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Complex Regional Pain Syndrome (CRPS)

Ahry Lee, Youjin Jung, Hee-Kyu Kwon, Sung-Bom Pyun
Complex regional pain syndrome (CRPS) type I in stroke patients is usually known to affect the hemiplegic upper limb. We report a case of CRPS presented in an ipsilesional arm of a 72-year-old female patient after an ischemic stroke at the left middle cerebral artery territory. Clinical signs such as painful range of motion and hyperalgesia of her left upper extremity, swollen left hand, and dystonic posture were suggestive of CRPS. A three-phase bone scintigraphy showed increased uptake in all phases in the ipsilesional arm...
February 2018: Annals of Rehabilitation Medicine
Andrzej Żyluk, Piotr Puchalski
Complex regional pain syndrome (CRPS) is a descriptive term for a complex of symptoms and signs typically occurring following trauma of the extremity. Typical symptomatology includes severe pain, swelling, vasomotor instability and functional impairment of the affected limb. At present there is no one, effective method of treatment of the condition. A large number of treatments have been investigated but major multicentre randomized controlled trials are lacking. This study presents the results of a systematic review of the evidence on effectiveness of treatment methods in CRPS...
March 12, 2018: Neurologia i Neurochirurgia Polska
Marc Sorel, Naaman Zrek, Blanche Locko, Catherine Armessen, Samar S Ayache, Jean-Pascal Lefaucheur
OBJECTIVE: To evaluate the changes in glutamate/GABA balance of intracortical excitability produced by ketamine, delivered at subanaesthetic dose to treat patients with complex regional pain syndrome (CRPS). METHODS: In 19 patients with CRPS, we assessed the effect of a 5-day ketamine protocol on various clinical aspects, including pain and depression, and on cortical excitability parameters provided by transcranial magnetic stimulation testing. RESULTS: The rest motor threshold (RMT) and the amplitude of the motor evoked potentials at 120% of RMT were not modified after ketamine therapy...
March 8, 2018: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
Frank Birklein, Seena K Ajit, Andreas Goebel, Roberto S G M Perez, Claudia Sommer
Complex regional pain syndrome (CRPS) is a pain condition that usually affects a single limb, often following an injury. The underlying pathophysiology seems to be complex and probably varies between patients. Clinical diagnosis is based on internationally agreed-upon criteria, which consider the reported symptoms, presence of signs and exclusion of alternative causes. Research into CRPS biomarkers to support patient stratification and improve diagnostic certainty is an important scientific focus, and recent progress in this area provides an opportunity for an up-to-date topical review of measurable disease-predictive, diagnostic and prognostic parameters...
March 16, 2018: Nature Reviews. Neurology
Marc Sorel, Jacques-Christian Beatrix, Blanche Locko, Catherine Armessen, Anne-Marie Domec, Otilia Lecompte, Sofiane Boucheneb, Benoit Harache, Jacques Robert, Jean-Pascal Lefaucheur
OBJECTIVES: The efficacy of ketamine in relieving complex regional pain syndrome (CRPS) lacks predictive factors. The value of three-phase bone scintigraphy (TPBS) was assessed or this purpose. METHODS: TPBS was performed in 105 patients with unilateral, focal CRPS of type 1 before 5 days of ketamine infusions. Tracer uptake was measured in the region of interest concerned by CRPS and the contralateral homologous region. For the three scintigraphic phases (vascular, tissular, and bone phases), an asymmetry ratio of fixation was calculated between the affected and the unaffected sides (VPr, TPr, and BPr)...
March 13, 2018: Clinical Journal of Pain
Mark Gaertner, Jiang-Ti Kong, Kristen H Scherrer, Alyssa Foote, Sean Mackey, Kevin A Johnson
INTRODUCTION: Complex Regional Pain Syndrome (CRPS), a rare and severe chronic pain condition, often responds poorly to existing treatments. Previous studies demonstrated Transcranial Magnetic Stimulation (TMS) provided short-term pain relief for upper extremity CRPS. METHODS: Building on previous methodologies, we employed a TMS protocol that may lead to significant pain relief for upper and lower extremity CRPS in a nonrandomized open label pilot trial involving 21 participants...
