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

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.

PAIN SYNDROMES AFTER MISSILE-CAUSED PERIPHERAL NERVE LESIONS

Neurosurgery ◽  
2006 ◽  
Vol 59 (6) ◽  
pp. 1226-1237 ◽  
Author(s):  
Zoran Roganovic ◽  
Gordana Mandic-Gajic
Keyword(s):  
Pain Intensity ◽  
Complex Regional Pain Syndrome ◽  
Pain Syndrome ◽  
Diagnostic Procedures ◽  
Syndrome Type ◽  
Type Ii ◽  
Sympathetic Block ◽  
Pain Syndromes ◽  
Neuralgic Pain ◽  
Symptoms And Signs

Abstract OBJECTIVE To report on the clinical characteristics of pain and factors influencing pain intensity in patients with missile-caused nerve injuries. METHODS The prospective study included 326 patients with clinically significant pain syndromes including complex regional pain syndrome Type II, deafferentation pain, reinnervation pain, and neuralgic pain. Diagnostic procedures were analyzed, factors influencing the pain intensity were identified, and the patients' characteristics, pain characteristics, and other clinical symptoms and signs were compared between different types of pain syndromes. RESULTS The rate of painful injuries ranged from 17.3 to 22.9% for mixed nerves and from 2.6 to 4.6% for motor nerves. Peripheral nerve block and sympathetic block were useful and safe adjuvant diagnostic procedures, obtaining pain relief in 66.7% of patients with neuralgic pain and in 90.1% of patients with complex regional pain syndrome Type II. Pain started 2.6 days after injury in patients with complex regional pain syndrome Type II and 11.9 days after injury in patients with painful nerve adhesions (analysis of variance, P&lt; 0.001). Permanent pain was more frequent (79.1%) than paroxysmal pain, superficial pain was more frequent (55.2%) than deep pain, and burning pain was the most frequent pain descriptor (43.6%). Ten factors were found to significantly influence the pain intensity (binary logistic analysis), including three independent predictors (multivariate analysis): type of pain syndrome (P&lt; 0.001), multiple nerve damage in the injury site (P= 0.022), and onset of pain in the first two days after injury (P= 0.031). CONCLUSION Pain syndromes after missile-caused nerve injury differ significantly regarding time of pain onset, pain characteristics, and other symptoms and signs. The type of pain syndrome, multiple nerve damage, and early onset of pain are independent predictors of initial pain intensity. Although medical history and physical examination are the main diagnostic keys, nerve exploration preceded by a nerve block and sympathetic block are safe and useful adjuvant diagnostic procedures.

Body Perception Disturbance and Pain Reduction in Longstanding Complex Regional Pain Syndrome Following a Multidisciplinary Rehabilitation Program

Pain Medicine ◽  
2019 ◽  
Vol 20 (11) ◽  
pp. 2213-2219 ◽  
Author(s):  
Jennifer S Lewis ◽  
Sara Kellett ◽  
Ryan McCullough ◽  
Ashley Tapper ◽  
Chelsey Tyler ◽  
...  
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Pain Syndrome ◽  
Rehabilitation Program ◽  
Data Sets ◽  
Body Perception ◽  
Duration Of Symptoms ◽  
Multidisciplinary Rehabilitation ◽  
Numerical Rating

Abstract Objective Clinical guidelines for the treatment of complex regional pain syndrome recommend multidisciplinary rehabilitation, yet limited evidence exists to support the effectiveness of this approach. Body perception disturbance, a common and debilitating feature of complex regional pain syndrome, is recommended by guidelines as important to treat. However, no study has yet explored whether disturbances change in response to multidisciplinary rehabilitation. We aimed to determine whether there is a change in body perception disturbance and pain following a two-week multidisciplinary rehabilitation program for complex regional pain syndrome. Methods Retrospective clinical data from complex regional pain syndrome patients who completed the program between September 2014 and December 2016 were extracted and anonymized. Data collected pre- and post rehabilitation comprising the Bath Body Perception Disturbance scale and a pain intensity numerical rating scale were analyzed. Results Thirty complete data sets were analyzed from a sample of 50 consecutive patient records. After the program, there was a significant reduction in body perception disturbance (P < 0.0001), strength of negative emotional feelings (P < 0.0001), and pain (P = 0.0038). There was a significant correlation between a change in disturbance and pain (r = 0.44, P = 0.024). No relationship was found between the duration of symptoms and changes in disturbance (r = 0.04, P = 0.82). Conclusions This study provides evidence that both body perception disturbance and pain reduce after rehabilitation. Findings suggest that targeting these disturbances may be important in reducing pain and may be a potentially useful measure for recovery. Controlled trials are required to confirm the effectiveness of rehabilitation and determine what factors are responsible for these reductions.

