Complex Regional Pain Syndrome: The Worst Pain Known to Humankind

2016 ◽  
Author(s):  
Pradeep Chopra
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Pain Syndrome ◽  
Clinical History ◽  
Body Part ◽  
Axial Skeleton ◽  
The Body ◽  
Labor Pain ◽  
Whole Body ◽  
Temperature Differential ◽  
Unaffected Side

Complex regional pain syndrome (CRPS) is the worst pain known to humankind. It has been classified as pain worse than cancer pain, amputation of a digit, or labor pain. The difference is that CRPS is a chronic condition that lasts for many years. As in all medical conditions, the essential piece to diagnosis of CRPS is based on the clinical history and physical examination. The diagnosis of CRPS depends on the following: pain, color and temperature asymmetry, swelling, and nail and hair growth changes. The intensity of the pain is far more than expected from the inciting injury and in some cases from immobilization. The pain spreads to a wider area than the original site. It may spread to the opposite side and even to the whole body, including the viscera. The pain is unrelated to any physical activity but does increase significantly with using the body part. A color differential between the affected and the unaffected side is often very obvious but may not be present continuously. A temperature differential of 1.1ºC between the affected and the unaffected side is considered significant. The color and temperature differential is not as obvious in the torso or the axial skeleton as in CRPS of the abdomen, perineum, or chest wall. The swelling is much more evident in the initial stages of the condition and can vary from a small area of pitting edema to large diffuse swelling to the point of skin becoming thin and glossy and even breaking down. Hair changes may consist of darker, coarser hair or light and sparse hair. Nails may be brittle, discolored, and ridged. There is no gold standard test to diagnose CRPS. Testing may be done to rule out another possible diagnosis.

scholarly journals Attentional Modulation of Neural Dynamics in Tactile Perception of Complex Regional Pain Syndrome Patients

2020 ◽  
Author(s):  
Serena Defina ◽  
Maria Niedernhuber ◽  
Nicholas Shenker ◽  
Christopher Brown ◽  
Tristan A. Bekinschtein
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Pain Syndrome ◽  
Stimulus Onset ◽  
Task Demands ◽  
The Body ◽  
Neural Representation ◽  
Neural Dynamics ◽  
Control Mechanisms ◽  
Clinical Markers ◽  
Unaffected Side

AbstractBody perceptual disturbances are an increasingly acknowledged set of symptoms and possible clinical markers of Complex Regional Pain Syndrome (CRPS), but the neurophysiological and neurocognitive changes that underlie them are still far from being clear. We adopted a novel multivariate and neurodynamical approach to the analysis of EEG modulations evoked by touch, to highlight differences between patients and healthy controls, between affected and unaffected side of the body, and between “passive” (i.e. no task demands and equiprobable digit stimulation) and “active” tactile processing (i.e. where a digit discrimination task was administered and spatial probability manipulated). Contrary to our expectations we found no support for early differences in neural processing between CRPS and healthy participants, however, there was increased decodability in the CRPS group compared to healthy volunteers between 280 and 320 ms after stimulus onset. This group difference seemed to be driven by the affected rather than the unaffected side and was enhanced by attentional demands. These results found support in the exploratory analysis of neural representation dynamics and behavioural modelling, highlighting the need for single participant analyses. Although several limitations impacted the robustness and generalizability of our comparisons, the proposed novel analytical approach yielded promising insights (as well as possible biomarkers based on neural dynamics) into the relatively unexplored alterations of tactile decision-making and attentional control mechanisms in chronic CRPS.

scholarly journals Attentional Modulation of Neural Dynamics in Tactile Perception of Complex Regional Pain Syndrome (CRPS) Patients

2020 ◽  
Author(s):  
Serena Defina ◽  
Maria Niedernhuber ◽  
Nicholas Shenker ◽  
Christopher Brown ◽  
Tristan Bekinschtein
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Pain Syndrome ◽  
Stimulus Onset ◽  
Task Demands ◽  
The Body ◽  
Neural Representation ◽  
Neural Dynamics ◽  
Control Mechanisms ◽  
Clinical Markers ◽  
Unaffected Side

Body perceptual disturbances are an increasingly acknowledged set of symptoms and possible clinical markers of Complex Regional Pain Syndrome (CRPS), but the neurophysiological and neurocognitive changes that underlie them are still far from being clear. We adopted a novel multivariate and neurodynamical approach to the analysis of EEG modulations evoked by touch, to highlight differences between patients and healthy controls, between affected and unaffected side of the body, and between “passive” (i.e. no task demands and equiprobable digit stimulation) and “active” tactile processing (i.e. where a digit discrimination task was administered and spatial probability manipulated). Contrary to our expectations we found no support for early differences in neural processing between CRPS and healthy participants, however, there was increased decodability in the CRPS group compared to healthy volunteers between 280 and 320 ms after stimulus onset. This group difference seemed to be driven by the affected rather than the unaffected side and was enhanced by attentional demands. These results found support in the exploratory analysis of neural representation dynamics and behavioural modelling, highlighting the need for single participant analyses. Although several limitations impacted the robustness and generalizability of our comparisons, the proposed novel analytical approach yielded promising insights (as well as possible biomarkers based on neural dynamics) into the relatively unexplored alterations of tactile decision-making and attentional control mechanisms in chronic CRPS.

