scholarly journals NEW APPROACH TO SOLVING THE PROBLEM OF COMPLEX REGIONAL PAIN SYNDROME

2017 ◽  
Vol 2 (3) ◽  
pp. 32-38
Author(s):  
AS S Pankratov ◽  
SV V Ardatov ◽  
DA A Ogurtsov ◽  
YuD D Kim ◽  
DS S Shitikov
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Lower Limb ◽  
Technology Use ◽  
Bone Fractures ◽  
Pain Syndrome ◽  
Integrated Approach ◽  
Lower Limbs ◽  
New Approach ◽  
Limb Bones ◽  
Prolonged Immobilization

Aim - to improve the results of treatment of patients with complex regional pain syndrome (CRPS) in bone fractures of the lower extremities by applying a new integrated approach. Methods. A new approach to solving the problem of complex regional pain syndrome in fractures of lower limb bones is proposed, including the use of modern minimally invasive methods for surgical treatment of fractures of the lower limb bones, such as blocked osteosynthesis, Fixion technology, use of angular stability plates, metal structures for osteosynthesis of the proximal femur. All these measures help to minimize the negative effect that is produced on the bone by such factors as prolonged immobilization and absence of early movements of the joints, which will make it possible to perform CRPS prophylaxis in bone fractures of the lower limbs more effectively. If it is not possible to prevent the development of CRPS, then it is necessary to administer complex therapy, including psychoemotional correction, adherence to the regime, proper immobilization, rehabilitation exercises, physiotherapy, medical treatment, hyperbaric oxygenation, and gravitational therapy. Results. Clinical tests, radiography, densitometry, method of statistical analysis and mathematical modeling with elements of evidencebased medicine objectively confirmed the activation of the restorative processes in altered tissues of the lower limbs due to the use of the new complex. Conclusion. The analysis of the obtained data of clinical and functional methods of research has proved that the total value of positive results is 80%.

Lumbar Sympathetic Plexus Radiofrequency Ablation for Chronic Non-Cancer Pain: A Brief Review and Two Case Reports

2020 ◽  
pp. 85-92
Author(s):  
Andrea Tinnirello
Keyword(s):  
Chronic Pain ◽  
Complex Regional Pain Syndrome ◽  
Lower Limb ◽  
Case Reports ◽  
Pain Syndrome ◽  
Lower Limbs ◽  
Ischemic Pain ◽  
Sympathetically Maintained Pain ◽  
Ischemic Disease ◽  
Conventional Medical Therapy

Background: Lumbar sympathetic plexus (LSP) has been described as a target for managing chronic pain with a sympathetic component in the lower limbs such as complex regional pain syndrome (CRPS) or pain of ischemic origin. LSP neurolysis with phenol or ethanol has been applied; more recently, radiofrequency (RF) lesioning has been proposed as an alternative. RF denervation has the advantage of avoiding the complications associated with ethanol/phenol spread. Case Report: We describe 2 cases in which RF denervation of LSP was performed in patients suffering from chronic pain from CRPS and chronic ischemic disease of the lower limb. Conclusion: RF denervation of LSP could be considered as a treatment for CRPS and chronic ischemic pain when conventional medical therapy fails. Compared to chemical neurolysis, RF denervation carries less risk for postprocedural deafferentation pain. Key words: Complex regional pain syndrome; ischemic pain; lumbar sympathetic plexus; neurolysis; radiofrequency; sympathetically maintained pain

scholarly journals Massive Edema of the Lower Limbs in Patients after Spinal Cord Injury—One Picture, Different Diagnoses

2021 ◽  
Vol 18 (8) ◽  
pp. 4219
Author(s):  
Magdalena Mackiewicz-Milewska ◽  
Małgorzata Cisowska-Adamiak ◽  
Katarzyna Sakwińska ◽  
Iwona Szymkuć-Bukowska ◽  
Iwona Głowacka-Mrotek
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Heterotopic Ossification ◽  
Lower Limb ◽  
Bone Fractures ◽  
Lower Limbs ◽  
University Hospital ◽  
Pain Sensation ◽  
Vein Thrombosis ◽  
Cord Injury