March 4, 2018: Neuromodulation: Journal of the International Neuromodulation Society
Silvia Duong, Daniela Bravo, Keith J Todd, Roderick J Finlayson, De Q Tran
PURPOSE: Although multiple treatments have been advocated for complex regional pain syndrome (CRPS), the levels of supportive evidence are variable and sometimes limited. The purpose of this updated review is to provide a critical analysis of the evidence pertaining to the treatment of CRPS derived from recent randomized-controlled trials (RCTs). SOURCE: The MEDLINE, EMBASE, Psychinfo, and CINAHL databases were searched to identify relevant RCTs conducted on human subjects and published in English between 1 May 2009 and 24 August 2017...
February 28, 2018: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Tara L Packham, Joy C MacDermid, Susan L Michlovitz, Norman Buckley
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...
January 1, 2018: Canadian Journal of Occupational Therapy. Revue Canadienne D'ergothérapie
Koji Abe, Toshiyasu Nakamura, Eiko Yamabe, Koichi Oshio, Takeshi Miyamoto, Masaya Nakamura, Morio Matsumoto, Kazuki Sato
Patients with complex regional pain syndrome (CRPS) exhibit diverse symptoms, such as neuropathic pain, allodynia, local edema and skin color changes in the affected lesion. Although nerve injury may cause CRPS, pathophysiological mechanisms underlying the syndrome are unclear, and local edema, a characteristic of CRPS, has not been evaluated quantitatively for technical reasons. Here, using a rat spinal nerve ligation-induced CRPS model, we show that edematous changes in gastrocnemius muscle can be detected quantitatively by diffusion magnetic resonance imaging (MRI)...
2018: PloS One
Tara Packham, Janet Holly
STUDY DESIGN: Narrative review. INTRODUCTION: There are a variety of treatments with demonstrated effectiveness for the management of complex regional pain syndrome (CRPS). However given the variability in symptom presentation in this population, therapists may be unsure what treatments would be most effective for individual clients. PURPOSE OF THE STUDY: To present a brief synthesis of the literature and propose a rehabilitation version of a mechanism-specific management algorithm to guide personalized treatment of CRPS...
February 13, 2018: Journal of Hand Therapy: Official Journal of the American Society of Hand Therapists
Jennifer Chu, Frans Bruyninckx, Duncan V Neuhauser
Introduction: Favourable pain relief results on evoking autonomous twitches at myofascial trigger points with Electrical Twitch Obtaining Intramuscular Stimulation (ETOIMS). Aim: To document autonomic nervous system (ANS) dysfunction in Complex Regional Pain Syndrome (CRPS) from blood pressure (BP) and pulse/heart rate changes with ETOIMS. Methods and materials: A patient with persistent pain regularly received serial ETOIMS sessions of 60, 90, 120 or ≥150 min over 24 months...
July 2017: BMJ Innovations
SuHwan Shin, Seung Gyeong Jang, KyeongTae Min, Won Lee, So Yoon Kim
BACKGROUND: Complex regional pain syndrome (CRPS) involves severe pain and it is difficult to identify the exact cause or pathogenesis. Therefore, there are controversies regarding legal issues related to the establishment of damage in medical malpractice lawsuits involving CRPS. This study aimed to analyze malpractice lawsuits involving CRPS, which occurred after the disputed medical treatment, to provide information on the courts' opinion and characteristics of the cases. METHODS: This study analyzed 23 lawsuit judgments involving CRPS that were sentenced from 2005 to 2015...
February 26, 2018: Journal of Korean Medical Science
Dominic Hegarty
No abstract text is available yet for this article.
January 2018: Pain Reports (Baltimore, Md.)
M Wittayer, V Dimova, F Birklein, T Schlereth
Neglect-like symptoms (NLS) are frequently observed in CRPS. The clinical meaning of NLS, however, is largely unknown. Therefore, this study sets out to assess the importance of NLS for patient outcome and to explore their clinical correlates. We assessed NLS in a group of 53 CRPS patients and compared the results to 28 healthy volunteers. In order to define the origin of the NLS reports, we tested the subjective visual midline (SVM), performed a limb-laterality recognition test (LLT), and quantitative sensory testing (QST)...
