Fundamentals of Infrared Thermal Imaging
U. Snekhalatha, K. Palani Thanaraj, Kurt Ammer in Artificial Intelligence-Based Infrared Thermal Image Processing and Its Applications, 2023
Complex regional pain syndrome (CRPS) is a chronic pain syndrome which affects the upper and lower extremities following injuries, often of minor in nature, but surgery or in rare cases even heart infarction or a lung tumor may be the initial trigger. Early diagnosis and treatment of CRPS improve the functional prognosis. The International Association for the Study of Pain (IASP) classified CRPS into two types as follows: Type I, formerly known as “reflex sympathetic dystrophy,” in which a peripheral nerve injury is not observed, and type II, formerly known as “causalgia.” Diagnosis of CRPS is based on the “Budapest Criteria,” where a temperature difference of 1°C between affected and non-affected limb is required to evidence vasomotor disturbance. There are several non-invasive methods available to detect the components of CRPS. The skin temperature changes can be measured by a thermal camera and a GSR sensor may be used for sweating detection. Quantitative sensory testing identifies sensory deficits, trophic alterations, and edematous swellings found by inspection and palpation. Pain related information is captured in the patient’s history and quantified by a pain scale.
Topical Pain Medications and Their Role in Pain Management
Sahar Swidan, Matthew Bennett in Advanced Therapeutics in Pain Medicine, 2020
Complex regional pain syndrome (CRPS) is a condition that develops in the limbs following surgery or trauma. This syndrome involves multiple pathological mechanisms including vasoconstriction, free radical generation, and the production of inflammatory cytokines. There is limited documentation for treatment for this syndrome, but it has been found that a multimodal treatment approach is effective at combatting this condition. A retrospective review of patients who were prescribed a compounded cream containing ketamine 10%/pentoxifylline 6%/clonidine 0.2%/dimethyl sulfoxide 6% to 10% was conducted to assess the effectiveness of this topical formulation on CRPS. Thirteen patients in total were included in the study. Nine patients reported pain reduction following treatment. Seven of those reported a major benefit and two reported complete resolution; however, all patients were on additional medications. Six of them were taking an additional opioid analgesic and one was taking prednisone. The average change in numerical pain score was 3.4 for the patients who reported benefit. The overall conclusion from this study was that compounded analgesic creams have the potential to be an effective adjunctive treatment for pain in patients suffering from CPRS.30
Ethical Issues in the Medical Assessment and Subsequent Treatment of Chronic Pain
Michael E. Schatman in Ethical Issues in Chronic Pain Management, 2016
When one examines a specific disease, such as RSD, or, as it is now called, complex regional pain syndrome type I (CRPS I), the numbers become even more disturbing. Hendler reported that 27 of the 38 patients (71%) referred to Mensana Clinic with the diagnosis of RSD or CRPS I were initially diagnosed inaccurately, and many of them never had received the appropriate diagnostic studies to confirm this diagnosis (3). A full 100% of the patients referred were never tested for allodynia, never underwent peripheral nerve blocks or phentolamine testing, 31 of the 38 (81.5%) never had received a bone scan, and 16 of the 38 (42%) never had received sympathetic blocks. These are all essential tests for establishing a diagnosis and differential diagnosis of CRPS I. After evaluation, these patients were provided with a variety of other diagnoses to explain their symptoms, confirmed by objective testing. The most commonly overlooked diagnosis was nerve entrapment found in 37 of the 38 patients (96%), followed by thoracic outlet syndrome in 16 of the 38 patients (42%).
