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CRPS has characteristics similar to those of other disorders, such as shoulder-hand syndrome, which sometimes occurs after a heart attack and is marked by pain and stiffness in the arm and shoulder ; Sudeck syndrome, which is prevalent in older people and women and is characterized by bone changes and muscular atrophy, but is not always associated with trauma ; and Steinbrocker syndrome, which includes symptoms such as gradual stiffness, discomfort, and weakness in the shoulder and hand.
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CRPS and has
The International Association for the Study of Pain has proposed dividing CRPS into two types based on the presence of nerve lesion following the injury.
CRPS has been diagnosed in children as young as 2 years old.
It is also theorized that certain people might be genetically predisposed to develop symptoms of RSD / CRPS after a significant or seemingly insignificant injury has been sustained.
The IASP criteria for CRPS I diagnosis has shown a sensitivity ranging from 98 – 100 % and a specificity ranging from 36 – 55 %.
However, Lorimer Moseley ( University of South Australia ) has cautioned that the beneficial effects of mirror therapy for CRPS are still unproven.
One treatment, ( graded motor imagery ) has now been tested in three randomised controlled trials and has shown to be effective at reducing pain and disability in people with chronic CRPS, or phantom limb pain after amputation or avulsion injury of the brachial plexus.
The Netherlands currently has the most comprehensive program of research into CRPS, as part of a multi-million Euro initiative called TREND.
CRPS has also been described in animals.
It has shown to be beneficial if used in the first 3 months of the CRPS diagnosis.
CRPS and similar
An example is severe Carpal Tunnel Syndrome, which can often present very similar to CRPS.
CRPS and those
Investigators estimate that 2-5 percent of those with peripheral nerve injury, and 13-70 percent of those with hemiplegia ( paralysis of one side of the body ), will suffer from CRPS.
Also, not all patients diagnosed with CRPS demonstrate such " vasomotor instability "— less often, still, those in the later stages of the disease.
CRPS and other
Two other criteria used for CRPS I diagnosis are Bruehl's criteria and Veldman's criteria which have moderate to good interobserver reliability.
Although CRPS may, in some cases, lead to measurably-altered blood flow throughout an affected region, many other factors can also contribute to an altered thermographic reading, including the patient's smoking habits, use of certain skin lotions, recent physical activity, and prior history of trauma to the region.
CRPS is a " diagnosis of exclusion ", which requires that there be no other diagnosis that can explain the patient's symptoms.
CRPS and such
Physical therapy interventions for CRPS can include specific modalities such as transcutaneous electrical nerve stimulation, progressive weight bearing, tactile desensitization, massage, and contrast bath therapy.
Physicians use a variety of drugs to treat CRPS, including antidepressants, anti-inflammatories such as corticosteroids and COX-inhibitors such as piroxicam, bisphosphonates, vasodilators, GABA analogs such gabapentin and pregabalin, and alpha-or beta-adrenergic-blocking compounds, and the entire pharmacy of opioids.
It can also occur due to autonomic nervous system dysfunction, such as in some cases of CRPS.
CRPS and syndrome
Complex regional pain syndrome ( CRPS ), formerly Reflex Sympathetic Dystrophy or Causalgia, is a chronic progressive disease characterized by severe pain, swelling, and changes in the skin.
In Type II the " cause " of the syndrome is the known or obvious injury, although the cause of the mechanisms of CRPS Type II are as unknown as the mechanisms of Type I.
The International Association for the Study of Pain ( IASP ) lists the diagnostic criteria for complex regional pain syndrome I ( CRPS I ) ( RSDS ) as follows:
* Complex regional pain syndrome, more usually abbreviated as CRPS
* complex regional pain syndrome ( CRPS ), also known as reflex sympathetic dystrophy ( RSD )
CRPS and which
The symptoms of CRPS usually manifest near the site of an injury, which is usually minor.
No specific test is available for CRPS, which is diagnosed primarily through observation of the symptoms.
Conversely, warming of an affected extremity may indicate a disruption of the body's normal thermoregulatory vasoconstrictor function, which may sometimes indicate underlying CRPS.
Patchy osteoporosis ( post-traumatic osteoporosis ), which may be due to disuse of the affected extremity, can be detected through X-ray imagery as early as two weeks after the onset of CRPS.
They can be used as one of the primary methods to distinguish between CRPS I & II, which differ based on whether there is evidence of actual nerve damage.
Another approach to CRPS is based on a treatment called sensory discrimination training, which was used for phantom limb pain.
Unfortunately, these study designs are very prone to bias, which means we still need high quality randomised controlled trials of ketamine infusion for CRPS to know about its effects and side effects.
CRPS and sometimes
The condition currently known as CRPS was originally described during the American Civil War by Silas Weir Mitchell, who is sometimes also credited with inventing the name " causalgia.
CRPS and after
Type I CRPS develops following an initiating noxious event that may or may not have been traumatic, while type II CRPS develops after a nerve injury.
show that 500 mg vitamin C daily, reduces the chance for the occurrence of CRPS after wrist fractures.
In a survery of 15 patients with CRPS Type 1, 11 responded that their life was better after amputation.
Investigators are studying new approaches to treat CRPS and intervene more aggressively after traumatic injury to lower the patient's chances of developing the disorder.
CRPS and is
The pathophysiology of CRPS is not fully understood.
CRPS can strike at any age, but the mean age at diagnosis is 42.
It affects both men and women ; however, CRPS is 3 times more frequent in females than males.
The number of reported CRPS cases among adolescents and young adults is increasing.
The pain of CRPS is continuous and may be heightened by emotional or physical stress.
It is now believed that patients with CRPS do not progress through these stages sequentially.
It is important to remember that often the sympathetic nervous system is involved with CRPS, and the autonomic nervous system can go haywire and cause a wide variety of odd complaints that are not mental in origin.
Rather than a progression of CRPS from bad to worse, it is now thought, instead, patients are likely to have one of the three following types of disease progression:
According to the IASP, CRPS II ( causalgia ) is diagnosed as follows:
Per the IASP guidelines, interobserver reliability for CRPS I diagnosis is poor.
This is very important to emphasize, because otherwise patients can be given a wrong diagnosis of CRPS when they actually have a treatable condition that better accounts for their symptoms.
The general strategy in CRPS treatment is often multi-disciplinary, with the use of different types of medications combined with distinct physical therapies.
There is one systematic review of the use of physical and occupational therapy for the treatment of CRPS.
Although there is no denying the importance of a multidisciplinary approach in the management of CRPS, recent research suggests that physical therapy intervention may be successful in decreasing symptoms of CRPS without the use of medications.
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