Diagnosis of the cause of massive edema of the lower limbs in patients after spinal cord injury (SCI) can be difficult because of loss of pain sensation, commonly occurring in this group of patients. This paper reviews several different pathologies that can lead to lower-limb edema and the associated diagnostic difficulties. We present four cases of patients with massive edemas of lower limbs at different times after SCI undergoing treatment in the Department of Rehabilitation, University Hospital in Bydgoszcz, Poland. All patients had a lack of pain sensation in the lower limbs and significantly elevated levels of D-dimer. In two cases, deep vein thrombosis (DVT) and intramuscular hematomas (IHs) were diagnosed. IHs were probably a consequence of antithrombotic treatments implemented due to the occurrence of DVT. Heterotopic ossification (HO) was diagnosed in a third case, and, in another patient, who was hospitalized for the longest period after injury, we found humeral bone fractures. Heterotopic ossification, intramuscular haematomas, and bone fractures of the lower limb can mimic DVT. Careful observation of the edema evolution is recommended, as the onset of new symptoms may indicate a different cause of edema from that initially established.

scholarly journals Successful Treatment of Lower Limb Complex Regional Pain Syndrome following Three Weeks of Hyperbaric Oxygen Therapy

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Rita Katznelson ◽  
Shira C. Segal ◽  
Hance Clarke
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Hyperbaric Oxygen ◽  
Lower Limb ◽  
Hyperbaric Oxygen Therapy ◽  
Skin Color ◽  
Oxygen Therapy ◽  
Pain Syndrome ◽  
Animal Pain ◽  
History Of ◽  
One Year

Hyperbaric oxygen therapy (HBOT) is a treatment that delivers 100% oxygen at increased atmospheric pressures. The efficacy of HBOT for treating pain has been described in various animal pain models and may have clinical efficacy in the treatment of human chronic pain syndromes. We present our experience with posttraumatic Complex Regional Pain Syndrome (CRPS) type 2 in a patient who underwent 15 sessions of HBOT. A 41-year-old male with one-year history of CRPS of left foot followed by left ankle fracture demonstrated less pain, decreased swelling, less allodynia, and improvement in skin color and range of motion of the lower limb after 3 weeks of HBOT. Patient was back to work for the first time in over a year. HBOT may be considered as a valuable therapeutic tool in the treatment of long-standing CRPS.

scholarly journals The effectiveness of therapeutic massage in lumbar and cervical spine pain syndrome – case study

2015 ◽  
Vol 9 (2) ◽  
pp. 24-27
Author(s):  
Iwona Wilk
Keyword(s):  
Cervical Spine ◽  
Lower Limb ◽  
Pain Syndrome ◽  
Lymphatic Drainage ◽  
Lower Limbs ◽  
Substantial Part ◽  
Therapeutic Massage ◽  
Spine Pain ◽  
Patient Reported ◽  
Pain Symptoms

Background: The spine pain syndrome is a common problem in a substantial part of the population which currently affects younger and younger people. The underlying risk factors include the character of work, sedentary lifestyle and lack of physical activity. Except for complex physiotherapy which should be applied during treatment, a lifestyle prophylaxis also seems to be a key factor. Aim of the study: The aim of this study was to present the possibility to use the classical and therapeutic massage of the back, and a lymphatic drainage of lower limbs in case of the lumbar and cervical spine pain syndrome accompaniedby the lower limb swelling. Material and methods: A young woman with the lumbar and cervical spine pain syndrome received a 55-minute lymphatic drainage (four sessions), a 30-minute classical massage (four sessions) and a 45-minute therapeutic massage (two sessions). All the procedures were performed every two days. Results: After the application of all kinds of the massage, selected individually to current symptoms and needs of the patient, the pain in the area of the spine was relieved. After the therapy the pressure pain in the back muscles such as: latissimus dorsi (lats), trapezius (traps) and spinal erectors was also decreased. The swelling in the area of the lower limb was reduced and the patient reported general decrease of pain. Conclusions: A massage may constitute an effective anti-pain therapy in case of the lumbar and cervical spine pain syndrome. Combined with educating patients about proper motor habits might prevent similar pain symptoms in the future.

