An Osteopathic Approach to Complex Regional Pain Syndrome (CRPS)

2021 ◽  
Vol 31 (4) ◽  
pp. 47-54
Author(s):  
Navneet Deol ◽  
Victor Nuño ◽  
Molly Schuman ◽  
Cristian Contreras
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Pain Syndrome ◽  
Well Being ◽  
The Body ◽  
Menopausal Woman ◽  
Full Time ◽  
Individualized Approach ◽  
Osteopathic Treatment ◽  
Post Menopausal ◽  
Specific Symptoms

Abstract Complex Regional Pain Syndrome (CRPS) is a chronic neuropathic pain condition in a region of the body where the pain experienced by the patient is disproportionate to the stimuli preceding the pain. In this case, a 52-year-old post-menopausal woman presents with chronic distal limb pain due to a left ankle contusion from a work injury. Previous treatments that focused on specific symptoms failed. However, the patient was then evaluated and treated comprehensively by an osteopathic physician. Treatment was tailored to individual patient needs based on the five models of osteopathic care. Within a 1.5 years period of integrative osteopathic treatment that utilized osteopathic manipulative treatment (OMT) in addition to medications and supplements, the patient was able to start walking again with only mild discomfort. This individualized approach seemed to improve her quality of life, and overall satisfaction with her health, psyche, and well-being. The patient is now discharged from the practice, has resumed normal daily activities, and is working full-time as a cashier.

scholarly journals Ketamine for Non-Neuropathic Pain

2021 ◽  
Author(s):  
Subbulakshmi Sundaram ◽  
Ashok Swaminathan Govindarajan
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Complex Regional Pain Syndrome ◽  
Antinociceptive Effect ◽  
Pain Syndrome ◽  
Well Being ◽  
Pain Mechanisms ◽  
Cardiovascular Side Effects ◽  
Chronic Pain Conditions ◽  
Rescue Agent

Chronic pain is one of the leading causes of years lost to disability, as most of the time it is refractory to conventional treatment. Recent advances in understanding the pain mechanisms have favored the use of ketamine as a rescue agent in refractory chronic pain conditions, as it has potential modulating effect on both sensory-discriminative and affective motivational components of pain. Preclinical studies also suggested the antinociceptive effect of sub anesthetic dose of ketamine against central and peripheral neuropathic pain conditions and non-neuropathic pain conditions such as inflammatory and nociceptive pain states. Subanesthetic infusion of ketamine along with adjuvants such as midazolam and clonidine is found to reduce the psychomimetic and cardiovascular side effects of ketamine. Even though the consensus guidelines for intravenous use of ketamine for chronic pain advocate the use of ketamine only for complex regional pain syndrome, various other clinical studies suggested its role in other refractory painful conditions. Hence the present topic focuses specifically on the effect of ketamine on non-neuropathic pain conditions such as complex regional pain syndrome, fibromyalgia, headache, ischemic limb pain, etc. Many studies had shown that ketamine not only reduces the pain scores but also the analgesic medications, which further improves the well-being and quality of life.

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.

Co-morbidity between trigeminal autonomic cephalalgias and complex regional pain syndrome: Two case reports

Cephalalgia ◽  
2021 ◽  
pp. 033310242110582
Author(s):  
Peter D Drummond ◽  
Philip M Finch
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Upper Limb ◽  
Case Reports ◽  
Stellate Ganglion ◽  
Pain Syndrome ◽  
Pain Modulation ◽  
The Body ◽  
Trigeminal Autonomic Cephalalgias ◽  
Mechanical Stimuli ◽  
Co Morbidity

Background Trigeminal autonomic cephalalgias and complex regional pain syndrome are rare conditions, and their co-occurrence has not been reported previously. Clinical findings: In two patients, ipsilateral trigeminal autonomic cephalalgias developed after the onset of upper limb complex regional pain syndrome. Hyperalgesia to thermal and mechanical stimuli extended beyond the affected limb to encompass the ipsilateral forehead, and was accompanied by ipsilateral hyperacusis and photophobia. In addition, examination of the painful limb and bright light appeared to aggravate symptoms of trigeminal autonomic cephalalgias. Detailed examination of the association between facial and upper limb pain indicated that both sources of pain cycled together. Furthermore, in one case, stellate ganglion blockade inhibited pain for an extended period not only in the affected limb but also the face. Conclusions These findings suggest some overlap in the pathophysiology of complex regional pain syndrome and trigeminal autonomic cephalalgias. Specifically, central sensitization and/or disruption of inhibitory pain modulation on the affected side of the body in complex regional pain syndrome might trigger ipsilateral cranial symptoms and increase vulnerability to trigeminal autonomic cephalalgias.

Complex Regional Pain Syndrome of the Upper and Lower Extremity

2018 ◽  
Author(s):  
Agnes Stogicza ◽  
Bartha Peter Tohotom ◽  
Edit Racz ◽  
Andrea Trescot ◽  
Alan Berkman
Keyword(s):  
Nervous System ◽  
Sympathetic Nervous System ◽  
Complex Regional Pain Syndrome ◽  
Medication Management ◽  
Pain Syndrome ◽  
The Body ◽  
Loss Of Function ◽  
Early Presentation ◽  
Temperature Changes ◽  
Sympathetic Nervous

Complex regional pain syndrome (CRPS) is a chronic debilitating pain condition of the extremities; it can affect, less commonly, other areas of the body (face, pelvis, abdomen). Its early presentation—pain disproportionate to the injury, skin temperature changes, hyperalgesia, allodynia—is often not recognized, delaying treatment. In later phases, with sympathetic nervous system involvement, it presents with skin and muscle atrophy, hair loss, allodynia, loss of function, and decreased range of motion. In severe cases, it can spread from one area to the other. Imaging findings (X-ray, MRI, bone scintigraphy) are nonspecific. They are used to support the diagnosis, and to exclude conditions that can present similarly. Treatment is challenging and includes physical therapy, psychologic support, medication management, and minimally invasive interventions to decrease pain, to positively influence the sympathetic nervous system, and to preserve function. A multidisciplinary approach is likely to be the most beneficial.

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

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.

scholarly journals Client Satisfaction of Hand Therapy Intervention: An Evaluation of the Effectiveness of Therapy for Clients Recovered From Complex Regional Pain Syndrome

2008 ◽  
Vol 16 (1) ◽  
pp. 27-35 ◽  
Author(s):  
Nirmeen Zagzoog ◽  
Shrikant J Chinchalkar ◽  
Thelma Sumsion
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Client Satisfaction ◽  
Pain Syndrome ◽  
The Body ◽  
Unique Contribution ◽  
Therapy Regimen ◽  
Therapy Program ◽  
Level Of Satisfaction ◽  
Before And After ◽  
High Level

Complex regional pain syndrome (CRPS) is a neuropathic pain condition that may develop following trauma to an extremity. Clients treated for CRPS at St Joseph's Health Care London – Hand and Upper Limb Centre, London, Ontario, were asked to evaluate their level of satisfaction with the treatment they had received by comparing their pain, functional status and emotional status before and after receiving therapy. The results indicated a high level of satisfaction among clients, attributable to the unique nature of the therapy program in use at this facility, where the occupational therapist works in close collaboration with the surgeon and pain specialists, and the therapy regimen is designed for each client individually according to his or her needs. The unique contribution of the present study to the body of clinical literature on CRPS is that it introduces a focus on client functionality and on client satisfaction with therapy received.

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