Complex Regional Pain Syndrome: A Clinical Guide

Description

This book provides an up-to date, extensive, and focused review of complex regional pain syndrome (CRPS). It reflects the current scientific understanding of the disorder, describes appropriate treatment recommendations, and explores future directions of diagnosis and treatment.  Divided into three sections, the first section covers the etiology and pathology of CRPS. The following section offers treatments and emerging advances in evaluation and/or treatment. The book then closes with an exploration of varying patient populations. Each chapter is authored by specialists experienced with CRPS research and treatment. Additionally, the review and recommendations provided reflect careful consideration of evidence-based medicine and medical consensus guidelines.  Complex Regional Pain Syndrome targets a range of healthcare specialties including pain management, rheumatology, neurology, internal medicine, and family practice. Preface Acknowledgments Contents Contributors Part I: CRPS Basics 1: Complex Regional Pain Syndrome: An Introduction Introduction Diagnosis Epidemiology Risk Factors Pathophysiology Sympathetically Maintained Pain Peripheral Sensitization Central Sensitization Acute-Warm-Peripheral CRPS Versus Chronic-Cold-Central CRPS Oxidative Stress Autoimmunity Central Nervous System Alterations Psychological Mechanisms Natural History Acute Versus Chronic CRPS Spread Conclusions References 2: Peripheral Injury and CRPS Peripheral Sensitization Inflammatory Processes in CRPS CRPS and Brain Plasticity References 3: Differential Diagnosis of Complex Regional Pain Syndrome Introduction Neurologic Nerve Entrapment Syndromes Carpal Tunnel Syndrome Distal Symmetric Polyneuropathies Diabetic Polyneuropathy HIV Polyneuropathy Postherpetic Neuralgia Neurogenic Claudication Central Post-stroke Pain Thoracic Outlet Syndrome Vascular Disease Peripheral Artery Disease and Ischemic Claudication Lymphedema Deep Vein Thrombosis and Thrombophlebitis Erythromelalgia Inflammatory Disease Rheumatoid Arthritis Infection and Cellulitis Chronic Inflammatory Demyelinating Polyneuropathy Gout Myofascial Pain Syndromes Sprains/Strains/Tendinopathies Fibromyalgia Psychological Syndromes Somatoform Syndrome Factitious Disorder/Munchausen’s Syndrome Conclusion References Suggested Reading 4: Diagnostic Tests and Physical Exam for CRPS Definition Presentation and Physical Exam Diagnosis Criteria Severity of Disease Diagnostic Tests Thermography Radionuclide Bone Scintigraphy Diagnostic Imaging Techniques Electromyography (EMG) Musculoskeletal Ultrasound Skin Biopsy Conclusion References Part II: Treatment of CRPS 5: Pharmacologic Treatments for CRPS Nonsteroidal Anti-inflammatory Drugs Bisphosphonates Calcitonin Corticosteroids Anticonvulsants and Antidepressants Local Anesthetics N-methyl D-aspartate (NMDA) Receptor Antagonists Vitamin C Opioids Topical Agents Botulinum Toxin Immunoglobulins Conclusion References Suggested Reading 6: Behavioral Health Interventions for CRPS Diagnostic Considerations and Theoretical Foundations Assessment Functional Impact Pain Coping Psychiatric Comorbidities Validated Measures Behavioral Health Interventions Cognitive Therapy Psychoeducation Reframing Cognitive Restructuring Behavioral Therapy Activity Pacing (AP) Graded Exposure Physiological Self-regulation Strategies Relaxation Training (RT) Mindfulness-Based Interventions (MBI) Self-Hypnosis Biofeedback (BFB) Acceptance and Commitment Therapy (ACT) Case Example of ACT for CRPS Motivational Interviewing (MI) Group-Delivered Interventions CBT Groups Mindfulness- and Acceptance-Based Group Therapies Patient Education: Explain Pain Groups Innovative Digital Directions for the Field Conclusions References 7: Comprehensive Rehabilitation of Patients with Complex Regional Pain Syndrome Introduction Background Medical Treatment in Interdisciplinary Rehabilitation Interdisciplinary Medical Rehabilitation of CRPS: Assessment Treatment Considerations in Medical Rehabilitation of CRPS: Interventions Used Interdisciplinary Rehabilitation of CRPS: Physical Therapy Interdisciplinary Rehabilitation of CRPS: Physical Therapy Assessment Interdisciplinary Rehabilitation of CRPS: Physical Therapy Objective Measures Interdisciplinary Rehabilitation of CRPS: Physical Therapy Interventions Interdisciplinary Occupational Rehabilitation of CRPS Interdisciplinary Occupational Rehabilitation of CRPS: Assessment Interdisciplinary Occupational Rehabilitation of CRPS: Objective Measures Interdisciplinary Occupational Rehabilitation of CRPS: Interventions Interdisciplinary Psychological Rehabilitation of CRPS Interdisciplinary Psychological Rehabilitation of CRPS: Assessment Interdisciplinary Psychological Rehabilitation of CRPS: Objective Measures Interdisciplinary Psychological Rehabilitation of CRPS: Interventions Key Considerations, Limitations, and Barriers Future Considerations References 8: Adjuvant Treatments for CRPS Introduction Acupuncture