February 5, 2018: Pain
Tom J Crijns, Bonheur A T D van der Gronde, David Ring, Nina Leung
BACKGROUND: Complex regional pain syndrome (CRPS) is frequently diagnosed in patients recovering from surgery or injury. The symptoms and signs included in consensus diagnostic criteria for CRPS are expected after injury. Categorizing symptoms and signs that occur on a continuum as disproportionate or not is subjective and prone to bias. Psychiatrists and psychologists do not diagnose CRPS and instead measure and treat anxiety and catastrophic thinking on its continuum. Given the expected variation in subjective diagnoses such as CRPS, this study addresses factors associated with use of this diagnosis and how it influences care...
February 5, 2018: Clinical Orthopaedics and related Research
Rashmi Datta, Jyotsna Agrawal, Amit Sharma, Vikram Singh Rathore, Shivesh Datta
Background and Aims: The effect of stellate ganglion blocks (SGBs) was examined in complex regional pain syndromes (CRPS) of the upper body. Material and Methods: A total of 287 SGB were given to patients with documented CRPS on medications. Spontaneous and provoked pain assessment was done with numeric pain rating scale (NPRS). The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and range of motion (ROM) was recorded before and after each blockade...
October 2017: Journal of Anaesthesiology, Clinical Pharmacology
Stephan Ott, Christian Maihöfner
Complex regional pain syndrome (CRPS) is a complex pain disorder that can emerge after limb trauma or a lesion in the peripheral nervous system. Typical features include continuing pain, sensory, vasomotor, sudomotor, motor and trophic changes as well as edema. These signs provide the basis of CRPS diagnosis. A detailed description of the signs, symptoms and medical history of CRPS could potentially facilitate an earlier and more accurate diagnosis. The aim of this study is to provide such a description, based on epidemiological measures, clinical presentation and a thorough description of pain sensations...
February 1, 2018: Journal of Pain: Official Journal of the American Pain Society
Jae Won Lee, Sang Ki Lee, Won Sik Choy
Diagnosis of Complex regional pain syndrome (CRPS) is made primarily on a clinical basis, and no specific test is known to confirm or exclude CRPS diagnosis. That is, there aren't specific diagnostic tools and instrumental tests are made only for identifying an etiology at the basis of the CRPS. Numerous therapeutic methods have been introduced, but none have shown definitive results. When symptoms persist, patients experience permanent impairment and disability. Therefore, early recognition of CRPS, along with proper treatment, is important for minimizing permanent loss of function...
March 2018: Journal of Hand Surgery Asian-Pacific Volume
Ivan Urits, Abra H Shen, Mark R Jones, Omar Viswanath, Alan D Kaye
PURPOSE OF REVIEW: Complex regional pain syndrome (CRPS) refers to a chronic pain condition that is characterized by progressively worsening spontaneous regional pain without dermatomal distribution. The symptomatology includes pain out of proportion in time and severity to the inciting event. The purpose of this review is to present the most current information concerning epidemiology, diagnosis, pathophysiology, and therapy for CRPS. RECENT FINDINGS: In recent years, discovery of pathophysiologic mechanisms of CRPS has led to significant strides in the understanding of the disease process...
February 5, 2018: Current Pain and Headache Reports
Jianli Zhao, Yajing Wang, Dajie Wang
PURPOSE OF REVIEW: Complex regional pain syndrome (CRPS) is a painful debilitating neurological condition that accounts for approximately 1.2% of adult chronic pain population. Ketamine, an NMDA receptor antagonist, is an anesthetic agent that has been used by some pain specialists for CRPS. There is a growing body of clinical evidence to support the use of ketamine in the treatment of neuropathic pain, especially CRPS. This meta-analysis study was aimed to examine the efficacy of ketamine in the treatment of CRPS...
February 5, 2018: Current Pain and Headache Reports
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