CRPS: Complex Regional Pain Syndrome

Question 1

CRPS: What is it?

Answer 1

• Formerly RSD
• Regional, post-traumatic, neuropathic pain prob that most often affects 1 or more limbs
• *Challenging to treat BUT better prognosis when dx’d EARLY ON

Question 2

CRPS in Children called______

Answer 2

AMPS

Amplified MSK Pain Syndrome

*usually involves entire body

Question 3

CRPS

Clinical Features:

Answer 3

• spontaneous pain
• edema
• hypERalgesia
• temp or sudomotor changes
• motor function abnorms
• autonomic changes**

Question 4

CRPS is ______

Answer 4

COMPLICATED!

not easy to understand

Question 5

Pathophysiology of CRPS

Answer 5

• Not well understood
• Multiple Mechanisms such as:
  
  • Altered cutaneous nerve innervation after injury
  • Neurogenic inflammation
  • Central Sensitization* (explained on other card)
  • Peripheral Sensitization* (explained on other card)

Question 6

Pathophysiology of CRPS

Central Sensitization

Explain further

Answer 6

• Persistent or intense noxious input resulting from tissue damage or nerve injury triggers inc’d excitability of nociceptive neurons in the SC

Question 7

Central Sensitization is mediated by:

Answer 7

Central Sensitization is mediated by the nociception-induced release of neuropeptides

Question 8

Central Sensitization results in:

Answer 8

Results in exaggerated responses to nociceptive stimuli (hyperalgesia) and permits normally nonpainful stimuli such as light touch or cold to activate nociceptive pathways

Question 9

Peripheral Sensitization

Explain further

Answer 9

Initial tissue trauma itself also elicits local peripheral sensitization

Question 10

Type I CRPS

Answer 10

occurs AFTER injury or illness that did not directly affect nerve

*Accts for 90% of CRPS cases

Question 11

Type II CRPS

Answer 11

Occurs after DISTINCT nerve injury

*very localized

Question 12

Risk Factors for developing CRPS:

6:

Answer 12

1. Crush injury*→ common
2. Fx*→ common
3. TBI
4. CVA
5. Post-op
6. AFter LMN injury* (Type II’s)

Question 13

Generally ______ stages of CRPS

Answer 13

3

Question 14

Prognosis of CRPS is BETTER when found in this stage

Answer 14

Stage 1

*usually 1-3mos

Question 15

Stage 1 CRPS

*usually 1-3mos

Answer 15

*usually 1-3mos

• Severe burning or aching pain that INCs w/ even a very slight touch or breeze
• Fluctuations in skin temp bw hot/cold
• Rapid hair and nail growth initially
• Mm spasms and jt pain
• Changes in skin’s color, appearance, texture
  
  • pale, red, purple, mottled, and appears thin and shiny*** see pics
• Inc’d sweating
  
  • in a particular limb

Question 16

Stage 2 CRPS

*typ 3-6mos

Answer 16

*typ 3-6mos

• Skin cont’s to change and the nails become brittle and cracked
• Lvl of pain INC’s
• Hair growth SLOWS DOWN**
• Jts stiffen and muscles weaken

Question 17

Stage 3 CRPS

*diff/too painful to move affected limb

Answer 17

• If CRPS remains untreated to this point→ diff or too painful to move affected limb
• Mm’s and tendons waste (atrophy) and contract→ contractures (see pics) of hand/foot affected
• These changes can become permanent

Question 18

Medical Mgmt of CRPS:

Answer 18

• pain relievers
• antidepressants & anticonvulsants
  
  • tx nerve pain
    
    • Ex. Gabapentin (common)
• Corticosteroids to reduce inflammation
  
  • *Esp stage I
• Bone loss meds bc atrophy
• Sympathetic nerve blocking meds
  
  • Esp severe cases
• Intravenous ketamine*
  
  • to reset NS

Question 19

PT Interventions for CRPS

Answer 19

• Stress loading for Jt approximation
  
  • want mechanoreceptors to fire
• Biofeedback to allow for improved body awareness (more on this in other card)
• Graded Motor Imagery
  
  • Laterality cards for L & R Discrimination
    
    • flashcards
      
      • ID L&R limbs
        
        • reteaches brain
  • Mirror Tx
    
    • affected side into mirror box→ non-affected side moves and tricks affected limb into moving

*

Question 20

PT Interventions for CRPS

More on Biofeedback for body awareness

Answer 20

• Brain remaps body
  
  • Brain cannot ID affected limb= neglect
    
    • So…biofeedback to bring back awareness