447 DOES TREATING THE PAIN HEAL THE BRAIN? ANATOMICAL AND FUNCTIONAL CHANGES IN PEDIATRIC COMPLEX REGIONAL PAIN SYNDROME AFTER MULTIDISCIPLINARY TREATMENT

Complex regional pain syndrome (CRPS) is a chronic, localized pain condition following an injury, typically affecting a distal extremity. Although the pathophysiology of CRPS is unclear, multiple mechanisms are implicated, including peripheral and central sensitization as well as sympathetically mediated pain. Peripheral nerve blockade can treat the somatic component of CRPS pain, while sympathetic blockade may alleviate pain that is sympathetically mediated. Signs and symptoms manifest as abnormal sensory, motor, vasomotor, and sudomotor changes that are disproportionate to the inciting event. Early recognition of the signs and symptoms, followed by rapid implementation of a multidisciplinary treatment approach—including physical therapy, psychotherapy, pharmacotherapy, and sympathetic nerve blocks, is a major factor in improving outcome and preventing treatment-resistant CRPS.

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Is the brain of complex regional pain syndrome patients truly different?

European Journal of Pain ◽

10.1002/ejp.882 ◽

2016 ◽

Vol 20 (10) ◽

pp. 1622-1633 ◽

Cited By ~ 16

Author(s):

G.A.J. van Velzen ◽

S.A.R.B. Rombouts ◽

M.A. van Buchem ◽

J. Marinus ◽

J.J. van Hilten

Keyword(s):

Complex Regional Pain Syndrome ◽

Pain Syndrome ◽

The Brain

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Complex Regional Pain Syndrome (CRPS), Sudeck’s Dystrophy: EMDR Reprocessing Therapy Applied to the Psychotherapeutic Strategy

Journal of EMDR Practice and Research ◽

10.1891/1933-3196.7.3.167 ◽

2013 ◽

Vol 7 (3) ◽

pp. 167-172 ◽

Cited By ~ 3

Author(s):

Silvia B. Gauvry ◽

Pedro Lesta ◽

Ana Larrarte Alonso ◽

Roberto Pallia

Keyword(s):

Complex Regional Pain Syndrome ◽

Stress Disorder ◽

Muscular Atrophy ◽

Multidisciplinary Treatment ◽

Life Quality ◽

Pain Syndrome ◽

Motor Dysfunction ◽

Potential Benefits ◽

A Minor

Complex regional pain syndrome (CRPS) Type 1, formerly termed Sudeck’s dystrophy, is a disproportionate pain condition after a minor injury in a limb, with sensory, autonomic, motor dysfunction, and muscular atrophy without a demonstrated peripheral nerve injury. In children, its course can be self-limiting or evolve chronically and be accompanied with psychological distress and deterioration in life quality. CRPS may occur in association with posttraumatic stress disorder (PTSD) and may benefit from multidisciplinary treatment. The eye movement desensitization and reprocessing (EMDR) approach, with demonstrated efficacy in PTSD, has also been reported to be helpful with chronic pain. The application of EMDR in a case of uncontrolled pain during an adolescent’s hospitalization for CRPS is presented and its potential benefits are discussed.

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Neuroanatomical correlates of poststroke complex regional pain syndrome: a voxel-based lesion symptom-mapping study

Scientific Reports ◽

10.1038/s41598-021-92564-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Jae-Ik Lee ◽

Soon-Woo Kwon ◽

Ahry Lee ◽

Woo-suk Tae ◽

Sung-Bom Pyun

Keyword(s):

Ischemic Stroke ◽

Complex Regional Pain Syndrome ◽

Pain Syndrome ◽

Neural Substrates ◽

Clinical Findings ◽

Control Group ◽

Function Test ◽

Mini Mental Status Examination ◽

Lesion Symptom Mapping ◽

The Brain

AbstractComplex regional pain syndrome (CRPS) is a common poststroke complication. However, the neural substrates associated with CRPS remain unclear. We investigated the neural correlates associated with poststroke CRPS using voxel-based lesion‒symptom mapping (VLSM) analysis. Among 145 patients with ischemic stroke, 35 were diagnosed with CRPS and categorized into the poststroke CRPS group, and the remaining 110 into the control group. We compared the clinical characteristics between the groups. VLSM analysis was performed to identify the brain region associated with the development of poststroke CRPS. The clinical findings suggested that the poststroke CRPS group had lower muscle strength; lower scores on Fugl‒Meyer assessment, Manual Function Test, Mini-Mental Status Examination; and higher incidence of absent somatosensory evoked potentials in the median nerve than the control group. The head of the caudate nucleus, putamen, and white matter complexes in the corona radiata were significantly associated with poststroke CRPS development in ischemic stroke patients. These results facilitate an understanding of poststroke CRPS pathophysiology. Monitoring patients with lesions in these structures may aid the prevention and early treatment of poststroke CRPS.

