Systemic Complications of Complex Regional Pain Syndrome

@article{Schwartzman2012SystemicCO,
  title={Systemic Complications of Complex Regional Pain Syndrome},
  author={Robert Jay Schwartzman},
  journal={Neuroscience and Medicine},
  year={2012},
  volume={03},
  pages={225-242}
}
  • R. Schwartzman
  • Published 21 September 2012
  • Medicine
  • Neuroscience and Medicine
Complex Regional Pain Syndrome (CRPS) is a neuropathic pain disorder that is characterized by: 1) Severe pain beyond the area of injury; 2) Autonomic dysregulation; 3) Neuropathic edema; 4) A movement disorder, atrophy and dystrophy. It is most often caused by a fracture, soft-tissue injury or surgical procedure and is divided into Type I, in which no nerve lesion is identified (classic reflex sympathetic dystrophy), and Type II where a specific nerve has been damaged (causalgia). In addition… 
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There was significant hesitation from the provider and patient to use invasive treatments for incontinence symptoms when the patient's pain symptoms have been well controlled with an existing spinal device, however, in this patient with type 1 CRPS, even in the setting of anexisting spinal cord stimulator, sacral neuromodulation therapy was an effective treatment.
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References

SHOWING 1-10 OF 239 REFERENCES
Clinical features and pathophysiology of complex regional pain syndrome
Complex regional pain syndrome type I (RSD)
TLDR
In chronic RSD, efferent nerve fibers were histologically unaffected; from afferent fibers, only C-fibers showed histopathologic abnormalities.
Complex regional pain syndrome
  • F. Birklein
  • Medicine, Psychology
    Journal of Neurology
  • 2005
TLDR
Major mechanism for CRPS symptoms, which might be present subsequently or in parallel during the course of CRPS, are trauma-related cytokine release, exaggerated neurogenic inflammation, sympathetically maintained pain and cortical reorganisation in response to chronic pain (neuroplasticity).
Is reflex sympathetic dystrophy/complex regional pain syndrome type I a small‐fiber neuropathy?
TLDR
This work proposes that persistent RSD/CRPS‐I is a post‐traumatic neuralgia associated with distal degeneration of small‐diameter peripheral axons, and small distal nerve injuries in rodents reproduce many CRPS features, further supporting this hypothesis.
The use of ketamine in complex regional pain syndrome: possible mechanisms
Complex regional pain syndrome is a neuropathic pain syndrome that is characterized by: severe pain beyond the area of injury; autonomic dysregulation; neurogenic edema; movement disorder; and
Reflex sympathetic dystrophy: complex regional pain syndrome type I in children with mitochondrial disease and maternal inheritance
TLDR
In one tertiary-care paediatric genetics practice, children meeting the CRPS-I diagnostic criteria frequently had additional autonomic-related conditions secondary to maternally inherited mitochondrial disease, suggesting that mitochondrial DNA sequence variants can predispose children towards the development of CR PSI and other dysautonomias.
Complex regional pain syndrome with associated chest wall dystonia: a case report
TLDR
A patient with long standing CRPS after a brachial plexus injury, who after displaying several features of the movement disorder previously, developed painful dystonia of chest wall musculature is presented.
Vascular abnormalities in reflex sympathetic dystrophy (CRPS I): mechanisms and diagnostic value.
TLDR
It is suggested that, in CRPS I, unilateral inhibition of sympathetic vasoconstrictor neurones leads to a warmer affected limb in the acute stage, whereas sympathetic activity is still depressed.
The Prevalence of Fibromyalgia in Other Chronic Pain Conditions
  • M. Yunus
  • Medicine
    Pain research and treatment
  • 2012
TLDR
Diagnosis and proper management of FMS among these diseases are of crucial importance so that unwarranted use of such medications as corticosteroids can be avoided, since FMS often occurs when RA or SLE is relatively mild.
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