-affected side moves and tricks affected limb into moving
-
Laterality cards for L & R Discrimination
*
PT Interventions for CRPS
More on Biofeedback for body awareness
- Brain remaps body
- Brain cannot ID affected limb= neglect
- So…biofeedback to bring back awareness
- Brain cannot ID affected limb= neglect
