scholarly journals Persons with Complex Regional Pain Syndrome Renegotiate Social Roles and Intimacy: A Qualitative Study

Pain Medicine ◽  
2019 ◽  
Author(s):  
Tara L Packham ◽  
Kaitlyn Wainio ◽  
Ming-Kin Wong
Keyword(s):  
Lived Experience ◽  
Complex Regional Pain Syndrome ◽  
Social Relationships ◽  
Secondary Analysis ◽  
Pain Syndrome ◽  
Health Care Team ◽  
Interpretive Description ◽  
Pain Experience ◽  
Shared Experiences ◽  
Patient Reported

Abstract Objective Persons with complex regional pain syndrome often experience allodynia, where touch is painful. Allodynia is associated with poor prognosis, but the impacts on roles, activities, social relationships, and intimacy remain unclear. There is a need to examine intimacy in complex regional pain syndrome from a lived experience perspective. Methods We conducted a secondary analysis of cognitive debriefing interview data from 44 persons with complex regional pain syndrome who completed a patient-reported questionnaire. Using interpretive description and thematic analysis, we analyzed items and responses addressing allodynia, relationships, and intimacy. Results Two themes were developed to understand intimacy related to the pain experience: a renegotiated social identity and participation and a reinvented intimate self. These themes included elements of a) loss of control, b) loss of shared experiences, c) feeling that their condition was misunderstood, d) a need for self-preservation, e) altered self-concept, and e) the concept of intimacy is broader than sexuality. Our findings suggest that complex regional pain syndrome has pervasive impacts on relationships and intimacy that merit discussion with their health care team. Conclusions Persons with persistent pain need to be supported in roles and activities that allow them to express intimacy in their everyday lives.

scholarly journals Prednisone for Acute Complex Regional Pain Syndrome: A Retrospective Cohort Study

2020 ◽  
Vol 2020 ◽  
pp. 1-10 ◽  
Author(s):  
Andrew Jamroz ◽  
Michael Berger ◽  
Paul Winston
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Oral Prednisone ◽  
Pain Syndrome ◽  
Outpatient Rehabilitation ◽  
Inclusion Criteria ◽  
Duration Of Symptoms ◽  
Time To Treatment ◽  
Prednisone Treatment ◽  
Patient Reported ◽  
Symptoms And Signs

Objective. The objective of this study was to evaluate prednisone effectiveness on complex regional pain syndrome (CRPS) features in a community-based outpatient rehabilitation setting. Design. A single-centre, retrospective inception cohort design was used. Inclusion criteria were CRPS diagnosis according to the Budapest criteria, involvement of multiple joints, treatment with prednisone, and duration of symptoms less than one year. Typical prednisone treatment was 28-day taper regimen with 60 mg. Patient symptoms and signs were compared before and after treatment. Results. There were 39 patients who met inclusion criteria for analysis. Duration of symptoms before treatment was 80.8 ± 67.7 days. Following treatment, 19 (48.7%) patients reported complete pain resolution, 19 (48.7%) patients reported decreased pain permitting functional use, and 1 (2.6%) patient reported no improvement. All symptoms and signs decreased significantly following oral prednisone treatment (p<0.001). Range of motion (ROM) deficits persisted in 19 (49%) patients. However, 17 of these patients reported functional ROM recovery. Degree of ROM recovery and time-to-treatment had low positive correlation (r = 0.354, p<0.05). Logistic regression did not demonstrate associations among any patient factors and clinical outcomes. Conclusions. These data support short-course prednisone treatment for acute and subacute CRPS with multijoint involvement in a community rehabilitation setting. The association between time-to-treatment and ROM recovery suggests earlier treatment may result in improved ROM outcomes.

scholarly journals Ketamine Treatment for Intractable Pain in a Patient with Severe Refractory Complex Regional Pain Syndrome: A Case Report

2008 ◽  
Vol 3;11 (5;3) ◽  
pp. 339-342
Author(s):  
Paul E. Schulz
Keyword(s):  
Case Report ◽  
Complex Regional Pain Syndrome ◽  
Upper Extremity ◽  
Pain Syndrome ◽  
Future Research ◽  
Intractable Pain ◽  
Ganglion Block ◽  
Ketamine Infusion ◽  
Patient Reported ◽  
Intravenous Ketamine

