Complex Regional Pain Syndrome复杂区域性疼痛综合征.pptVIP

Complex Regional Pain Syndrome Jeremy Bennett CRPS History CRPS (complex regional pain syndrome) initially considered in early 1800s by Claude Bernard et al. During the Civil War it was seen that soldiers who suffered from low-velocity, high-mass missile injuries developed a neuropathic pain that was termed causalgia by Silas Weir-Mitchell. In 1940s the term of reflex sympathetic dystrophy came into use relating the belief of an abnormal efferent reflex from the sympathetic nervous system to bodily injury. Since that time much study and frustration has come from this relatively rare condition of which the pathophysiology is still not fully understood. CRPS is rare, but has started to see an increase in dx. Basics Often seen after injury to a limb or related to some inciting event. The patient complains of and can manifest skin color/ temperature/ appearance changes in the affected limb. Pain often excruciating – burning, tingling, electric-like, etc. are often symptoms that patients feel. The pain is often out of proportion to stimulus or the event. Physical Appearance Diagnostic Criteria IASP (International Assoc for the Study of Pain) diagnostic criteria include 4 subjective and/ or objective findings: 1. The presence of an initiating event or a cause of immobilization – peripheral injury or central (stroke, etc)*. (Injury) 2. Continuing pain, allodynia, or hyperalgesia in which the pain is disproportiate to inciting event. (Sensory) 3. Evidence of edema, changes in skin blood flow, or abnormal sudomotor activity in region of pain. (Vasomotor) 4. Diagnosis is excluded by the existence of other conditions that would otherwise account for the degree of pain/ dysfunction. One?symptom from?each category (except #1 as 5% of pts lack known event) and at least one sign from 2 categories must be evident to diagnose CRPS, at least by research criteria. *Not always present or identifiable. CRPS More Widely Diagnosed Quickly becoming more recognized, and possibly o