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    Complex Regional Pain Syndrome

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    Janine Rust
    Complex Regional Pain Syndrome (CRPS) is a chronic pain disorder that usually starts as an injury to an extremity and then develops into chronic pain, inflammation, and mobility issues. There are two types of CRPS, distinguished by whether there is direct nerve damage. Symptoms may include pain, swelling, temperature changes, and hypersensitivity. While the cause is unknown, it likely involves interactions between the central and peripheral nervous systems and inflammation. Diagnosis involves ruling out other conditions through exams and comparing limbs. Treatment includes medications, physical therapy techniques like TENS and mirror therapy exposure, and in severe cases, spinal cord stimulation. Prognosis depends on early and aggressive treatment, as later stages can lead to irreversible changes like muscle at

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    Complex Regional Pain Syndrome

    Uploaded by

    Janine Rust
    53 views24 pages
    Complex Regional Pain Syndrome (CRPS) is a chronic pain disorder that usually starts as an injury to an extremity and then develops into chronic pain, inflammation, and mobility issues. There are two types of CRPS, distinguished by whether there is direct nerve damage. Symptoms may include pain, swelling, temperature changes, and hypersensitivity. While the cause is unknown, it likely involves interactions between the central and peripheral nervous systems and inflammation. Diagnosis involves ruling out other conditions through exams and comparing limbs. Treatment includes medications, physical therapy techniques like TENS and mirror therapy exposure, and in severe cases, spinal cord stimulation. Prognosis depends on early and aggressive treatment, as later stages can lead to irreversible changes like muscle at

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    Complex Regional Pain Syndrome (CRPS) is a chronic pain disorder that usually starts as an injury to an extremity and then develops into chronic pain, inflammation, and mobility issues. There are two types of CRPS, distinguished by whether there is direct nerve damage. Symptoms may include pain, swelling, temperature changes, and hypersensitivity. While the cause is unknown, it likely involves interactions between the central and peripheral nervous systems and inflammation. Diagnosis involves ruling out other conditions through exams and comparing limbs. Treatment includes medications, physical therapy techniques like TENS and mirror therapy exposure, and in severe cases, spinal cord stimulation. Prognosis depends on early and aggressive treatment, as later stages can lead to irreversible changes like muscle at

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    53 views24 pages

    Complex Regional Pain Syndrome

    Uploaded by

    Janine Rust
    Complex Regional Pain Syndrome (CRPS) is a chronic pain disorder that usually starts as an injury to an extremity and then develops into chronic pain, inflammation, and mobility issues. There are two types of CRPS, distinguished by whether there is direct nerve damage. Symptoms may include pain, swelling, temperature changes, and hypersensitivity. While the cause is unknown, it likely involves interactions between the central and peripheral nervous systems and inflammation. Diagnosis involves ruling out other conditions through exams and comparing limbs. Treatment includes medications, physical therapy techniques like TENS and mirror therapy exposure, and in severe cases, spinal cord stimulation. Prognosis depends on early and aggressive treatment, as later stages can lead to irreversible changes like muscle at

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    Complex Regional Pain

    Syndrome (CRPS)

    Objectives
    At the conclusion of the presentation, the
    audience should be able to:
    1. Describe CRPS and its cause.
    2. Describe the emotional impact of CRPS.
    3. Identify the different types of CRPS.
    4. Discuss the nervous system
    dysfunctions that
    may lead to CRPS.
    5. Identify various physical therapy
    interventions that can
    help improve the
    symptoms of CRPS.

    What is CRPS
    CRPS (a.k.a Reflex Sympathetic Dystrophy

    Syndrome) is a chronic pain disorder that is


    not fully understood.
    CRPS usually starts with an injury to an
    extremity, but it can also occur after surgery
    or as a result of a heart attack or stroke3.
    The initial insult, which has a known and
    predictable course of resolution, morphs
    into a chronic pain condition often
    accompanied by inflammation and some
    type of mobility dysfunction2.

    The Emotional Impact of


    CRPS
    CRPS sufferers can experience emotional and

    psychological trauma because he/she might not


    understand what is happening to them.
    Furthermore, friends and family members may not
    believe that they could be suffering from as much
    pain as they have described.
    One solution to this situation would be to educate
    everyone involved about condition and symptoms
    of CRPS.
    Another emotional boost for CRPS sufferers would
    be to maintain normal activities and hobbies as
    much as possible, getting plenty of rest, and by
    staying connected with family and friends.3

    What Causes CRPS


    Most studies suggest that CRPS may be due to a

    dysfunctional interaction between the central


    and peripheral nervous systems and an
    inappropriate inflammatory response 3.
    MRI brain scans of CRPS sufferers revealed that

    the emotional, autonomic, and pain perception


    area of the brain was different from normal
    scans. This suggests that chronic pain may be
    driven by the brains interpretation of pain which
    may no longer be dependent on the nociceptor
    transmission of pain5.

    Two Types of CRPS


    Complex regional pain syndrome occurs in two
    types, with similar signs and symptoms, but
    different causes3.
    Type 1: Usually occurs after an illness or injury that
    did not directly damage the nerves in the affected
    limb. Type 1 is the most common form and
    effects about 90% of those diagnosed with CRPS 3.
    Type 2: This type of CRPS is usually caused by a
    distinct
    nerve injury3.

    Etiology of CRPS
    CRPS usually has an early warm phase that

    suggests an inflammatory process, with


    local swelling, erythema, heat, and the
    presence of cytokines2.
    It can then progress to a cold phase, which
    often goes on for months or even years2.
    CRPS can also migrate from the initial
    involved site to other limbs as well4.