Movement-Based Mind-Body Practices (Qigong Therapy, Tai Chi, Yoga) Relaxation-Based Mind-Body Techniques Herbs and Supplements Transcutaneous Electrical Stimulation Noninvasive Brain Stimulation Pulsed Electromagnetic Field Therapy Prism Adaptation Therapy Hyperbaric Oxygen Therapy Ozone Therapy Hirudotherapy Physiotherapy-Based Interventions Use of Adjuvants in Children With CRPS Conclusion References 9: Interventional Treatment of Complex Regional Pain Syndrome Introduction Intravenous Therapies Description of IVRB Complications Intravenous Infusions and IVRB with Sympatholytic Agents Intravenous Infusions and IVRB with Non-sympatholytic Agents Sympathetic Blocks Stellate Ganglion Block for Upper Extremity CRPS Thoracic Sympathetic Block for Upper Extremity CRPS Lumbar Sympathetic Block for Lower Extremity CRPS Outcomes Neuromodulation Therapies Preoperative Considerations Peripheral Nerve Block and Stimulation Indication Procedure Outcomes Complications Spinal Cord Stimulation Procedure Complications Outcomes Intrathecal Drug Delivery Therapy Procedure Complications Pharmacologic Agents Concluding Remarks References 10: Interventional Treatments for CRPS in Children References 11: Emerging Therapies for the Treatment of Complex Regional Pain Syndrome Introduction Neuromodulation Cost Efficacy Dorsal Column Stimulation Dorsal Root Ganglion Stimulation Peripheral Nerve Stimulation Brain Stimulation Deep Brain Stimulation Motor Cortex Stimulation Transcranial Magnetic Stimulation References 12: Treatment Algorithm for Complex Regional Pain Syndrome Introduction Definition and Terminology Clinical Presentation Diagnosis and Evaluation Diagnostic Criteria Investigations Epidemiology Incidence and Risk Factors Surgery Fracture Pathophysiology Inflammation Central and Peripheral Sensitization Altered Cutaneous Innervation Altered Sympathetic Nervous System Function Autoimmunity Brain Plasticity Genetic Factors Psychological Factors Management Physiotherapy Psychological Therapy Medical Management Surgical Management Novel Therapeutic Approaches Treatment Algorithm Conclusion References Part III: Special Considerations in CRPS 13: Children and Adolescents with CRPS Background Epidemiology Etiology and Pathogenesis fMRI Data Genetics Psychological Factors Other Clinical Features Diagnosis Treatment Physical and Occupational Therapy Psychological Therapy Medications Invasive Treatments Spinal Cord Stimulation Alternative Treatments Prognosis Conclusion Bibliography 14: Review and Management of Complex Regional Pain Syndrome in Pregnancy Introduction Pathophysiology Clinical Symptoms Diagnosis Management Pharmacotherapy Antipyretics Anti-Inflammatories Tricyclic Antidepressants (TCAs) Antiepileptics Muscle Relaxants Alpha-Adrenergic Agonists Immunomodulators Opioids Other Oral Medications Topicals Botulinum Toxin Ketamine Cannabis (Marijuana) Interventional Therapies Trigger Point Injection Sympathetic Nerve Block Bier Block Dorsal Root Ganglion Stimulation Radiofrequency Ablation Spinal Cord Stimulator Acupuncture Therapy and Modalities Physical Therapy Modalities TENS Contrast Bath Fluidotherapy Ultrasound Occupational Therapy Mirror Therapy Chiropractic Care Psychological and Behavioral Therapy Cognitive Behavioral Therapy (CBT) and Other Behavioral Therapy Biofeedback Meditation and Relaxation Hypnotherapy Bibliography 15: Chronic Regional Pain Syndrome in the Geriatric Patient Introduction Epidemiology Pathophysiology Clinical Diagnosis Clinical Presentation Budapest Criteria Assessing Pain in the Elderly Treatment Nonpharmacologic Treatments Pharmacologic Treatments Conclusion References 16: Challenges and Controversies in Complex Regional Pain Syndrome (CRPS) Treatment Sympathetic Blocks in CRPS Which Sympathetic Blocks Can be Used and How Are They Performed? Stellate Ganglia Block (SGB) Ultrasound-Guided Technique Fluoroscopically Guided Technique CT-Guided Technique Lumbar Sympathetic Block (LSB) Fluoroscopically Guided Technique Ultrasound-Guided Technique Thoracic Sympathetic Block Erector Spinae Plane Block Intravenous Sympathetic Block Is One Sympathetic Block Technique Superior to Another? What Agents Can Be Used for Sympathetic Blocks? Are Sympathetic Blocks Effective in Treating CRPS Pain? Does the Response to Sympathetic Blocks Predict Success of Other Treatment Modality Such as Spinal Cord Stimulation? Should Sympathetic Neurolysis Be Used to Treat CRPS Pain? Summary of Sympathetic Block for CRPS Intravenous Ketamine Infusion for CRPS Is IV Ketamine Infusion Effective in Managing CRPS Pain? What IV Ketamine Infusion Protocol Is Optimal? Which Patients Are Likely to Respond to IV Ketamine Infusion? What Are the Short- and Long-Term Consequences of IV Ketamine Infusion? Summary of IV Ketamine Infusion for CRPS Peripheral Nerve Stimulation for CRPS Is PNS Effective in Treating CRPS? Which Patient Is Likely to Respond to PNS? Is PNS Cost-Effective in Treating CRPS? Summary of PNS for CRPS Summary and Future Directions References Index