Presentation on theme: "COMPLEX REGIONAL PAIN SYNDROME (crps)"— Presentation transcript:
1 COMPLEX REGIONAL PAIN SYNDROME (crps) THE CIVIL WAR DISEASE
2 COMPLEX REGIONAL PAIN SYNDROME: HISTORY "Perhaps few persons who are not physicians can realize the influence of which long-continued and unendurable pain can have upon both body and mind".Silas Weir Mitchell, a Philadelphia neurologist treating causalgia in Civil War soldiers in 1864His observations…
3 SILAS WEIR MITCHELL 1864"its favorite site is the foot or hand...the palm of the hand or palmar face of the fingers, and on the dorsum of the foot; scarcely ever on the sole of the foot or the back of the hand…”“When it first existed in the whole foot or hand, it always remained last in the parts referred to...if it lasted long it was finally referred to the skin alone….”“The part itself is not alone subject to an intense burning sensation, but becomes exquisitely hyperaesthetic, so that a touch or a tap of the finger increases the pain."
4 SILAS WEIR MITCHELL 1864"As the pain increases, the general sympathy becomes more marked. The temper changes and grows irritable, the face becomes anxious, and has a look of weariness and suffering.The sleep is restless, and the constitutional condition, reacting on the wounded limb, exasperates the hyperaesthetic state, so that the rattling of a newspaper, a breath of air...the vibrations caused by a military band, or the shock of the feet in walking, gives rise to increase of pain.
5 SILAS WEIR MITCHELL 1864At last...the patient walks carefully, carries the limb with the sound hand, is tremulous, nervous, and has all kinds of expedients for lessening his pain."
6 WHAT’S IN A NAME? Algodystro-phy Mimo causalgia Sudeck’s atrophy Minor caus-algiaMajor causalgiaReflex neurovas-cular dystrophyPost-traumatic dystrophyPost-traumatic algodystro-phyNeurovas-cular dystrophyMorbus SudeckPourfour du Petit SyndromePeripheral trophoneurosis
7 RSD RENAMEDReflex Sympathetic Dystrophy renamed as Complex Regional Pain Syndrome in 1995CRPS type 1 is RSDCRPS type 2 is Causalgia (nerve lesion)Current evidence suggests CRPS 1 is minute nerve injury in C fibers (Oaklander AL MD PhD et al Pain 2006)
8 CRPS TODAYMulti-system syndrome characterized by chronic pain usually affecting one limbCan begin/affect any part of the bodyBlood supply to the limb is affectedHand, knee, hip and shoulder most commonly affectedEarly diagnosis brings best prognosis
9 WHAT CAUSES RSD/CRPS? 65% cases: soft tissue injury e.g. sprain Fracture or surgeryBack/neck disordersCumulative strain injury, repetitive strainOther: infection, stroke, heart attack, venipuncture
10 SYMPTOMS PAIN: in area other than primary site SWELLING SKIN CHANGES: in temperature (hot/cold) and color (red, blue, mottled)MOVEMENT limited active range of motionINCREASE of complaints after exerciseIASP criteria
11 OTHER SYMPTOMSMotor dysfunction: tremor, weakness, atrophy, myoclonus, dystoniaLimbic system dysfunction: insomnia, agitation, depression, memory loss, anxietyHair, skin and nail changesSweating (not in all cases)
12 HOW IS IT DIAGNOSED? THERE IS NO SINGLE TEST Thorough medical history and examination by a qualified clinicianThermography may be helpfulCT, MRI, bone scan may be normalX-ray may show osteoporosis (bone loss)
13 TREATMENT OPTIONS Drugs Blocks Physical therapy: aqua or physiotherapy Sympathectomy: (rare cases)SCS, PNS, morphine pumpPsychological support
14 OTHER TREATMENT OPTIONS Cognitive behaviour therapyRelaxation techniques e.g. Qi Gong, biofeedback, progressive muscle relaxation, Tai Chi, guided imagery, YogaAlternative medicine options: chronic pain diet, naturopathy, homeopathy, massage, photon therapy, etc.TO IMPROVE, MOVE: Exercise program
15 WHEN TO SUSPECT CRPS“Excruciating pain, stiffness, inflammation following a minor trauma…”“….Persistent pain and swelling of unexplained origin aggravated by bed rest or upon awakening. ..’” Hooshmand , H MD CRPS:Diagnosis and Therapy Spring Verlager 1999“Injury that has not healed, (past normal healing time) and pain out of proportion to the injury”.
16 EARLY DIAGNOSIS CRITICAL Early diagnosis ( <3 mo.) with PROPER treatment, success rate is highest, the best prognosisIf left untreated, can lead to lifetime of severe, intractable, chronic painFirst 3-6 months after onset: 80-90% recovery rate6 months to 2 years 70-80%, after 2 years: 20%
17 MC GILL PAIN INDEX cancer pain rated 28, CRPS pain rated 42 Causalgia is rated higher than cancer pain.
19 SELF-MANAGEMENT OF CRPS MEDICAL SUPPORTCONTACT ORGANIZATIONDEVELOP PLANALTERNATIVE THERAPIESWORK PIECES OF PUZZLESTAY POSITIVE
20 PATIENT RESOURCES Build your medical support team Inform yourself: VISIT:Join P.A.R.C: help promote awarenessEducate yourself, your family/friendsDevelop your own support network of friends/familyUse a combination of medical and alternative therapies, make a plan
21 RSDCANADA SURVEY RESULTS Rating own successProgress over timeHas your CRPS spread?
23 PROGRESSION: IS YOUR CRPS WORSE, BETTER OR SAME?
24 HAS YOUR CRPS SPREAD?Most cases progress and travel through other body partsProgression causes systemic chronic problemsPain is hallmark feature
25 RSDCANADA SURVEY CONCLUSIONS MUST educate medical profession about early recognitionSUFFERING MUST BE recognized: pain rating levels between 6-10; pain is grossly under-treated; pain level as vital signLow success ratings (10-50%) show lack of effective treatments for CRPS
26 CRPS FACTSWhen not caught early, CRPS can be progressive (70% of cases)NEED to find single diagnostic testEarly recognition through educationEarly diagnosis equals BETTER prognosisNeed more effective treatments for CRPSResearch is desperately needed
27 WHAT CAN A MEDICAL PROFESSIONAL DO? EARLY RECOGNITION IS ESSENTIAL TO PATIENT RECOVERYATTEND CRPS INFORMATION SESSIONSIF YOU SUSPECT CRPS, REFER IMMEDIATELY FOR TREATMENTBELIEVE THE PATIENT’S PAIN: IT IS REALLISTEN/SUPPORT PATIENT
28 COMPLEX REGIONAL PAIN SYNDROME… THANK YOU FOR INVITING ME!