Complex regional pain syndrome

Kinesiophobia in Elderly Polish Patients After Ischemic Stroke, Including Frailty Syndrome

INTRODUCTION

In patients after stroke, the relationship between the occurrence of kinesiophobia and the accompanying frailty syndrome, as well as the acceptance of the disease and the level of mood, has not been recognized so far. The aim of this study was to determine the prevalence of kinesiophobia in elderly Polish people after ischemic stroke, including the frailty syndrome and the associations between the prevalence of kinesiophobia and feelings of anxiety and degree of the illness acceptance.

METHODS

A cross-sectional study was used to achieve the study objectives. The study involved 152 hospitalized patients aged of minimum 60 (mean age 63), qualified for post-stroke rehabilitation, including 76 women and 76 men. The patients were divided into two groups, with kinesiophobia (119 persons) and without kinesiophobia (33 persons). The Tampa Scale of Kinesiophobia (TSK), the Tilburg Frailty Indicator (TFI), the Hospital Anxiety Depression Scale (HADS) and the Acceptance of Illness Scale (AIS) were used. Study results were calculated using MedCalc Software.

RESULTS

Kinesiophobia has been demonstrated in 78% of people after ischemic stroke. The values of TFI and HADS were higher in the patients with kinesiophobia (p<0.001). In patients with ischemic stroke, it was shown that the level of kinesiophobia increased with higher anxiety (p<0.001), higher total TFI score, (p<0.05), and a lower level of illness acceptance (p<0.001).

CONCLUSION

The occurrence of kinesiophobia in elderly Polish people after ischemic stroke is common and the determinants of its development are the coexistence of the frailty syndrome, anxiety and a low level of illness acceptance. In post-stroke patients, the presence of kinesiophobia should be considered, especially in the situation of comorbid frailty syndrome. The issue of kinesiophobia in patients after stroke requires further in-depth research, especially in the field of cognitive-behavioral prevention aimed at ways to reduce this phenomenon.

Chiropractic Care of a Patient With Complex Regional Pain Syndrome Type 1 (CRPS-1): A Case Report

Objective

The purpose of this case report is to describe the evaluation and treatment of a patient presenting with left upper extremity pain and neck pain after a slip and fall.

Clinical Features

A 56-year-old woman sustained a left distal radius fracture secondary to a slip-and-fall accident. She was placed in a cast for 6 weeks, and after the removal of her cast she developed excruciating left forearm, wrist, hand, and finger pain. The patient was diagnosed with complex regional pain syndrome type 1 utilizing the modified (Budapest) International Association for the Study of Pain criteria.

Intervention and Outcome

The patient did not respond positively to initial management, which included the application of a cast after closed reduction of the distal radius fracture, 8 weeks of physical/occupational therapy, and the use of a brace which kept her left wrist, hand, and fingers in a flexed position. Subsequently, the patient presented to the University of Bridgeport College of Chiropractic outpatient clinic, where she was evaluated and treated. She received a total of 36 chiropractic treatments between her initial office visit in January 2018 and the follow-up in June 2018. The patient reported and demonstrated amelioration of her presenting complaints, decreased pain, increased ranges of motion, and increased function.

Conclusion

This case report underscores the importance of a rapid, accurate, initial diagnosis of complex regional pain syndrome type 1, during the acute (warm) stage.

Understanding the Rehabilitation Needs of Korean Patients With Complex Regional Pain Syndrome

OBJECTIVE

To evaluate the current status of pain severity and quality of life (QoL) in patients with complex regional pain syndrome (CRPS), and to assess both their perceived needs and any unmet needs of current rehabilitation services.

METHODS

A single-center questionnaire-based survey was conducted on 47 patients with CRPS who were diagnosed based on Budapest's criteria. It collected demographic and clinical data, and the structured questionnaire included the Brief Pain Inventory (BPI), the Korean version of the World Health Organization Disability Assessment Schedule II (WHODAS-K II), as well as the 5-Level EuroQol-5D (EQ-5D-5L) for measuring the QoL.

RESULTS

The average value of BPI and WHODAS-K II were 7.69%±2.26% and 70.49%±19.22%, respectively. In the evaluation of their perceived needs and unmet needs for rehabilitation, patients had the highest rehabilitation needs in terms of pain (95.74%), followed by bodyaches (80.85%). Regarding their unmet needs, patients had the highest unmet needs in terms of memory impairment (83.33%), followed by weight management (72.00%). According to the regression analysis, only the overall BPI was significantly associated with QoL (p=0.01), and a higher BPI value led to poorer results for QoL.

CONCLUSION

In Korea, patients with CRPS do not receive adequate rehabilitation, and they are not satisfied with current received treatments. A more structured and individualized rehabilitation treatment plan is required to manage every aspect related to chronic pain, and provision should be made for improved care guidelines for future CRPS management.