scholarly journals What is the incidence of complex regional pain syndrome (CRPS) Type I within four months of a wrist fracture in the adult population? A systematic review

Hand Therapy ◽  
2020 ◽  
Vol 25 (2) ◽  
pp. 45-55
Author(s):  
Catherine Rolls ◽  
Candy McCabe ◽  
Alison Llewellyn ◽  
Gareth T Jones
Keyword(s):  
Systematic Review ◽  
Complex Regional Pain Syndrome ◽  
Diagnostic Criteria ◽  
Adult Population ◽  
Pain Syndrome ◽  
Wrist Fracture ◽  
Type I ◽  
Inclusion Criteria ◽  
Fracture Management ◽  
Incidence Risk

Introduction Complex regional pain syndrome (CRPS) is a severe chronic pain condition, the symptoms of which may develop following trauma to a limb. Despite wrist fracture being a common antecedent, estimates of the incidence of CRPS following this injury vary widely. Our objective was to establish the incidence of CRPS in adults within four months of a wrist fracture, using a systematic review of the literature published since 2010. Methods The databases MEDLINE, PubMed, EMBASE, PsychINFO, CINAHL, BNI and AMED were searched for observational studies reporting the incidence of CRPS following a wrist fracture. Inclusion criteria were the use of a validated diagnostic tool to assess for CRPS within four months of the fracture. Randomised controlled trials and clinical trials were excluded, as were data from patients with evidence of prior neurology. Incidence risk was then extracted or calculated. Included studies were assessed for methodological rigour using the Newcastle–Ottowa Scale for assessment of bias. Results Nine studies met the inclusion criteria. There was a high degree of heterogeneity in study populations including study setting, fracture management and diagnostic criteria. From the three studies with the highest methodological rigour we determined that the incidence risk of CRPS in adults is between 3.7% and 14% using the Budapest criteria, with an observation of lower rates in conservatively managed fractures. Discussion We found evidence that the reported incidence of CRPS is influenced by choice of diagnostic criteria, along with the study location and/or how the fracture is managed.

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.

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.

On rehabilitation of patients with complex regional pain syndrome in the upper extremity

2021 ◽  
Vol 22 (1) ◽  
pp. 78-82
Author(s):  
N. A. Burmatov ◽  
◽  
K. S. Sergeev ◽  
A. A. Gerasimov ◽  
N. V. Zykova ◽  
...  
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Upper Extremity ◽  
Electric Stimulation ◽  
Early Mobilization ◽  
Pain Syndrome ◽  
Skin Surface ◽  
Outpatient Rehabilitation ◽  
Temporary Work ◽  
Rehabilitation Period ◽  
Orthopedic Patients

The aim of this study is to improve the results of treating patients with Complex Regional Pain Syndrome (CRPS). Materials and Methods. The study analyses the use of intratissual electric stimulation (ITES) combined with the complex of special exercises for recovery of upper extremity function at the outpatient rehabilitation stage in patients (179 persons) who underwent osteosynthesis of upper limb bones, or nerve and tendon transfer surgery. The objective pain syndrome and trophic innervation of the injured extremity assessment was performed by measuring skin surface electric potential using Gerasimov’s method. The results were interpreted according to “Personalized system of assessing the results of treating trauma and orthopedic patients”. Results. “Combination treatment in the rehabilitation of the upper extremity” proved to be effective to fight pain syndrome and trophic dysfunction of the nervous system. It allows the patient to do the complex of special exercises to prevent limb contracture if used during late rehabilitation period. It is an efficient method of preventing and treating neurotrophic dysfunction. The use of this technique leads to early mobilization and the reduction of treatment period and the period of temporary work disability. Conclusion. The pathogenetically substantiated method of treating upper extremity, the use of intratissual electric stimulation (ITES) at the outpatient rehabilitation stage of humerus fractures prove to be effective.

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