Need for early recognition and multidisciplinary management of paediatric complex regional pain syndrome:

BMJ ◽  
2015 ◽  
pp. h4748 ◽  
Author(s):  
Christina Liossi ◽  
Jacqui Clinch ◽  
Richard Howard
Author(s):  
Sarah Choxi

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.


2017 ◽  
Vol 40 (3) ◽  
pp. 166-173
Author(s):  
Shahana Akhter Rahman ◽  
Mujammel Haque ◽  
Mohammed Mahbubul Islam

Musculoskeletal pain is a frequent complaint of children, is the most common presenting problem of children referred to pediatric rheumatology clinics. Chronic musculoskeletal (MSK) pain in children is responsible for substantial personal impacts and societal costs, but it has not been intensively or systematically researched. The majority of musculoskeletal pain complaints in children are benign in nature and attributable to trauma, overuse, and normal variations in skeletal growth. There is a subset of children in whom chronic pain complaints develop that persist in the absence of physical and laboratory abnormalities including growing Pain, juvenile fibromyalgia, complex regional pain syndrome. During recent years studies of the epidemiology, etiology and rehabilitation of pain and pain-associated disability in children have revealed a large prevalence of clinically relevant pain, and have emphasized the need for early recognition and intervention.Bangladesh J Child Health 2016; VOL 40 (3) :166-173


2011 ◽  
Vol 36 (9) ◽  
pp. 771-777 ◽  
Author(s):  
S. E. Varitimidis ◽  
L. K. Papatheodorou ◽  
Z. H. Dailiana ◽  
L. Poultsides ◽  
K. N. Malizos

Complex regional pain syndrome type I (CRPS-I) is a known complication after surgery or trauma to the upper extremity and is difficult to treat. A simple and easily tolerated method of treatment that includes intravenous regional anaesthetic block with lidocaine and methyloprednisolone is presented. One hundred and sixty-eight patients with CRPS-I of the upper extremity were treated in a 5-year period. At the end of treatment 88% of the patients reported minimal or no pain. After a mean follow-up of 5 years (range 28 months to 7 years) complete absence of pain was reported by 92% of patients. The symptoms of the acute phase of the syndrome were reversed. Early recognition and prompt initiation of treatment is very important for the course of the disease as symptoms can be reversible when treatment starts early. Permanent results with a functional upper extremity and very satisfactory pain relief can be anticipated.


2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Foad Elahi ◽  
Chandan G. Reddy

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.


2018 ◽  
Vol 23 (01) ◽  
pp. 1-10 ◽  
Author(s):  
Jae Won Lee ◽  
Sang Ki Lee ◽  
Won Sik Choy

Diagnosis of Complex regional pain syndrome (CRPS) is made primarily on a clinical basis, and no specific test is known to confirm or exclude CRPS diagnosis. That is, there aren’t specific diagnostic tools and instrumental tests are made only for identifying an etiology at the basis of the CRPS. Numerous therapeutic methods have been introduced, but none have shown definitive results. When symptoms persist, patients experience permanent impairment and disability. Therefore, early recognition of CRPS, along with proper treatment, is important for minimizing permanent loss of function. As there is no gold standard test for CRPS, several clinical diagnostic criteria have been introduced and applied in various studies. However, to date, no formal or standardized diagnostic criteria for CRPS have been widely accepted. However, the Budapest diagnostic criteria have recently increased in popularity and are frequently used in scientific studies. The goal for management of CRPS is the return of normal limb function. No specific technique has been shown to prevent CRPS following surgery, but avoidance of prolonged immobilization may be important. Therefore, initiating early post-surgical rehabilitation, where possible, is important. A multidisciplinary approach would seem to be optimal, above all things objectives of physical and occupational therapy are fulfilled with combination pharmacotherapy due to provide pain relief to facilitate physical rehabilitation. Future research using large randomized controlled trials should focus on collecting strong evidence for the etiology of CRPS, testing pharmacological effects, and determining appropriate combination treatment strategies.


2009 ◽  
Vol 14 (6) ◽  
pp. 1-9
Author(s):  
Robert J. Barth

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.


2017 ◽  
Vol 22 (2) ◽  
pp. 3-5
Author(s):  
James B. Talmage ◽  
Jay Blaisdell

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.


2006 ◽  
Vol 11 (2) ◽  
pp. 1-3, 9-12
Author(s):  
Robert J. Barth ◽  
Tom W. Bohr

Abstract From the previous issue, this article continues a discussion of the potentially confusing aspects of the diagnostic formulation for complex regional pain syndrome type 1 (CRPS-1) proposed by the International Association for the Study of Pain (IASP), the relevance of these issues for a proposed future protocol, and recommendations for clinical practice. IASP is working to resolve the contradictions in its approach to CRPS-1 diagnosis, but it continues to include the following criterion: “[c]ontinuing pain, which is disproportionate to any inciting event.” This language only perpetuates existing issues with current definitions, specifically the overlap between the IASP criteria for CRPS-1 and somatoform disorders, overlap with the guidelines for malingering, and self-contradiction with respect to the suggestion of injury-relatedness. The authors propose to overcome the last of these by revising the criterion: “[c]omplaints of pain in the absence of any identifiable injury that could credibly account for the complaints.” Similarly, the overlap with somatoform disorders could be reworded: “The possibility of a somatoform disorder has been thoroughly assessed, with the results of that assessment failing to produce any consistencies with a somatoform scenario.” The overlap with malingering could be addressed in this manner: “The possibility of malingering has been thoroughly assessed, with the results of that assessment failing to produce any consistencies with a malingering scenario.” The article concludes with six recommendations, and a sidebar discusses rating impairment for CRPS-1 (with explicit instructions not to use the pain chapter for this purpose).


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