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Venipuncture-Induced Complex Regional Pain Syndrome: A Case Report and Review of the Literature

Case Reports in Medicine ◽

10.1155/2014/613921 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Foad Elahi ◽

Chandan G. Reddy

Keyword(s):

Neuropathic Pain ◽

Pain Management ◽

Complex Regional Pain Syndrome ◽

Upper Extremity ◽

Early Recognition ◽

Multidisciplinary Treatment ◽

Pain Syndrome ◽

Treatment Modalities ◽

Medical Procedure ◽

Chronic Neuropathic Pain

Venipuncture, the most frequently performed invasive medical procedure, is usually benign. Generally it produces only transitory mild discomfort. Venipuncture-induced neuropathic pain is hard to recognize at an early stage. Medical literature reviews show that there is not adequate medical knowledge about this important subject. The inciting incident in complex regional pain syndrome (CRPS) can often seem far too trivial to result in a condition with such severe pathophysiologic effects. The practicing physician has little information available to enable early recognition of the condition, initiation of multidisciplinary treatment modalities, and proper referral to pain specialists. We encountered a unique case of venipuncture-induced complex regional pain syndrome (CRPS). The patient is a 52-year-old school teacher with no significant past medical history, who presented initially to the Center of Pain Medicine with left upper extremity pain. The pain started while phlebotomy was performed in the patient’s left antecubital area for routine blood check. The patient’s pain did not improve with multiple medications, physical therapy, or several nerve blocks. The patient demonstrated all the signs and symptoms of chronic neuropathic pain of CRPS in the upper extremity with minimal response to the continuous pain management. We decided to proceed with cervical spinal cord nerve stimulation along with continuing other modalities. The patient responded to this combination. During the follow-up, we noticed that the patient’s pain course was complicated by extension of the CRPS to her lower extremity. We will describe the course of treatment for the patient in this paper. In this paper we will discuss the electrical neuromodulation as an important modality in addition to the multidisciplinary pain management for a patient with venipuncture-induced chronic neuropathic pain.

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Development of Guidelines for the Diagnostics and Multidisciplinary Treatment of Complex Regional Pain Syndrome Type I

Journal of Neuropathic Pain & Symptom Palliation ◽

10.3109/j426v02n03_14 ◽

2006 ◽

Vol 2 (3) ◽

pp. 73-77 ◽

Cited By ~ 1

Author(s):

Jan H. B. Geertzen

Keyword(s):

Complex Regional Pain Syndrome ◽

Multidisciplinary Treatment ◽

Pain Syndrome ◽

Type I ◽

Syndrome Type

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An Update on the Pathophysiology of Complex Regional Pain Syndrome

Anesthesiology ◽

10.1097/aln.0b013e3181e3db38 ◽

2010 ◽

Vol 113 (3) ◽

pp. 713-725 ◽

Cited By ~ 83

Author(s):

Stephen Bruehl ◽

David S. Warner

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Complex Regional Pain Syndrome ◽

Genetic Factors ◽

Pain Syndrome ◽

The Past ◽

Poor Understanding ◽

The Brain ◽

Over Time ◽

Pathophysiologic Mechanisms

Complex regional pain syndrome (CRPS) is a neuropathic pain disorder with significant autonomic features. Few treatments have proven effective, in part, because of a historically poor understanding of the mechanisms underlying the disorder. CRPS research largely conducted during the past decade has substantially increased knowledge regarding its pathophysiologic mechanisms, indicating that they are multifactorial. Both peripheral and central nervous system mechanisms are involved. These include peripheral and central sensitization, inflammation, altered sympathetic and catecholaminergic function, altered somatosensory representation in the brain, genetic factors, and psychophysiologic interactions. Relative contributions of the mechanisms underlying CRPS may differ across patients and even within a patient over time, particularly in the transition from "warm CRPS" (acute) to "cold CRPS" (chronic). Enhanced knowledge regarding the pathophysiology of CRPS increases the possibility of eventually achieving the goal of mechanism-based CRPS diagnosis and treatment.

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