Treatment of Type 1 Complex Regional Pain Syndrome in 14 Years Old Child

Case report on 14 years old girl with type 1 complex regional pain syndrome (CRPS) is presented. At first admission in 5.5 months after right hand injury and development of type 1 CRPS, paravasal sympathectomy on the right upper extremity was performed. Complete elimination of pain syndrome and restoration of the extremity function was achieved. Five and a half months after discharge the left foot and in 3 weeks later the right hand were injured. In both cases injuries were accompanied by pronounced CRPS clinical picture. At second admission in 6 weeks after foot injury interventional treatment with placement of catheters next to nerve trunks and bolus administration of antibiotics was performed for 1 week and enabled to achieve remission of the disease. It was noted that not only hypersymphaticotony but also psychological status of a patient were important for the disease development.

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Treatment of Type 1 Complex Regional Pain Syndrome in 14 Years Old Child

N.N. Priorov Journal of Traumatology and Orthopedics ◽

10.17816/vto20140479-82 ◽

2014 ◽

Vol 21 (4) ◽

pp. 79-82

Author(s):

V. N Merkulov ◽

A. I Dorokhin ◽

A. I Krupatkin ◽

M. V Merkulov ◽

M. A Avakova

Keyword(s):

Complex Regional Pain Syndrome ◽

Pain Syndrome ◽

Hand Injury ◽

Psychological Status ◽

Interventional Treatment ◽

Bolus Administration ◽

Right Hand ◽

Foot Injury ◽

The Right

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Diagnosis of Complex Regional Pain Syndrome I Following Traumatic Axonal Injury of the Corticospinal Tract in a Patient with Mild Traumatic Brain Injury

Diagnostics ◽

10.3390/diagnostics10020095 ◽

2020 ◽

Vol 10 (2) ◽

pp. 95 ◽

Cited By ~ 1

Author(s):

Sung Ho Jang ◽

You Sung Seo

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Complex Regional Pain Syndrome ◽

Mild Traumatic Brain Injury ◽

Corticospinal Tract ◽

Axonal Injury ◽

Pain Syndrome ◽

Traumatic Axonal Injury ◽

Right Hand ◽

The Right

A 54-year-old male suffered from direct head trauma resulting from a fall while working. At approximately two months after the accident, he began to feel pain (burning sensation) and swelling of the dorsum of the right hand and wrist. He showed the following clinical features among the clinical signs and symptoms of revised diagnostic criteria for complex regional pain syndrome (CRPS): spontaneous pain, mechanical hyperalgesia, vasodilation, skin temperature asymmetries, skin color changes, swelling, motor weakness. No specific lesion was observed on brain MRI taken at ten weeks after onset. Plain X-ray, electromyography, and nerve conduction studies for the right upper extremity detected no abnormality. A three-phase bone scan showed hot uptake in the right wrist in the delayed image. On two-month diffusion tensor tractography, partial tearing of the corticospinal tract (CST) was observed at the subcortical white matter in both hemispheres (much more severe in the left CST). In addition, the fiber number of the right CST was significantly decreased than that of seven normal control subjects. CRPS I of the right hand in this patient appeared to be related to traumatic axonal injury of the left CST following mild traumatic brain injury.

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Pediatric Complex Regional Pain Syndrome Type 1

10.1093/med/9780190685157.003.0054 ◽

2018 ◽

Author(s):

Bobbie Riley ◽

Navil Sethna

Keyword(s):

Complex Regional Pain Syndrome ◽

Diagnostic Tests ◽

Treatment Options ◽

Pain Syndrome ◽

Underlying Mechanism ◽

Interventional Treatment ◽

Syndrome Type ◽

Delay In Diagnosis ◽

Skin Hypersensitivity

Complex regional pain syndrome type 1 (CRPS-1) is a condition that affects adolescents and children under the age of 7. It usually follows minor injury and rarely occurs spontaneously. The pain is usually out of proportion to the inciting injury. Pain, allodynia, and/or hyperalgesia are severe enough to inhibit use of the affected limb. Delay in diagnosis and self and/or iatrogenic immobilization of the affected limb may lead to worsening pain, skin hypersensitivity and discoloration, swelling, and vasomotor and dystrophic abnormalities. The diagnosis of CRPS-1 and 2 is based on symptoms. There are no diagnostic tests that can confirm the presence or absence of CRPS-1. CRPS-2 diagnosis is established by nerve conduction test and electromyography. Clinical practice neuropathic guidelines are most effective for CRPS-2 treatment. Pharmacological and interventional treatment options for CRPS-1 are limited and usually ineffective because the underlying mechanism(s) are yet to be determined.