A rare complication of total knee arthroplasty: Type l complex regional pain syndrome of the foot and ankle

Complex regional pain syndrome (CRPS) is a painful and disabling disorder that usually affects the extremities. This complication may affect the knee joint after total knee arthroplasty (TKA). We report a unique case of CRPS of the foot and ankle, which was an unusual involvement site for CRPS after TKA.

Spinal cord stimulation as treatment for complex regional pain syndrome should be considered earlier than last resort therapy

BACKGROUND

Spinal cord stimulation (SCS), by virtue of its historically described up-front costs and level of invasiveness, has been relegated by several complex regional pain syndrome (CRPS) treatment algorithms to a therapy of last resort. Newer information regarding safety, cost, and efficacy leads us to believe that SCS for the treatment of CRPS should be implemented earlier in a treatment algorithm using a more comprehensive approach.

METHODS

We reviewed the literature on pain care algorithmic thinking and applied the safety, appropriateness, fiscal or cost neutrality, and efficacy (S.A.F.E.) principles to establish an appropriate position for SCS in an algorithm of pain care.

RESULTS AND CONCLUSION

Based on literature-contingent considerations of safety, efficacy, cost efficacy, and cost neutrality, we conclude that SCS should not be considered a therapy of last resort for CRPS but rather should be applied earlier (e.g., three months) as soon as more conservative therapies have failed.

Efficacy of ultrasonography guided stellate ganglion blockade in the stroke patients with complex regional pain syndrome

Objective

To compare the efficacy of ultrasonography guided stellate ganglion block (US-SGB) with that of blind SGB in management of the stroke patients with complex regional pain syndrome (CRPS) type 1.

Method

Forty-two patients with post-stroke CRPS were randomly assigned to either US-guided SGB (22 patients) or blind SGB group (20 patients). The mean age of US-guided SGB and blind SGB groups was 61.3±5.6 years and 59.1±4.5 years. We performed two blockades at 7-day intervals on the affected side of patients with CRPS. Pain intensity, using a visual analog score (VAS), score of CRPS clinical severity, and the amounts of affected hand swelling with a hand volumeter were assessed before, 2 weeks and 4 weeks after treatment.

Results

In both groups, VAS and the amount of hand swelling were significantly decreased after 2 weeks and after 4 weeks. Between two groups, VAS difference of US-guided SGB group and that of blind SGB group were 2.61±1.09, 1.88±0.62 at 2 weeks and 3.67±1.03, 3.13±0.62 at 4 weeks, respectively. US-guided SGB group showed more significant improvement in mean change of VAS compared to the blind SGB group (p-value<0.05).

Conclusion

Both US-guided SGB and blind SGB techniques were effective in relieving pain in subacute stroke patients with CRPS. US-guided SGB was better in pain relief but has no advantages in reduction of hand swelling in this study.

Complex regional pain syndrome: state of the art update

OPINION STATEMENT

Although the pathophysiology of complex regional pain syndrome (CRPS) is not fully understood, it appears to reflect multiple interacting mechanisms. In addition to altered autonomic function, a role for inflammatory mechanisms and altered somatosensory and motor function in the brain is increasingly suggested. Several possible risk factors for development of CRPS, including genetic factors, have been identified. Few treatments have been proven effective for CRPS in well-designed clinical trials. However, recent work suggests that bisphosphonates may be useful in CRPS management and that the N-methyl-D: -aspartate receptor antagonist ketamine significantly reduces CRPS pain when administered topically or intravenously at subanesthetic dosages. Extended use of ketamine at anesthetic dosages ("ketamine coma") remains a controversial and unproven treatment for CRPS. Spinal cord stimulation may be effective for reducing pain in approximately two thirds of CRPS patients not responding to other treatments, but its efficacy appears to diminish over time.

Complex regional pain syndrome in a patient with spinal cord injury: management with pulsed radiofrequency lumbar sympatholysis

STUDY DESIGN

Short communication.

OBJECTIVES

To report a case with bilateral lower extremity complex regional pain syndrome (CRPS) in a patient with paraplegia occurring following spinal disc herniation surgery, who was treated successfully with pulse radiofrequency (PRF) lumbar sympatholysis.

SETTING

Departments of Physical Medicine and Rehabilitation, Algology Department of Anaesthesiology and Nuclear Medicine, Medical Faculty of Ege University, Izmir, Turkey.

METHODS

A 55-year-old woman had neuropathic pain in her lower extremities after T12-L1 disc herniation surgery. The pain decreased to a tolerable level with conservative treatment and her condition remained stable for the following 6 months; then she developed swelling, redness and severe burning pain in both feet. Physical examination showed edema and redness in the feet. On the basis of clinical findings and Tc-99m methylene diphosphonate (MDP) three-phase bone scintigraphy, she was diagnosed to have CRPS.

