scholarly journals Complex Regional Pain Syndrome in Children: Asking the Right Questions

2012 ◽  
Vol 17 (6) ◽  
pp. 386-390 ◽  
Author(s):  
Kenneth R Goldschneider
Keyword(s):  
Risk Factors ◽  
Nervous System ◽  
Complex Regional Pain Syndrome ◽  
Pain Syndrome ◽  
Developmental Factors ◽  
Motor Component ◽  
The Right ◽  
Sensory Condition ◽  
Significant Motor

BACKGROUND: Complex regional pain syndrome (CRPS) is a painful disorder without a known unifying mechanism. There are little data on which to base evaluation and treatment decisions, and what data are available come from studies involving adults; however, even that literature is relatively sparse. Developing robust research for CRPS in children is essential for the progress toward optimal treatment.OBJECTIVES: To determine potential avenues of research in pediatric CRPS based on a review of the literature. Areas of concern include diagnostic criteria, peripheral mechanisms, central nervous system mechanisms, the role of the autonomic nervous system, possible risk factors, options for prevention and potential avenues of treatment.METHODS: A literature review was performed and the results applied to form the hypotheses posited in the form of research questions.RESULTS AND CONCLUSIONS: CRPS is a complicated entity that is more than a painful sensory condition. There is evidence for peripheral inflammatory and neurological changes, and reorganization in both sensory and motor cortexes. In addition, a significant motor component is frequently observed and there appear to be tangible risk factors. Many of these pieces of evidence suggest options for prevention, treatment and monitoring progress and outcome. Most of the data are derived from adult studies and need to be replicated in children. Furthermore, there may be factors unique to pediatrics due to developmental changes in neuroplasticity as well as somatic, endocrinological and emotional growth. Some of these developmental factors may shed light on the adult condition.

scholarly journals Venipuncture Induced Complex Regional Pain Syndrome Presenting as Inflammatory Arthritis

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Punit Pruthi ◽  
Pramod Arora ◽  
Manoj Mittal ◽  
Anugrah Nair ◽  
Waqia Sultana
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Inflammatory Arthritis ◽  
Young Male ◽  
Pain Syndrome ◽  
Poor Response ◽  
History Of ◽  
Diagnostic Modalities ◽  
Musculoskeletal Ultrasonography ◽  
The Right

Venipuncture is one of the most commonly done medical procedures. We report a unique case of a 23-year-old young male who presented with features suggestive of inflammatory arthritis. The symptoms, which initially started on the right side, also involved the other side after a few weeks. Although the patient’s symptoms and signs were simulating inflammatory arthritis, he had atypical features like poor response to anti-inflammatory medicines and normal laboratory parameters. His musculoskeletal ultrasonography was also not suggestive of arthritis. His history was reviewed and on direct questioning he revealed a history of venipuncture for blood sample withdrawal, done from right antecubital region for routine health check on the day prior to the onset of symptoms. Complex regional pain syndrome was suspected and triple-phase radioisotope bone scan was done which was highly suggestive of this diagnosis. The patient was managed with multidimensional approach and responded very well to the treatment. Complex regional pain syndrome is usually not thought of in the initial differential diagnosis of inflammatory arthritis. In this report we highlight the need to elicit the often overlooked history of trivial trauma like venipuncture, especially in atypical cases of arthritis. Also the role of newer diagnostic modalities in such cases is emphasized.

CRPS: what’s in a name? Taxonomy, epidemiology, neurologic, immune and autoimmune considerations

2019 ◽  
Vol 44 (3) ◽  
pp. 376-387 ◽  
Author(s):  
Michael d‘A Stanton-Hicks
Keyword(s):  
Nervous System ◽  
Autonomic Nervous System ◽  
Complex Regional Pain Syndrome ◽  
Severity Score ◽  
Clinical Management ◽  
Pain Syndrome ◽  
Clinical Syndromes ◽  
Shed Light ◽  
Historical Origins

