Complex regional pain syndrome

Question 1

Complex regional pain syndrome

Answer 1

Often occurs after recent minor surgery, 3x more common in women

2 types:
1: no demonstratable lesion to a major nerve
2: lesion to a major nerve

Features:
- progressive, disproportionate symptoms to the original injury/surgery
- allodynia
- temperature and skin colour changes
- oedema and sweating
- motor dysfunction
- Budepest Diagnostic Criteria

Management:
-early physiotherapy
- neuropathic analgesia - amitriptyline
- Pain team

Question 2

Budapest diagnostic criteria of CRPS

Answer 2

Symptoms

To receive a diagnosis under the Budapest Criteria, a person must have at least one symptom in three of the four following categories:

Sensory – Hyperaesthesia (an abnormal increase in sensitivity), and/or allodynia, which is pain caused by stimuli which shouldn’t trigger a painful response. Examples of allodynia include lightly touching the affected limb, perhaps by moving a bedsheet or by a gentle tap on the wrist.
Vasomotor – Skin colour changes and/or changes in temperature of the limb.
Sudomotor/oedema – Swelling of the limb and/or an excess of sweat from the affected limb, or changes in sweating swelling of the limb.
Motor/Trophic – Decreased range of motion and/or motor dysfunction, including weakness, spasms, tremors or wasting. Trophic changes include changes to the hair, nails or skin on the affected limb.
Signs

At the time of clinical examination, at least one sign must be present to the person carrying out the examination in two or more of the categories listed below, they vary slightly to the list above.

Sensory – Hyperalgesia (to pinprick), a heightened sensitivity to pain, and/or allodynia to light touch or deep somatic (physical) pressure and/or joint movement
Vasomotor: temperature differences between the limb, and/or skin colour changes and/or skin colour changes between the limb
Sudomotor/oedema: oedema and/or sweating changes and/or sweating differences between the limbs.
Motor/trophic: decreased range of motion and/or motor dysfunction (ie weakness, tremor or muscle spasm) and/or trophic changes (hair and/or nail and/or skin changes).

For a diagnosis to be made, most importantly there should be no other condition able to explain the presented signs and symptoms. An early diagnosis is important to limit the progression of CRPS and to prevent the onset of more disabling signs and symptoms.

Question 3

Autonomic dysreflexia

Answer 3

Occurs in patients who have spinal injury at or above T6

Breifly, afferent signals, most commonly triggered by faecal impaction or urinary retention cause a sympathetic nerve reflex via thoracolumbar outflow, but the usual centrally medicated parasympathetic response is prevented by the spinal cord lesion

HTN, flushing, sweating above the level of the cord lesion, agitation