Body Image in Anorexia Nervosa

1981 ◽  
Vol 26 (4) ◽  
pp. 224-227 ◽  
Author(s):  
David M. Garner
Keyword(s):  
Body Image ◽  
Anorexia Nervosa ◽  
Body Satisfaction ◽  
Body Part ◽  
The Body ◽  
Size Perception ◽  
Whole Body ◽  
Size Estimation ◽  
Psychological Disturbance ◽  
Body Image Disturbances

Despite much recent interest in the objective measurement of body image in anorexia nervosa, many questions remain regarding basic mechanisms responsible for the findings as well as their meaning in the disorder. It is unclear if “whole body” measures assess the same underlying phenomena as the “body part” method, and it is unclear if body image disturbances are etiologic or a byproduct of anorexia nervosa. The possible association between self-esteem and body satisfaction and the relationship of the latter variable to actual size estimation supports the hypothesis that size perception may be closely tied to satisfaction with non-physical aspects of self. Finally it must be determined if over estimation is a function of a general psychological disturbance or of a deficit of specific interest in this disorder. Despite these questions, the way in which anorexic patients see themselves as well as the cognitive and affective responses to this perception remains an interesting and potentially fruitful area of study with this disorder.

IS DR. PATRICK BLAIR'S DESCRIPTION OF PYLORIC STENOSIS IN 1717 THE EARLIEST ON RECORD?

PEDIATRICS ◽  
1978 ◽  
Vol 62 (1) ◽  
pp. 76-76
Author(s):  
T. E. C.
Keyword(s):  
Pyloric Stenosis ◽  
Royal Society ◽  
Clinical History ◽  
The Body ◽  
Whole Body ◽  
Autopsy Report

The first description of pyloric stenosis in infants has been attributed successively to earlier and earlier writers. Hezekiah Beardsley of Connecticut described such a case in 1788.1 George Armstrong recorded the case of an infant similarly affected in 1777.2 However, the credit for drawing attention to the earliest description on record belongs to the late Ernest Caulfield of Connecticut, who pointed out that in 1717 Patrick Blair (1665-1728) reported to the Royal Society a clinical history and autopsy report of a 5-month-old boy who had pyloric stenosis. Blair's description follows: The Child was five months old and was so emaciated that he appear'd rather to have decreased than to have encreased [sic] in Bulk from the time of his Birth, the whole Body not weighing above five Pounds. The Skin and Muscles of the Abdomen were very thin, but the Peritoneum was preternaturally thick. The Ventriculus was more like to an Intestine than to a Stomach, its length being five inches and its breadth but one inch. The Coats of it were thick and fleshy, and the cavity very inconsiderable. The Pylorus and almost half the Duodenum were cartilaginous and something inclined to an ossification, so that no nourishment could have passed into the Intestines tho' the Stomach had been capable of Containing it, which makes it no wonder that the Body was so emaciated.... Upon enquiring after the Symptoms this Child had been affected with, his Mother told me he seem'd to be healthy till he was about a Month old, when he was seized with a violent Vomiting and a Stoppage of Urine and Stool. Some time after both these became more regular, but the Vomiting still continued. He seem'd to have a great Appetite, taking what Suck, Drink, or other Food was offer'd him with a kind of eagerness but he immediately threw it all up again.... There could be nothing more emaciated than this Child was.

scholarly journals Cutaneous noradrenaline measured by microdialysis in complex regional pain syndrome during whole-body cooling and heating

2013 ◽  
Vol 247 ◽  
pp. 456-465 ◽  
Author(s):  
Astrid J. Terkelsen ◽  
Janne Gierthmühlen ◽  
Lars J. Petersen ◽  
Lone Knudsen ◽  
Niels J. Christensen ◽  
...  
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Pain Syndrome ◽  
Whole Body ◽  
Body Cooling ◽  
Whole Body Cooling

How do you smile along a path?