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Reflex sympathetic dystrophy/complex regional pain syndrome, type 1

South African Journal of Radiology ◽

10.4102/sajr.v8i2.133 ◽

2004 ◽

Vol 8 (2) ◽

pp. 38

Author(s):

S.H. Botha

Keyword(s):

Complex Regional Pain Syndrome ◽

Weight Bearing ◽

Pain Syndrome ◽

Blood Pool ◽

Magnetic Resonance Images ◽

Stress Fractures ◽

X Rays ◽

The Right ◽

A Minor

Complex regional pain syndrome (CPRS), type 1 is a pain disorder that develops unpredictably and can follow a minor injury. A 12-year-old boy presented with severe pain in the feet and could not walk or stand weight bearing. Normal X-rays showed osteopenic changes and radiolucent lines, which appeared to be stress fractures. Three-phase bone scintigraphy showed no uptake in the left lower leg on the blood pool phase or on the immediate or delayed images. This indicated typical CPRS type 1 in children. The uptake in the right foot was increased and the stress fracture and other illness could not be differentiated. Computed tomography was done to exclude stress fractures. Only osteopenic changes in both calcaneus bones were found and there was no evidence of cortical stress fractures. Magnetic resonance images revealed oedema in the calcaneus and talus bones of both feet. The patient received epidural narcotic infusion with sympathetic blockage for 1 week combined with extensive physiotherapy. The blood pool phase of the bone scan became normal within 2 weeks, and increased uptake in both feet was noticed. The patient was followed up with MRI every 3 months and the bone marrow oedema disappeared after 6 months.

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The long-term effect of complex regional pain syndrome type 1 on disability and quality of life after foot injury

Disability and Rehabilitation ◽

10.1080/09638288.2019.1650295 ◽

2019 ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

Dominique Mouraux ◽

Cédric Lenoir ◽

Turgay Tuna ◽

Eric Brassinne ◽

Stéphane Sobczak

Keyword(s):

Quality Of Life ◽

Complex Regional Pain Syndrome ◽

Pain Syndrome ◽

Term Effect ◽

Syndrome Type ◽

Long Term Effect ◽

Foot Injury

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Intervention Using Body Shadow to Evoke Loading Imagery in a Patient with Complex Regional Pain Syndrome in the Foot: A Case Report

Brain Sciences ◽

10.3390/brainsci10100718 ◽

2020 ◽

Vol 10 (10) ◽

pp. 718

Author(s):

Yoshiyuki Hirakawa ◽

Ryota Imai ◽

Hayato Shigetoh ◽

Shu Morioka

Keyword(s):

Complex Regional Pain Syndrome ◽

Pain Syndrome ◽

The Body ◽

Walking Ability ◽

Mirror Therapy ◽

Person Perspective ◽

Foot Injury ◽

Third Person ◽

Third Person Perspective ◽

The Right

We present the case of a female patient who developed complex regional pain syndrome (CRPS) after a right-foot injury. The patient had pain from the right knee to the toes and showed severe disgust at the appearance of the affected limb. Consequently, the affected limb was not fully loaded, and the patient had difficulty walking. General interventions, such as mirror therapy, were attempted, but the effect was limited. We hypothesized that this was due to the disgust toward the affected limb, and we implemented a body-shadow intervention that we developed. This reduced the disgust for the affected limb and improved pain, but neither changed the anticipated pain of loading the affected limb nor improved the patient’s walking ability. The reason for this was considered to be that the previous interventions using the body shadow utilized the third-person perspective, denoting that the image of the load sensation on the sole of the foot during walking was insufficient; therefore, we attempted a first-person body-shadow intervention. The results showed improvement in the patient’s walking ability. In CRPS of the foot, it is important to use interventions that evoke images of loading without causing anticipatory pain, pointing to the effectiveness of body-shadow interventions.