    Incidence of CRPS
    The estimated incidence varies from 5.46

    to 26.2 per 100,000 persons per year.


    CRPS in the adult populations occurs
    slightly more often in the upper
    extremities, where fracture is the common
    initial insult.
    Women are affected 3.4 to 4 times more
    often than men.4

    Risk Factors Associated with


    CRPS
    Anxiety, frustration and other behavioral

    and psychological factors can exacerbate


    the pain and dysfunction in CRPS-11.
    A sedentary lifestyle after an injury can

    make one more prone to developing CRPS 3.

    Signs and Symptoms


    Symptoms may change over time and vary from

    person to person.
    Most commonly the first symptoms may be pain,
    general swelling, redness, noticeable changes in
    temperature and hypersensitivity to cold and
    touch.
    Over time, the patient may acquire additional
    symptoms such as muscle spasms, weakness
    and atrophy as well as joint stiffness, swelling
    and damage.3
    Also, some patients have restricted AROM while
    PROM may be normal1.

    Diagnosis
    There is no single test that can definitively

    diagnose CRPS
    However, a doctor may use a variety of physical
    exams and the patients medical history to help
    piece together a diagnosis.
    Several exams that a doctor may perform are:
    Bone density scan
    Test sympathetic nervous system activity
    Thermography
    Compare affected and non-affected limbs
    MRI to detect tissue changes.3

    Diagnosis
    Bone density scan
    Thermography

    Diagnosis
    Compare affected and non-affected limbs

    Prognosis
    In some people, signs and symptoms of complex

    regional pain syndrome go away on their own.


    In others, signs and symptoms may persist for
    months to years.
    Aggressive Physical Therapy treatment in the early
    stages has produced improvement of symptoms and
    even remission of the condition in some cases.
    The pain associated with CRPS may make many
    sufferers reluctant to actively move the affected
    limb. Over time, the affected limb can become cold
    and pale and undergo skin and nail changes as well
    as muscle atrophy and contracture. Once these
    changes occur, the condition is often irreversible. 3

    Prognosis
    Muscle atrophy and contractures are often
    irreversible3.

    Medical Interventions
    Doctors may prescribe various medications
    and treatments for CRPS such as:
    NSAIDS
    Antidepressants & Anticonvulsants
    Corticosteroid and Bone-loss medications
    Intravenous ketamine (strong anesthetic 3)
    Phentolamine (an intravenous regional
    block4)
    Spinal cord stimulation2.

    Medical Interventions
    Spinal cord stimulation2
    The controller and
    electrodes are implanted
    under the skin and leads
    are placed into the
    epidural space of the
    spine. When activated, it
    stimulates the spine at a
    higher frequency than the
    incoming pain which
    blocks the pain and
    paresthesia.

    Physical Therapy
    Interventions
    Biofeedback
    Warm or cool water bath
    Transcutaneous electrical nerve stimulation

    (TENS)
    Mirror image therapy
    Pain Exposure Physical Therapy and Self
    massage

    Physical Therapy
    Interventions
    Biofeedback: Exercises that emphasize

    body awareness which help to relieve pain


    by learning relaxation techniques3.
    Warm or cool water bath: helps to make the

    limb easier to move by reducing muscle


    guarding2.

    Physical Therapy
    Interventions
    Transcutaneous Electrical Nerve Stimulation
    Electrical stimulation that sends signals to the
    brain that block pain signals.

    Physical Therapy
    Interventions
    Mirror Image Therapy
    An image of the affected limb is presented to the
    patient normalized by substitution with the mirror
    image of the normal limb. This is presumed to work
    through central neuronal plastic reorganization 2.

    Physical Therapy
    Interventions
    Pain Exposure Physical Therapy (PEPT)
    PEPT is a progressive-loading exercise program used to
    desensitize patients to pain, mobilize joints, and
    increase muscle stretching.
    Patients are reassured that an increase in pain is not a
    sign of injury or tissue damage, and they are
    encouraged to push through the exercise.
    Self-massage and forced use of the affected limb in
    daily activities is encouraged to decrease sensitivity.
    Studies have shown that up to 92% of the children with
    CRPS had a complete recovery of symptoms and 106
    patients with chronic CRPS-1 had 94% improved
    function and 49% experienced full functional recovery. 1

    Cited References
    1Barnhoorn, K. J., Bogdan D., Peter S., Melanie L., Volkmar N., Christoph M., and Martin
    T., "The effectiveness and cost evaluation of pain exposure physical therapy and
    conventional therapy in patients with complex regional pain syndrome type 1.
    Rationale and design of a randomized controlled trial." BMC Musculoskeletal Disorders
    13 (2012): 58. ProQuest. Web. 17 Feb. 2015.
    2Lee, J., BSc, MSc, MBBS, M.R.C.P., F.F.P.M.R.C.A., and Nandi, P., MBBS, FRCP, F.R.C.A.,
    F.F.P.M.R.C.A. "Early aggressive treatment improves prognosis in complex regional pain
    syndrome." Practitioner 255.1736 (2011): 23, 6, 3. ProQuest. Web. 26 Feb. 2015.
    3Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/complex-regional-painsyndrome/basics/definition/con-20022844. 12 April 2014. Article. 26 February 2015.
    4Niaki, A. S., et al. "Intravenous regional block with phentolamine in the treatment of
    complex regional pain syndrome." Acta Medica Iranica 49.8 (2011): 523-6. ProQuest.
    Web. 26 Feb. 2015.
    5Pleger, B., et al. "Complex regional pain syndrome type I affects brain structure in
    prefrontal and motor cortex." PLoS One 9.1 (2014): e85372. ProQuest. Web. 17 Feb.
    2015.

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