2019 ◽  
Vol 36 (3) ◽  
pp. 343-363 ◽  
Author(s):  
Patricia Irwin
Keyword(s):  
Syntactic Structure ◽  
Body Part ◽  
The Body ◽  
Whole Body ◽  
Body Parts ◽  
Syntactic Category ◽  
Root Structure ◽  
Core Component ◽  
Syntactic Structures ◽  
Root Content

Abstract This paper argues that a core component of root meaning is the distinction between body parts versus the body conceived as a whole. This distinction is shown to be relevant in the acceptability of motion sentences in English with whole-body roots like $\sqrt {\textsc{dance}} $ and body-part roots like $\sqrt {\textsc{smile}} $. In keeping with the assumption that roots lack syntactic category, I argue that verbal roots occur freely in syntactic structures but that some root-structure combinations are degraded (or unacceptable), and that this is due to an incompatibility between conceptual root content and interpreted syntactic structure.

scholarly journals Disputing space-based biases in unilateral complex regional pain syndrome

2020 ◽  
Author(s):  
Monika Halicka ◽  
Axel D Vittersø ◽  
Hayley McCullough ◽  
Andreas Goebel ◽  
Leila Heelas ◽  
...  
Keyword(s):  
Spatial Cognition ◽  
Complex Regional Pain Syndrome ◽  
Motor Function ◽  
Motor Impairment ◽  
Pain Syndrome ◽  
Body Representation ◽  
Visuospatial Attention ◽  
Unaffected Side ◽  
Affected Relative ◽  
Pathological Pain

AbstractThere is some evidence that people with Complex Regional Pain Syndrome (CRPS) show reduced attention to the affected relative to unaffected limb and its surrounding space, resembling hemispatial neglect after brain injury. These neuropsychological symptoms could be related to central mechanisms of pathological pain and contribute to its clinical manifestation. However, the existing evidence of changes in spatial cognition is limited and often inconsistent. We examined visuospatial attention, the mental representation of space, and spatially-defined motor function in 54 people with unilateral upper-limb CRPS and 22 pain-free controls. Contrary to our hypotheses and previous evidence, individuals with CRPS did not show any systematic spatial biases in visuospatial attention to or representation of the side of space corresponding to their affected limb (relative to the unaffected side). We found very little evidence of directional slowing of movements towards the affected relative to unaffected side that would be consistent with motor neglect. People with CRPS were, however, slower than controls to initiate and execute movements with both their affected and unaffected hands, which suggests disrupted central motor networks. Finally, we found no evidence of any clinical relevance of changes in spatial cognition because there were no relationships between the magnitude of spatial biases and the severity of pain or other CRPS symptoms. The results did reveal potential relationships between CRPS pain and symptom severity, subjective body perception disturbance, and extent of motor impairment, which would support treatments focused on normalizing body representation and improving motor function. Our findings suggest that previously reported spatial biases in CRPS might have been overstated.

scholarly journals Altered updating of bodily and spatial representations following tool-use in Complex Regional Pain Syndrome

2019 ◽  
Author(s):  
Axel D. Vittersø ◽  
Gavin Buckingham ◽  
Monika Halicka ◽  
Michael J. Proulx ◽  
Janet H. Bultitude
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Upper Limb ◽  
Tool Use ◽  
Pain Syndrome ◽  
Peripersonal Space ◽  
The Body ◽  
Lower Limbs ◽  
Spatial Representations ◽  
Hand Temperature ◽  
Free People

AbstractDistorted representations of the body and peripersonal space are common in Complex Regional Pain Syndrome (CRPS), and might modulate its symptoms (e.g. asymmetric limb temperature). In pain-free people, such representations are malleable, and update when we interact with objects in our environment (e.g. during tool-use). Distortions are also common after immobilisation, but quickly normalise once movement is regained. We tested the hypothesis that people with CRPS have problems updating bodily and spatial representations, which contributes to the maintenance of their distorted representations by preventing normalization. We also explored spatially defined modulations of hand temperature asymmetries, and any influence of updating bodily and spatial representations on this effect. Thirty-six people with unilateral CRPS (18 upper limb, 18 lower limb) and 36 pain-free controls completed tool-use tasks considered to alter body and peripersonal space representations (measured using tactile distance judgements and a visuotactile crossmodal congruency task, respectively). We also tested how the arrangement (crossed, uncrossed) of the hands and tools affected hand temperature. In upper limb CRPS the non-affected arm representation updated normally, but the affected arm representation updated in the opposite to normal direction. A similar pattern was seen in lower limbs CRPS, although not significant. Furthermore, people with CRPS showed more pronounced updating of peripersonal space than the controls. We did not observe any modulation of hand temperature asymmetries by the arrangement of hands or tools. Our findings suggest enhanced malleability of bodily and spatial representations in CRPS, potentially implicating central mechanisms in the aetiology of this condition.

Sign in / Sign up

Export Citation Format

Share Document