Term
| what is complex regional pain syndrome/reflex sympathetic dystrophy? |
|
Definition
| a chronic disease most often resulting from trauma, characterized by pain disproportionate to the inciting cause and frequently not explained by conventional diagnostics - thus under-diagnosed/under-treated by the medical community. |
|
|
Term
| what is the hx of RSD/CPRS? |
|
Definition
| was called causalgia back in the civil war and usually was related to trauma. |
|
|
Term
| what are the s/s of RSD/CPRS? |
|
Definition
| pain (unique burning) and skin hypersensitivity, vasomotor skin changes, sweat disturbance/edema, motor disturbances, and various degrees of trophic change. often follows musculoskeletal trauma, sx or immobilization. |
|
|
Term
| what are the 2 types of CRPS? |
|
Definition
| CRPS 1 = RSD. CRPS 2 = causalgia (involves nerve injury). CRPS NOS (not otherwise specified) = partially meets criteria, better explained by other conditions. |
|
|
Term
| who does CRPS affect more? |
|
Definition
| women 30-50 y/o, usually following trauma. possibly related to hormones. |
|
|
Term
| what characterizes the pain due to CRPS? |
|
Definition
| the initial pain due to injury is sharp and proportional to the injury - but when the musculoskeletal damage is repaired, a different, disproportionate, continuing burning pain occurs. this pain is characterized as *allodynia (pain from a stimulus that does not normally provoke pain), *hyperalgesia (excessive sensitivity to pain), and *hyperesthesia (increased sensitivity to a sensory stimulation). |
|
|
Term
| what are the other clinical features of CRPS (other than pain)? |
|
Definition
| hx of edema, changes in skin blood flow, or abnormal sweating in the region of pain (*red, shiny swollen limbs*). decreased ROM and other motor dysfunction (weakness, tremor, dystonia, neglect), and exclusion of medical conditions that would otherwise account for the degree of pain and dysfunction. the pain is often unilateral. abnormal sweating, swelling, limited movement, weakness, tremor, dystonia, neglect, and abnormal hair/nail growth. |
|
|
Term
| what characterizes the CRPS/RSD diagnosis? |
|
Definition
| no other dx better explains the symptoms |
|
|
Term
|
Definition
| yes, 95% of the time it moves horizontally or vertically (if it crosses over = worse prognosis). this can happen as late as 8 yrs later. |
|
|
Term
| what is in the ddx for CRPS/RSD? |
|
Definition
| DM and other small-fiber peripheral neuropathies, entrapment neuropathies, thoracic outlet syndrome, discogenic dz, cellulitis, vascular insufficiency, *lymphedema, costochondritis, brachial plexopathies, and *fibromyalgia. |
|
|
Term
| how is RSD/CPRS diagnosed? |
|
Definition
| x-ray, CT, MRI, triple phase bone scan, discogram, myelogram, arthogram, lab testing, EMG, SSEP (measure somatosensory components), QST-ANST (measures autonomic nerve function for vibration and sense), and *thermography (infrared, best diagnostic test for sympathetic dysfunction and RSD)*. |
|
|
Term
|
Definition
| goals: functional restoration, pain management, and psychological tx. requires physiotherapy, medical, psychological (all RSD pts are depressed) and family support. |
|
|
Term
| what diet and lifestyle alterations can help w/RSD? |
|
Definition
| anti-inflammatory diet, raw foods, smoking cessation, and home exercise |
|
|
Term
| what alternative therapies can help w/RSD? |
|
Definition
| reiki, manipulation/massage, acupuncture, and yoga/meditation. |
|
|
Term
| what vitamins help w/RSD/CRPS? |
|
Definition
|
|
Term
| what characterizes physical therapy for PSD/CRPS? |
|
Definition
| mobilization/movement asap, desensitization, and it is very important that the therapist have experience in this type of pt. |
|
|
Term
| what are the rx's for the 4 types of pain in CRPS? |
|
Definition
| muscle pain: muscle relaxants, inflammatory pain: NSAIDs/steroids. deep bone pain: analgesics. burning: neuroleptics. |
|
|
Term
| what are other medications which are used in CRPS/RSD? |
|
Definition
| antidepressants, anti-anxiety agents, antispasmodics, Ca++ channel blockers, antihypertensives, pamidronate, lenalidomide, mexilitine, capsaicin, DMSO, dextromethorphan, and amantadine |
|
|
Term
| does ketamine help w/CRPS? |
|
Definition
| under certain circumstances this IV is the **best drug available to give these pts their life back. |
|
|
Term
| what are other therapies used? |
|
Definition
| interventional pain management, sympathetic blocks, brachial plexus blocks, hospital based epidural infusions, spinal cord stimulators, intrathecal pumps, and prialt |
|
|
Term
| what is the risk with surgery in RSD pts? |
|
Definition
| high risk of spreading the disease. the worst is upper body, shoulder/breast sx. intra-operative ketamine can help prevent this. |
|
|
Term
| what underlying conditions need to be treated in RSD? |
|
Definition
| DM, hormonal imbalance, thyroid dysfunction, and cardiopulmonary issues (esp bradyarrhythmias) |
|
|
Term
| what are other symptoms of CRPS? |
|
Definition
| ha/, photophobia, otophobia, hoarseness, chest pain, cardiac arrhythmias, GI, GU, and immune system compromise. |
|
|