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A Novel Use of Epidural Continuous Infusion in the Outpatient Setting

Pain Management Case Reports ◽

10.36076/pmcr.2017/1/211 ◽

2017 ◽

pp. 211-213

Author(s):

Aram Shahinyan

Keyword(s):

Physical Therapy ◽

Pain Relief ◽

Epidural Catheter ◽

Complex Regional Pain Syndrome ◽

Local Anesthetic ◽

Pain Syndrome ◽

Outpatient Setting ◽

Epidural Infusion ◽

Right Hand ◽

The Right

Complex regional pain syndrome (CRPS, type 1 and type 2) describes a variety of disorders characterized by spontaneous or stimulus-induced pain that is disproportional to the inciting event and is accompanied by a myriad of autonomic and motor disturbances in highly variable combinations. Physical therapy, started as early as possible, is the mainstay of treatment, and pharmacological management and interventional techniques can be used to facilitate the participation in rehabilitation programs. Epidural local anesthetic (LA) use has been reported in the inpatient setting for the treatment of CRPS, but outpatient options are limited. Elastomeric pumps are commonly used for peripheral nerve blocks, postoperative pain, and palliative care in outpatient settings, but not described with epidural infusions. We describe a case of a cervical epidural catheter placed under fluoroscopy, utilizing an elastomeric pump in an outpatient setting. The system consists of a 270 mL elastomeric pump which is filled with 0.05% bupivicaine, delivering a constant 10 mL/hour. The system has a clamp that can be used by the patient to start and stop the infusion. A 23–year-old man presented with right hand/ thumb pain of approximately 2 months duration after an injury while cutting meat at work, resulting in an incomplete fracture of the proximal phalanx and injury to the extensor tendons of his thumb, which were repaired by orthopedics, and a thumb spica splint was placed. The patient described the pain as constant and stabbing, scored as a 5 – 6/10 on a numerical rating scale (NRS), and increased with any activities. The pain was associated with intermittent temperature changes, hypersensitivity to cold water, and occasional color changes. Physical examination was remarkable for a well-healed right thumb, mottling skin discoloration over the right thumb and hand, and hypersensitivity and allodynia to light touch and pinprick over the right hand and radial aspect of the wrist. Previous treatments consisted of physical therapy and oxycodone-acetaminophen as needed. A 3-week trial of pregabalin was tried, without improvement. After discussing alternative treatments (stellate ganglion block), the patient elected to try a local anesthetic (LA) infusion through a cervical epidural catheter. The epidural space was accessed at the C7-T1 level via left paramedian approach under fluoroscopy; the catheter was threaded 5 cm, and a 0.05% bupivacaine infusion was started via an elastomeric pump. On post-procedural day 4 the bupivacaine concentration was increased to 0.1% due to insufficient pain relief. The patient had good pain relief on day 8 and discontinued the infusion on day 16. The catheter was removed on day 18. We report a case of successful treatment of CRPS with an outpatient cervical epidural infusion. This modality has been used successfully for years at Geisinger Medical Center. Our goal is to bring attention to the outpatient use of elastomeric pumps for epidural infusion in the treatment of CRPS. The successful resolution of debilitating symptoms in this patient is encouraging, and the use of elastomeric pumps should be considered for further investigation into its efficacy in patients with CRPS. Key words: Complex regional pain syndrome (CRPS), cervical epidural, outpatient epidural infusion, tunneled epidural catheter

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Challenges in the Diagnostic Conceptualization of CRPS-1 (Formerly Conceptualized as RSD)

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2006.marapr01 ◽

2006 ◽

Vol 11 (2) ◽

pp. 1-3, 9-12

Author(s):

Robert J. Barth ◽

Tom W. Bohr

Keyword(s):

Clinical Practice ◽

Complex Regional Pain Syndrome ◽

Somatoform Disorders ◽

International Association ◽

Pain Syndrome ◽

Somatoform Disorder ◽

Syndrome Type ◽

Previous Issue

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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