CRPS.pptx
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This document provides an overview of Complex Regional Pain Syndrome (CRPS). It defines CRPS as a painful condition following injury that is disproportionate in magnitude and duration to the inciting event. It discusses the diagnostic criteria and classifications of CRPS. It also covers the etiology, assessment, differential diagnosis, investigations, treatment principles and specific treatment options for CRPS, including pharmacological interventions, rehabilitation, nerve blocks, sympathectomy and other surgical procedures.
CRPS.pptx
- 1. Complex Regional Pain Syndrome Ahmad Ashammery Moderator: Dr. Muath Hakami / Dr.Hazazi
- 3. IMPORTANT TERMS Analgesia: absence of pain in response to an insult that should produce pain. Allodynia: pain from a stimulus that is not normally painful e.g. light touch. Dysesthesia: painful sensations experienced in the absence of stimulation. Hyperpathia: Pain that persists after the stimulus has been removed. Hyperalgesia: exaggerated pain experienced from a painful stimulus. Sudomotor functions: sweating and piloerection.
- 4. DEFINITION As per the International Association for the Study of Pain, CRPS defined as: A variety of painful conditions following injury which appears regionally having a distal predominance of abnormal findings, exceeding in both magnitude and duration the expected clinical course of the inciting event often resulting in significant impairment of motor function, and showing variable progression over time
- 7. CLASSIFICATION TYPE I: CLASSICALLY DESCRIBED REFLEX SYMPATHETIC DYSTROPHY 2. TYPE II: CLASSICALLY DESCRIBED MAJOR CAUSALGIA 3. TYPE III: SYMPATHETICALLY INDEPENDENT PAIN SYNDROME
- 10. ETIOLOGY AND PATHOPHYSIOLOGY Several theories been described
- 11. CONTINUED,, Psychological theory Abnormal sympathetic nervous system Abnormal inflammation theory Immobilization theory Genetic theory CNS theory
- 12. ASSESSMENT 1) History: Sensory abnormalities Motor abnormalities Autonomic abnormalities Trophic changes Psychological changes
- 13. ASSESSMENT 2) Physical examination: Sensory Sudomotor / vasomotor Edema Trophic Palmar / plantar fasciitis Motor function
- 14. DEFERENTIAL DIAGNOSIS Normal response to trauma or surgery. CNS / PNS disorders: Multiple Sclerosis, amyotrophic lateral sclerosis, neuropathic pain syndromes, and peripheral neuropathies. Autoimmune disorders. Degenerative: arthritis. Vascular: Atherosclerosis, vasospastic disease. Neoplasm. Infection: Osteomyelitis, cellulitis
- 15. Disease course Early (Stage I, begins up to one month after inciting event,lasts 3-6 months) Middle (Stage II, lasts 3-6 months) Late stage (Stage III, lasts months to years)
- 16. INVESTIGATIONS X rays Three phase Bone scintigraphy MRI Thermography Microvascular flow Laser doppler Video photometric capillaroscopy
- 17. Diagnostic Sympathetic Blockade Regional blocks (stellate ganglion, brachial plexus or peripheral nerves) commonly using non-selective 留- blockers (phentolamine, guanethidine). Pain relief after phentolamine IV injection is diagnostic of Sympathetically Mediated Pain.
- 18. TREATMENT PRINCIBLES The best treatment is prevention. For CRPS type 2, the best treatment is: repair of the injured nerve.
- 19. PILLARS OF TREATMENT 1. Pain management 2. Rehabilitation 3. Psychological therapy
- 20. Prevention good analgesia after trauma or surgery vitamin C 5001000 mg daily Perioperatively, strategies and planning Corticosteroids. NSAIDs Non-operative: Psychological therapy. Stress management: relaxation techniques, cognitive behavioral therapy pharmacologic treatment of Axis 1 disorders and depression
- 21. Rehabilitation A) Early: Isometric stress-loading activities- compressive and distracting forces. Desensitization, edema management and sensory re-education. PROM relatively contraindicated as this worsens pain. Gentle PROM exercises may be used if pain is blocked. AROM. B) Later: gradual initiation of AROM/PROM exercises
- 22. Modalities: Heat/Hydrotherapy Paraffin bath (hot wax). Transcutaneous Electrical Nerve Stimulation Vocational rehab Edema control Biofeedback therapy Mirror box therapy Acupuncture
- 23. Pharmacological Classes Narcotics Anti-inflammatory Anti-depressants Membrane stabilizing agents: Anti-adrenergic/sympatholytics Continuous sympathetic blockade Ca-channel blockers NMDA (glutamate receptor)- antagonists Topical
- 25. Operative interventions: Prerequisite for diagnosis for sympathetically maintained pain. Most widely accepted treatment. Stellate ganglion and other nerve blocks:
- 26. Sympathectomy Greatest value in: Cases with proximal nerve injury. Patients who obtain repeated relief from sympathetic blocks. Patients refractory to all other treatments
- 27. Sympathectomy Modes Chemical: Using 5% phenol under CT guidance Results in reversible axonotemesis with recovery in 3-6 months. Surgical: Salvage Relief maybe temporary or incomplete due to incomplete sympathetic denervation or subsequent nerve regeneration.
- 28. Continued,, Surgical control of peripheral irritants. Implanted electrical stimulation: Placement sites,, Mechanism of action,,
- 29. Others,, CNS ABLATIVE TECHNIQUES PROCEDURES FOR IMPROVING ROM AMPUTATION
- 30. Thank you