RESULTS

The patient underwent a diagnostic sympathetic ganglion blockade with bupivacaine, which resulted in a marked decrease in the pain and edema of the feet. Consequently, PRF lumbar sympatholysis was performed with a successful outcome in pain, edema and color changes in the feet.

CONCLUSION

When treatment of CRPS fails with conventional modalities, PRF sympatholysis may be used for control of pain and other symptoms in such patients.

Comparison of prednisolone with piroxicam in complex regional pain syndrome following stroke: a randomized controlled trial

BACKGROUND

Complex regional pain syndrome (CRPS) following stroke aggravates morbidity. CRPS is categorized as CRPSI when no clear nerve injury is defined, and CRPSII when associated with clear nerve injury.

AIM

To compare the effect of prednisolone with that of piroxicam in patients with CRPSI following stroke.

DESIGN

Randomized controlled trial.

METHODS

Patients with CRPSI fulfilling the inclusion criteria (n = 60) underwent a detailed neurological examination, cranial CT scan, radiograph of chest and shoulder joint, blood counts and serum chemistry. Severity of stroke was assessed by the Canadian Neurological Scale (CNS), CRPS by scoring sensory, autonomic and motor symptoms, and activity of daily living by Barthel index (BI) score. Patients were randomly assigned prednisolone 40 mg or piroxicam 20 mg daily, and outcome was assessed at 1 month on the basis of CRPS and BI score.

RESULTS

Mean patient age was 56 years and 20 were female. Baseline clinical and radiological parameters were comparable between the two groups. In the prednisolone group, 83.3% patients showed significant improvement, compared to 16.7% in the piroxicam group. The mean change in CRPS score in prednisolone group was 6.47 (95%CI 4.37-7.36), whereas in piroxicam group it was only 0.47. The mean change in BI score was 7.9 (95%CI 0.82-5.98) in the prednisolone group, and 4.5 in the piroxicam group.

DISCUSSION

In this patient group, prednisolone resulted in significant improvement in the symptoms and signs of CRPSI following stroke, compared to piroxicam. Both drugs produced an improvement in the BI score.

Calcium Channels As Therapeutic Targets in Neuropathic Pain

Injury to the nerve can produce changes in dorsal horn function and pain. This facilitated processing may be mediated in part by voltage-sensitive calcium channels. Activation of these channels increases intracellular calcium, thereby mediating transmitter release and activating cascades serving to alter membrane excitability and initiate protein transcription. Molecular techniques reveal the complexity and multiplicity of these channels. At the spinal level, blocking of several of these calcium channels, notably those of the N type, can prominently alter pain behavior. These effects are consistent with the high levels of expression on primary afferents and dorsal horn neurons of these channels. More recently, agents binding to auxiliary subunits such as the alpha2delta of these calcium channels diminish excitability of the membrane without completely blocking channel function. Drugs that bind to this site, highly expressed in the superficial dorsal horn, will diminish neuropathic pain states. Continuing developments in our understanding of these channel functions promises to advance the control of aberrant spinal functions initiated by nerve injury.

PERSPECTIVE

Pharmacologic studies showing the role of spinal voltage-sensitive calcium channels in neuropathic pain models provide evidence suggesting their applicability in human pain states.

CRPS Typ I psychischer Genese—

The complex regional pain syndrome type I (CRPS I)-formerly named Sudeck's atrophy or reflex sympathetic dystrophy (RSD)-describes a complex of symptoms with chronic, poorly controllable pain, autonomic, sensomotor and trophic alterations. It is mainly caused by trauma or surgery. We describe the rare case of a spontaneous manifestation of a CRPS I in an adolescent patient with typical clinical and radiological findings and the recurrence of symptoms after a one-year symptom-free interval. Symptoms were resolved by an intense multimodal therapy concept. The likely psychosocial origin in this case is discussed. Clinical appearance, diagnostic means and therapy of the CRPS are described.

Complex regional pain syndrome involving the lower extremity: A report of 2 cases of sphenopalatine block as a treatment option

We report 2 cases of complex regional pain syndrome (CRPS) involving the lower extremity; in both, a sphenopalatine ganglion (SPG) block was performed as part of a pain management program. In the first case, a woman in her late twenties presented with CRPS in the left lower extremity that was inadequately controlled with typical oral medications. Sympathetic block of the extremity did not provide significant pain relief. However, a noninvasive sphenopalatine block with 4% tetracaine resulted in a 50% reduction in pain level. The patient was shown how to self-administer the sphenopalatine block and was provided with exercises and therapy to help improve her functional status. The second case involved a woman in her mid forties with CRPS in the right lower extremity that was partially controlled with oral medications. The patient experienced a 50% reduction in pain level when SPG block with 4% tetracaine was given. Further study is needed to determine the effects of SPG blocks on symptoms related to chronic regional pain syndrome.