scholarly journals Management of infected non-union of lower limb long bone fractures using ilizarov technique: a study of outcomes

2017 ◽  
Vol 3 (3) ◽  
pp. 557 ◽  
Author(s):  
Hrishikesh Pande ◽  
Chander Mohan Singh ◽  
Anjan Prabhakara ◽  
Vivek Mathew Philip ◽  
Mohd Shezan Iqbal ◽  
...  
Keyword(s):  
Lower Limb ◽  
Bone Fractures ◽  
Lower Limbs ◽  
Long Bone ◽  
Long Bones ◽  
Ilizarov Technique ◽  
Infected Nonunion ◽  
Ring Fixator ◽  
Long Bone Fractures ◽  
Ilizarov Ring Fixator

<p class="abstract"><strong>Background:</strong> Nonunion of long bone fractures is a common condition treated by an orthopaedic surgeon. Many nonunions can be treated effectively by internal fixation with or without bone grafting but, an infected nonunion can prove to be a tough challenge. The Ilizarov method is effective in managing infected nonunion of long bones. This study aims to assess the outcome of management of infected nonunions of long bones of lower limb with Ilizarov Ring fixator using bone and functional results as per Association for the Study and Application of Methods of Ilizarov (ASAMI) Scoring System.</p><p class="abstract"><strong>Methods:</strong> We retrospectively analysed 18 patients (16 Male: 2 Female; Mean age 43.2 years) managed with Ilizarov technique for an infected tibial or femoral nonunion between 01 January 2013 and 31 December 2014. They were followed up for an average of 25.4 months after removal of fixator. They were assessed for functional and Bone (radiological) outcomes using the Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria.<strong></strong></p><p class="abstract"><strong>Results:</strong> 17 limbs were salvaged and union could be achieved. One limb required amputation due to severe persistent intractable infection. None required any additional skeletal stabilisation after removal of fixator frame except casting in a few patients for a period of 6 weeks. Mean time to union was 211.83 days (range 136 - 320days/median 184) or 7.01 months. As per the ASAMI score, Bone results were excellent in 10, good in 5, fair in 2 and poor in 1. Functionally 7 were graded as excellent, 6 as good, 3 as fair and 1 as poor and 1 patient underwent amputation.</p><p><strong>Conclusions:</strong> The Ilizarov’s method remains one of the most versatile and successful means of achieving bone healing in infected nonunions of long bones of lower limbs with additional benefits of correcting bone defects, deformities and limb length inequalities. </p>

Complex regional pain syndrome

2011 ◽  
Author(s):  
Roger M. Atkins
Keyword(s):  
Chronic Pain ◽  
Complex Regional Pain Syndrome ◽  
Pain Syndrome ◽  
Functional Restoration ◽  
Lower Limbs ◽  
Pharmacological Intervention ◽  
Unknown Aetiology ◽  
Chronic Pain Condition ◽  
Chronic Disability ◽  
Maximum Period

♦ Complex regional pain syndrome (CRPS) is a disabling chronic pain condition of unknown aetiology♦ Traditionally it was thought to be rare; however, prospective studies demonstrate it to be common following both trauma and operative procedures involving the upper and lower limbs♦ The condition is usually self-limiting over a maximum period of 2 years, although minor abnormalities may remain♦ In a minority of cases it does not resolve and is responsible for severe chronic disability♦ Treatment is aimed at functional restoration of limb function supported by pharmacological intervention.

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.

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