In this case report, we describe the effect of ketamine infusion in a case of severe refractory complex regional pain syndrome I (CRPS I). The patient was initially diagnosed with CRPS I in her right upper extremity. Over the next 6 years, CRPS was consecutively diagnosed in her thoracic region, left upper extremity, and both lower extremities. The severity of her pain, combined with the extensive areas afflicted by CRPS, caused traumatic emotional problems for this patient. Conventional treatments, including anticonvulsants, bisphosphonates, oral steroids and opioids, topical creams, dorsal column spinal cord stimulation, spinal morphine infusion, sympathetic ganglion block, and sympathectomy, failed to provide long-term relief from pain. An N-methyl-d-aspartate (NMDA) antagonist inhibitor, ketamine, was recently suggested to be effective at resolving intractable pain. The patient was then given several infusions of intravenous ketamine. After the third infusion, the edema, discoloration, and temperature of the affected areas normalized. The patient became completely pain-free. At one-year of follow-up, the patient reported that she has not experienced any pain since the last ketamine infusion. Treatment with intravenous ketamine appeared to be effective in completely resolving intractable pain caused by severe refractory CRPS I. Future research on this treatment is needed. Key words: Ketamine, Complex Regional Pain Syndrome (CRPS), treatment

Sensory Function and Pain Experience in Arthritis, Complex Regional Pain Syndrome, Fibromyalgia Syndrome, and Pain-Free Volunteers

2019 ◽  
Vol 35 (11) ◽  
pp. 894-900 ◽  
Author(s):  
Shea Palmer ◽  
Jacqueline Bailey ◽  
Christopher Brown ◽  
Anthony Jones ◽  
Candy S. McCabe
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Fibromyalgia Syndrome ◽  
Pain Syndrome ◽  
Sensory Function ◽  
Pain Experience

Content validation of the Patient-Reported Hamilton Inventory for Complex Regional Pain Syndrome

2018 ◽  
Vol 85 (2) ◽  
pp. 99-105 ◽  
Author(s):  
Tara L. Packham ◽  
Joy C. MacDermid ◽  
Susan L. Michlovitz ◽  
Norman Buckley
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Social Impact ◽  
Pain Syndrome ◽  
Sampling Bias ◽  
Patient Reported Outcome ◽  
Measurement Properties ◽  
Content Validation ◽  
Patient Reported ◽  
Ceiling Effects ◽  
And Coping

Background. Complex regional pain syndrome (CRPS) is a perplexing neurological condition, and persons with CRPS experience substantial loss of daily roles and activities. A condition-specific measure is being developed to evaluate CRPS. Purpose. We describe the use of cognitive interviews to examine content validity of this patient-reported outcome measure for CRPS. Method. Interviews with 44 persons with CRPS were analyzed to identify problems with wording and support content validation. Item-total correlations were calculated for proposed subscales, and scores were plotted to consider floor/ceiling effects. Findings. Interviews identified questions where respondents considered factors unrelated to the construct of interest or were underaddressed by the questionnaire, including depression and skin temperature. The symptoms, daily function, and coping/social impact scales demonstrated satisfactory correlations (Cronbach’s alpha 0.76–0.86). Despite a sampling bias of severity, no frank floor/ceiling effects were noted. Implications. This study builds a foundation for continuing development and evaluation of the measurement properties of the Patient-Reported Hamilton Inventory for CRPS. It makes explicit the iterative decisions involved in rigorous instrument development.

Exploring peoples’ lived experience of complex regional pain syndrome in Australia: a qualitative study

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Darren Beales ◽  
David Carolan ◽  
Joshua Chuah-Choong ◽  
Sarah Hammond ◽  
Eimear O’Brien ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Lived Experience ◽  
Complex Regional Pain Syndrome ◽  
Healthcare Professionals ◽  
Pain Syndrome ◽  
Lessons Learned ◽  
Patient Perspectives ◽  
Future Research ◽  
Making Sense ◽  
The Right