Does a familial subtype of complex regional pain syndrome exist? Results of a systematic review
Published in Canadian Journal of Pain, 2019
S. Modarresi, E. Aref-Eshghi, D. M. Walton, J. C. MacDermid
Complex regional pain syndrome (CRPS) is a painful and disabling syndrome that can affect the upper and/or lower extremities.1 CRPS can be categorized into two types: CRPS I occurs spontaneously in the absence of any confirmed injury to the nerves and CRPS II is a type in which there is a known nerve injury.2 CRPS I or II occurs more often in women and can happen at any age, although most studies report an average age of onset of about 40.3–5 The clinical features of CRPS are diverse and can include severe regional but nondermatomal pain; allodynia; hyperalgesia; changes in skin temperature, texture, or color; and sudomotor and vasomotor dysfunction.6 This multifactorial array of symptoms as well as several potential underlying pathophysiological mechanisms give rise to the term “complex” in CRPS. Due in part to this complexity, the incidence of CRPS, which varies by injury, is poorly understood. Two retrospective population-based studies reported an incidence of 5.46 and 26.2 per 100,000 person-years in 19995 and 2007,7 respectively. The much higher incidence reported in 2007 could be because of differences in population characteristics such as ethnicity, socioeconomic aspects, or incidence of fractures but is more likely due to differences in case definitions and validation.7
Current practice in the rehabilitation of complex regional pain syndrome: a survey of practitioners
Published in Disability and Rehabilitation, 2019
Caroline Miller, Mark Williams, Peter Heine, Esther Williamson, Neil O’connell
Complex regional pain syndrome (CRPS) is an umbrella term for a variety of clinical presentations characterized by chronic and disabling persistent pain that is disproportionate to any preceding injury and that is not restricted anatomically to the distribution of a specific peripheral nerve. Symptoms typically start in the injured limb but can spread to wider body regions and, as well as pain, may include swelling, discoloration, abnormal hair or nail growth and dystonia [1–3]. While robust data are scarce, CRPS has an estimated incidence rate of between 5.4 and 26.2 per 100,000 person years [4,5]. It frequently affects patients following wrist fracture, developing in 3.8% of those injured [6]. The cause of CRPS is not known, but current consensus suggests it involves an aberrant inflammatory response with autonomic and central nervous system dysfunction [7]. The impact on sufferers can be severe. People with CRPS are frequently unable to use their affected limbs and their ability to work or participate in social activities is severely restricted, resulting in substantial deterioration of quality of life and high rates of comorbid depression.
Bio-Electro-Magnetic-Energy-Regulation (BEMER) for the treatment of type I complex regional pain syndrome: A pilot study
Published in Physiotherapy Theory and Practice, 2020
Maria Grazia Benedetti, Lorenzo Cavazzuti, Massimiliano Mosca, Isabella Fusaro, Alessandro Zati
Complex regional pain syndrome (CRPS) is a painful condition, typically affecting the limbs, which arises usually after an injury or a fracture and is divided into two forms: (1) the classical one, type 1 (CRPS-I); and (2) type 2 (CRPS-II), resulting from nerve injury. CRPS-I is characterized by regional pain and edema, not proportional in time or degree with respect to the usual course of any known trauma or other lesion, and is usually associated with abnormal sensory, motor, sudomotor, vasomotor, and/or trophic findings, and bone structure abnormalities (Harden, Bruehl, Stanton-Hicks, and Wilson, 2007). The cause of CRPS-I is unknown. Local release of pro-inflammatory neuropeptides and some cytokines has been recently claimed as the event that triggers and maintains the first stages of illness while, in subsequent stages, disturbance of the microcirculation and micro-damage vascular appears to be the pathogenetic mechanisms responsible for the observable clinical evolution in most cases (Varenna and Zucchi, 2015). Treatment of CRPS-I requires an integrated interdisciplinary approach, based on pain relief, patient information, and education to support self-management, psychological interventions, and physical and vocational rehabilitation. In the earliest stages of the disease, physiotherapy is proposed with the aim to reduce local edema and improve functional limitation associated with an adequate pharmacological coverage of the pain symptoms (Goebel et al., 2012).
Related Knowledge Centers
- Allodynia
- Edema
- Neurogenic Inflammation
- Neuroplasticity
- Nociceptor
- Range of Motion
- Pain
- Vasodilation
- Vasoconstriction
- Amplified Musculoskeletal Pain Syndrome
- Range of Motion