This account of the condition now termed complex regional pain syndrome (CRPS) spans approximately 462 years since a description embodying similar clinical features was described by Ambroise Paré in 1557. While reviewing its historical origins, the text describes why it became necessary to change the taxonomies of two clinical syndromes with similar pathophysiologies to one which acknowledges this aspect but does not introduce any mechanistic overtones. Discussed at length is the role of the sympathetic component of the autonomic nervous system (ANS) and why its dysfunction has both directly and indirectly influenced our understanding of the inflammatory aspects of CRPS. As the following article will show, our knowledge has expanded in an exponential fashion to include musculoskeletal, immune, autoimmune, central and peripheral nervous system and ANS dysfunction, all of which increase the complexity of its clinical management. A burgeoning literature is beginning to shed light on the mechanistic aspects of these syndromes and the increasing evidence of a genetic influence on such factors as autoimmunity, and its importance is also discussed at length. An important aspect that has been missing from the diagnostic criteria is a measure of disease severity. The recent validation of a CRPS Severity Score is also included.

scholarly journals Treatment of Type 1 Complex Regional Pain Syndrome in 14 Years Old Child

2014 ◽  
Vol 21 (4) ◽  
pp. 79-82
Author(s):  
V. N Merkulov ◽  
A. I Dorokhin ◽  
A. I Krupatkin ◽  
M. V Merkulov ◽  
M. A Avakova
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Pain Syndrome ◽  
Hand Injury ◽  
Psychological Status ◽  
Interventional Treatment ◽  
Bolus Administration ◽  
Right Hand ◽  
Foot Injury ◽  
The Right

Case report on 14 years old girl with type 1 complex regional pain syndrome (CRPS) is presented. At first admission in 5.5 months after right hand injury and development of type 1 CRPS, paravasal sympathectomy on the right upper extremity was performed. Complete elimination of pain syndrome and restoration of the extremity function was achieved. Five and a half months after discharge the left foot and in 3 weeks later the right hand were injured. In both cases injuries were accompanied by pronounced CRPS clinical picture. At second admission in 6 weeks after foot injury interventional treatment with placement of catheters next to nerve trunks and bolus administration of antibiotics was performed for 1 week and enabled to achieve remission of the disease. It was noted that not only hypersymphaticotony but also psychological status of a patient were important for the disease development.

scholarly journals Increased calcium-mediated cerebral processes after peripheral injury: possible role of the brain in complex regional pain syndrome

2020 ◽  
Vol 33 (2) ◽  
pp. 131-137
Author(s):  
Francis Sahngun Nahm ◽  
Jae-Sung Lee ◽  
Pyung-Bok Lee ◽  
Eunjoo Choi ◽  
Woong Ki Han ◽  
...  
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Pain Syndrome ◽  
Peripheral Injury ◽  
The Brain

scholarly journals Spinal cord stimulation for complex regional pain syndrome type 1 with dystonia: a case report and discussion of the literature

F1000Research ◽  
2014 ◽  
Vol 3 ◽  
pp. 97 ◽  
Author(s):  
Caroline Voet ◽  
Bernard le Polain de Waroux ◽  
Patrice Forget ◽  
Ronald Deumens ◽  
Etienne Masquelier
Keyword(s):  
Spinal Cord ◽  
Nervous System ◽  
Case Report ◽  
Complex Regional Pain Syndrome ◽  
Spinal Cord Stimulation ◽  
Behavioural Change ◽  
Pain Syndrome ◽  
Social Model ◽  
Syndrome Type

Background: Complex Regional Pain Syndrome type 1 (CRPS-1) is a debilitating chronic pain disorder, the physiopathology of which can lead to dystonia associated with changes in the autonomic, central and peripheral nervous system. An interdisciplinary approach (pharmacological, interventional and psychological therapies in conjunction with a rehabilitation pathway) is central to progress towards pain reduction and restoration of function.Aim: This case report aims to stimulate reflection and development of mechanism-based therapeutic strategies concerning CRPS associated with dystonia.Case description: A 31 year old female CRPS-1 patient presented with dystonia of the right foot following ligamentoplasty for chronic ankle instability. She did not have a satisfactory response to the usual therapies. Multiple anesthetic blocks (popliteal, epidural and intrathecal) were not associated with significant anesthesia and analgesia. Mobilization of the foot by a physiotherapist was not possible. A multidisciplinary approach with psychological support, physiotherapy and spinal cord stimulation (SCS) brought pain relief, rehabilitation and improvement in the quality of life.Conclusion: The present case report demonstrates the occurrence of multilevel (peripheral and central) pathological modifications in the nervous system of a CRPS-1 patient with dystonia. This conclusion is based on the patient’s pain being resistant to anesthetic blocks at different levels and the favourable, at least initially, response to SCS. The importance of the bio-psycho-social model is also suggested, permitting behavioural change.