AbstractObjectivesComplex regional pain syndrome (CRPS) is a persistent pain condition which is often misunderstood and poorly managed. Qualitative studies are needed to explore the lived experience of the condition and to better understand patient perspectives on their management experiences and needs. The aim of this study was to explore the lived experience of CRPS in Australia, including exploration of their perceptions of care and advice received from healthcare professionals.MethodsA qualitative study with individual in-depth semi-structured, face-to-face interviews was performed (n=15, 80% female, average time elapsed since diagnosis 3.8 years). Qualitative data were analysed using an inductive thematic analysis approach.ResultsFour main themes with associated subthemes were identified, representing the participants’ journey: (1) Life Changing Impact of CRPS (Subthemes: Impact on self, Impact on others); (2) Variable Experiences of Care (Subthemes: Helpful experiences of care, Unhelpful experiences of care); (3) Making Sense of CRPS (Subthemes: Knowledge and understanding, Dealing with unpredictability); and (4) Perceptions on Lessons Learned from Living with CRPS (Subthemes: Acceptance was an important part of the journey, Trial and error was necessary to find an individual way forward, Coping strategies).ConclusionsThe themes identified align to and expand on prior qualitative research findings in people with CRPS. It highlights the challenges people face related to their personal self, their close relationships and their social and work roles. It highlights the difficulties these people have in finding reliable, trust-worthy information. These findings suggest that healthcare professionals may benefit from education about how to better support people with CRPS, including helping people to navigate to the right care. Engaging people with CRPS in the development of educational resources should be a future research goal. It is recommended that patient perspectives are incorporated into the development of care pathways for CRPS.

Complex Regional Pain Syndrome Type I in a Female Division I Soccer Player: A Level 4 CASE Report

2020 ◽  
pp. 1-5
Author(s):  
Gina E. McAlear ◽  
Jennifer K. Popp
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Soccer Player ◽  
Delayed Diagnosis ◽  
Pain Syndrome ◽  
Functional Restoration ◽  
Division I ◽  
Tarsal Tunnel ◽  
Type I ◽  
Medicine Physician ◽  
Patient Reported

An 18-year-old female, Division I soccer player was diagnosed with complex regional pain syndrome approximately 2 weeks after tarsal tunnel release surgery. Postsurgically, the patient reported a significant increase in neuropathic pain, swelling, paresthesia, skin temperature asymmetry, and allodynia of the plantar and dorsal aspects of the foot, which were initially attributed to other causes. The intense pain and delayed diagnosis led to a decline in mental health and suicide ideation. Once diagnosed with complex regional pain syndrome, an epidural was placed at L5/S1 with a continuous flow of lidocaine, resulting in functional restoration. The patient’s diagnosis and recovery were based on the collaborative efforts of the surgeon, sports medicine physician, pain management specialist, and athletic trainer. She returned to soccer participation with minimal symptoms. This case is unique because the symptoms of complex regional pain syndrome were attributed to other causes, resulting in a delayed diagnosis and appropriate treatment. This delay resulted in the patient threatening self-harm.

scholarly journals Pain Relief in CRPS-II after Spinal Cord and Motor Cortex Simultaneous Dual Stimulation

2016 ◽  
Vol 4;19 (4;5) ◽  
pp. E631-E635
Author(s):  
Erich T. Fonoff
Keyword(s):  
Spinal Cord ◽  
Motor Cortex ◽  
Brachial Plexus ◽  
Complex Regional Pain Syndrome ◽  
Spinal Cord Stimulation ◽  
Rescue Therapy ◽  
Pain Syndrome ◽  
Syndrome Type ◽  
Type Ii ◽  
Patient Reported

We describe a case of a 30-year-old woman who suffered a traumatic injury of the right brachial plexus, developing severe complex regional pain syndrome type II (CRPS-II). After clinical treatment failure, spinal cord stimulation (SCS) was indicated with initial positive pain control. However, after 2 years her pain progressively returned to almost baseline intensity before SCS. Additional motor cortex electrode implant was then proposed as a rescue therapy and connected to the same pulse generator. This method allowed simultaneous stimulation of the motor cortex and SCS in cycling mode with independent stimulation parameters in each site. At 2 years follow-up, the patient reported sustained improvement in pain with dual stimulation, reduction of painful crises, and improvement in quality of life. The encouraging results in this case suggests that this can be an option as add-on therapy over SCS as a possible rescue therapy in the management of CRPS-II. However, comparative studies must be performed in order to determine the effectiveness of this therapy. Key words: Chronic neuropathic pain, Complex regional pain syndrome Type II, brachial plexus injury, motor cortex stimulation, spinal cord stimulation

