Síndrome de Dolor Regional Complejo

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Diferencias diagnósticas en el Síndrome de Dolor Regional Complejo

Diagnostic Differences about Complex Regional Pain Syndrome

Albert Dominguez Arasa

Published in: Health & Medicine
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Síndrome de Dolor Regional Complejo

  1. 1. Complex Regional Pain Syndrome CRPS Albert Domínguez Arasa PT at CROMa Grenoble ( France) dominguezarasa@gmail.com
  2. 2. Complex Regional Pain Syndrome A little bit of history… Diagnosis of CRPS What do our patients know?
  3. 3. Complex Regional Pain Syndrome Mitchel et all. 1864 Pain and sympathetic disturbances in soldiers with gunshot. CAUSALGIA Südeck 1901 German surgeon describes loss of bone arquitecture , SÜDECKS ATROPHY … + 64 names in English ( Veldman 1996 ) reflex symathetic dystrophy (RSD) IASP 1995 CRPS I No nervous damage CRPS II Nervous damage
  4. 4. Complex Regional Pain Syndrome Skin ? Muscle ? Bone ? Ligaments ?
  5. 5. Complex Regional Pain Syndrome Continued and disproportionate Pain to the injury One symptom in 3of 4 categories One sign in 2of 4 categories No other diagnosis that better explains de symptoms Sensory : hyperaestesia –allodynia Vasomotor: temperature – colour Sudomotor: oedema – sweating Motor/Trophy: ROM – dystonia - tremor - nails – air. Budapest Criteria for CRPS (2010)
  6. 6. Complex Regional Pain Syndrome DIAGONOSIS ONLY WITH RX ? DIAGNOSIS ONLY WITH RX ?
  7. 7. Complex Regional Pain Syndrome
  8. 8. Complex Regional Pain Syndrome What do our patients know? 7 patients 3 women Age : 42,6 Wrist fracture, sprained wrist, CTS 4 man Age: 51 Wrist fracture, wrist arthrodesis, sprained thump
  9. 9. Complex Regional Pain Syndrome Do you know what CRPS is ? -3/7 negative answers -4/7 positive answers What that means for you? - PAIN or heavy pain !!! - Algodystrophie or algoneurodystrophie
  10. 10. Complex Regional Pain Syndrome Which of the following names sounds familiar for you ? Causalgia 1/7 Südek 1/7 reflex sympathetic dystrophy 3/7 Complex regional pain syndrome 2/7 Others: “Algo-neuro-dystrophie” , shoulder-hand syndrome, CRPS
  11. 11. Complex Regional Pain Syndrome Who was the first health care professional who has reported about CRPS ? Surgeon 4/7 GP 2/7 PT 1/7 In the diagnosis of CRPS which were the most relevant factors for detection? RX 0/7 Scintigraphy 4/7 Simptoms + test 2/7 Only simptoms 1/7
  12. 12. Complex Regional Pain Syndrome Which aspects of everyday life are more affected by CRPS ? “le geste simple du quotidien” daily simple gest -take, lift, hold, eat, cut, wash, dress, drive, writing... DASH or quick DASH questionnaires
  13. 13. Complex Regional Pain Syndrome Have you ever done a research on Google to find information about CRPS ? Yes 3/7 No 4/7 If you have questions about CRPS, what is your preference when looking for information. Health care professional 7/7 Internet 0/7 Other patients 2/7
  14. 14. Complex Regional Pain Syndrome References: Berklein F, Rowbotham M. Does pain change de brain? Neurology 2005;65:666-667 Weber M, Birkelin F. Comlex Regional Pain Syndrome an actual survey. Expert Rev Neurotherapeuthics 2001;1(1) 100-109 Field J. Complex Regional Pain Syndrome: a rewiew. JHS (eur) 2013 0(0) 1-11 Moseley G.L. Graded Motor Imagery is effective for long standing CRPS: a randomised controled trial. Pain 108 (2004) 192-198. Koban M, Leis S, et all. Tissue Hypoxia in complex regional pain syndrome. Pain 104 ( 2003) 149-157 Marnius J, Moseley G L, et all. Clinical Features and pathophysiology of complex regional pain sindrome. www.thelancet/neurology vol. 10 July 2011. 637-648 Birklein F, Riedl B, et all. Neurological findings in complex regional pain syndromes – analysis of 145 cases. Acta nerologica escandinavica. 2000: 101: 262 – 269 Moseley L. Graded motor imagery for pathologic pain: A randomized controlled trial. Neurologi 2006;67;2129-2134
  15. 15. Complex Regional Pain Syndrome Albert Domínguez Arasa dominguezarasa@gmail.com dominguezarasa.wordpres.com Twitter: @dominguez_arasa

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