The Role of Periaqueductal Gray and Cingulate Cortex During Suppression of Pain in Complex Regional Pain Syndrome

2011 ◽  
Vol 27 (9) ◽  
pp. 796-804 ◽  
Author(s):  
Wolfgang Freund ◽  
Arthur P. Wunderlich ◽  
Gregor Stuber ◽  
Florian Mayer ◽  
Peter Steffen ◽  
...  
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Pain Syndrome ◽  
Cingulate Cortex ◽  
Periaqueductal Gray

scholarly journals Diagnosis of Complex Regional Pain Syndrome I Following Traumatic Axonal Injury of the Corticospinal Tract in a Patient with Mild Traumatic Brain Injury

Diagnostics ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. 95 ◽  
Author(s):  
Sung Ho Jang ◽  
You Sung Seo
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Complex Regional Pain Syndrome ◽  
Mild Traumatic Brain Injury ◽  
Corticospinal Tract ◽  
Axonal Injury ◽  
Pain Syndrome ◽  
Traumatic Axonal Injury ◽  
Right Hand ◽  
The Right

A 54-year-old male suffered from direct head trauma resulting from a fall while working. At approximately two months after the accident, he began to feel pain (burning sensation) and swelling of the dorsum of the right hand and wrist. He showed the following clinical features among the clinical signs and symptoms of revised diagnostic criteria for complex regional pain syndrome (CRPS): spontaneous pain, mechanical hyperalgesia, vasodilation, skin temperature asymmetries, skin color changes, swelling, motor weakness. No specific lesion was observed on brain MRI taken at ten weeks after onset. Plain X-ray, electromyography, and nerve conduction studies for the right upper extremity detected no abnormality. A three-phase bone scan showed hot uptake in the right wrist in the delayed image. On two-month diffusion tensor tractography, partial tearing of the corticospinal tract (CST) was observed at the subcortical white matter in both hemispheres (much more severe in the left CST). In addition, the fiber number of the right CST was significantly decreased than that of seven normal control subjects. CRPS I of the right hand in this patient appeared to be related to traumatic axonal injury of the left CST following mild traumatic brain injury.

scholarly journals Central Pain Due to Injury of the Spinothalamic Tract Misdiagnosed as Complex Regional Pain Syndrome: A Case Report

Diagnostics ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. 145 ◽  
Author(s):  
Jang ◽  
Kwon ◽  
Lee
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Memory Impairment ◽  
Whiplash Injury ◽  
Diffusion Tensor ◽  
Pain Syndrome ◽  
University Hospital ◽  
Central Pain ◽  
Spinothalamic Tract ◽  
Motor Weakness ◽  
The Right

Objectives: We report on a patient with whiplash injury who had central pain, due to injury of the spinothalamic tract (STT), but who was misdiagnosed as complex regional pain syndrome (CRPS). Case description: While a minivan in which a 43-year-old female was seated in the passenger seat was stopped for a signal, a truck collided with the minivan from behind, and the minivan then repeatedly collided with trucks in front and behind the minivan. Her head repeatedly struck the minivan seat resulting in whiplash injuries. After onset, she felt pain in both legs with mild motor weakness in all four extremities and memory impairment. Eight years after onset, she was diagnosed at a university hospital as CRPS type 1 with the clinical features of hyperalgesia and mild edema and motor weakness of both legs. She visited another university hospital nine years after onset and complained of pain in the right arm and both legs, constant tingling and burning pain along with allodynia and hyperalgesia. She also showed mild weakness in the four extremities, mild edema of both legs, and memory impairment. On diffusion tensor tractography (DTT), the left spinothalamic tract (STT) showed marked narrowing, and the right STT revealed mild narrowing and partial tearing. In addition, partial tears were observed in both corticospinal tracts and the right corticoreticulospinal tract. Discontinuations were observed in the left corticoreticulospinal tract and the left fornical crus. Conclusion: Injury of the STT was demonstrated on DTT in a patient with central pain following whiplash injury. Previously, the patient was misdiagnosed as CRPS.

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