Pain Relief Is Associated With Improvement in Motor Function in Complex Regional Pain Syndrome Type 1: Secondary Analysis of a Placebo-Controlled Study on the Effects of Ketamine

2013 ◽  
Vol 14 (11) ◽  
pp. 1514-1521 ◽  
Author(s):  
Johanna C.M. Schilder ◽  
Marnix J. Sigtermans ◽  
Alfred C. Schouten ◽  
Hein Putter ◽  
Albert Dahan ◽  
...  
Keyword(s):  
Pain Relief ◽  
Complex Regional Pain Syndrome ◽  
Motor Function ◽  
Secondary Analysis ◽  
Pain Syndrome ◽  
Controlled Study ◽  
Syndrome Type

A Historical Review of Complex Regional Pain Syndrome in the “Guides Library”

2009 ◽  
Vol 14 (6) ◽  
pp. 1-9
Author(s):  
Robert J. Barth
Keyword(s):  
Differential Diagnosis ◽  
Complex Regional Pain Syndrome ◽  
Reflex Sympathetic Dystrophy ◽  
International Association ◽  
Historical Review ◽  
Pain Syndrome ◽  
Sixth Edition

Abstract Complex regional pain syndrome (CRPS) is a controversial, ambiguous, unreliable, and unvalidated concept that, for these very reasons, has been justifiably ignored in the “AMA Guides Library” that includes the AMAGuides to the Evaluation of Permanent Impairment (AMA Guides), the AMA Guides Newsletter, and other publications in this suite. But because of the surge of CRPS-related medicolegal claims and the mission of the AMA Guides to assist those who adjudicate such claims, a discussion of CRPS is warranted, especially because of what some believe to be confusing recommendations regarding causation. In 1994, the International Association for the Study of Pain (IASP) introduced a newly invented concept, CRPS, to replace the concepts of reflex sympathetic dystrophy (replaced by CRPS I) and causalgia (replaced by CRPS II). An article in the November/December 1997 issue of The Guides Newsletter introduced CRPS and presciently recommended that evaluators avoid the IASP protocol in favor of extensive differential diagnosis based on objective findings. A series of articles in The Guides Newsletter in 2006 extensively discussed the shortcomings of CRPS. The AMA Guides, Sixth Edition, notes that the inherent lack of injury-relatedness for the nonvalidated concept of CRPS creates a dilemma for impairment evaluators. Focusing on impairment evaluation and not on injury-relatedness would greatly simplify use of the AMA Guides.

Peripheral Nerve and Brachial Plexus Impairment, AMA Guides, Sixth Edition

2017 ◽  
Vol 22 (2) ◽  
pp. 3-5
Author(s):  
James B. Talmage ◽  
Jay Blaisdell
Keyword(s):  
Peripheral Nerve ◽  
Brachial Plexus ◽  
Complex Regional Pain Syndrome ◽  
Lower Extremities ◽  
Pain Syndrome ◽  
Upper Extremities ◽  
Motor Deficits ◽  
Type I ◽  
Sixth Edition ◽  
Nerve Entrapments

Abstract Physicians use a variety of methodologies within the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, to rate nerve injuries depending on the type of injury and location of the nerve. Traumatic injuries that cause impairment to the peripheral or brachial plexus nerves are rated using Section 15.4e, Peripheral Nerve and Brachial Plexus Impairment, for upper extremities and Section 16.4c, Peripheral Nerve Rating Process, for lower extremities. Verifiable nerve lesions that incite the symptoms of complex regional pain syndrome, type II (similar to the former concept of causalgia), also are rated in these sections. Nerve entrapments, which are not isolated traumatic events, are rated using the methodology in Section 15.4f, Entrapment Neuropathy. Type I complex regional pain syndrome is rated using Section 15.5, Complex Regional Pain Syndrome for upper extremities or Section 16.5, Complex Regional Pain Syndrome for lower extremities. The method for grading the sensory and motor deficits is analogous to the method described in previous editions of AMA Guides. Rating the permanent impairment of the peripheral nerves or brachial plexus is similar to the methodology used in the diagnosis-based impairment scheme with the exceptions that the physical examination grade modifier is never used to adjust the default rating and the names of individual nerves or plexus trunks, as opposed to the names of diagnoses, appear in the far left column of the rating grids.

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