Restless sleep, fears and isolation: CRPS is NOT incurable

Medicina Universitaria, 2015

Complex regional pain syndrome is a chronic and painful condition that affects the quality of life of patients. It is usually triggered by a traumatic event of the soft tissues involving the nervous tissue. Although the factors that cause the syndrome are varied and not well known, different etiopathologic concepts have been proposed to explain the presence of this syndrome, such as autonomic dysfunction and changes in CNS plasticity, among others. The patient characteristically presents pain, sensory abnormalities, vasomotor disturbances in the skin, edema, changes in sweating, and motor alterations. The pain is associated with changes in the autonomic nervous system and has a distal predominance. Since there is no definitive diagnostic test, diagnosis is mainly based on a complete medical history and physical examination. Treatment is multidisciplinary and based on pain relief. Although in most cases evolution is favorable, rapid diagnosis and treatment are recommended to avoid dystrophic stage as much as possible.

BMJ (Clinical research ed.), 2014

2004

Part I of this article reviewed the history, etiology and underlying mechanisms of CRPS I and II. The current article reviews the available research of physical therapy treatment interventions for patients with CRPS. As outlined in Part 1 of this article, there continues to be much uncertainty about the underlying mechanisms of CRPS. It remains challenging to develop evidence-based guidelines for physical therapy or for any other discipline. There is a paucity of prospective randomized clinical trials. The majority of published reports are case reports or consensus-based. Although the article is written primarily from a physical therapy perspective, the clinical guidelines are also of interest to other health care providers. Given the complexity and scope of CRPS, an interdisciplinary management approach is recommended. & 2003 Elsevier Ltd. All rights reserved.

A B S T R A C T Complex regional pain syndrome (CRPS) is a condition of neuropathic pain, which is characterized by significant autonomic and inflammatory features. CRPS occurs in patients who have limb surgery, limb fractures, or trauma. Many patients may have pain resolve within twelve months of the inciting incident; however, a small subset progresses to the chronic form. This transitional process often happens by changing from warm CRPS with dominant inflammatory phase to cold CRPS, in which autonomic characteristics or manifestations dominate. Several peripheral and central mechanisms are involved, which might vary among individuals over a period of time. Other contributors include peripheral and central sensitization, autonomic alterations, inflammatory and immune changes, neurochemical changes, and psychological and genetic factors. Although effective management of the chronic CRPS form is often challenging, there are a few high quality randomized controlled trials that support the efficacy of the most commonly used therapeutic approaches.

PAIN, 2008

Knowledge concerning the medical history prior to the onset of complex regional pain syndrome (CRPS) might provide insight into its risk factors and potential underlying disease mechanisms. To evaluate prior to CRPS medical conditions, a case-control study was conducted in the Integrated Primary Care Information (IPCI) project, a general practice (GP) database in the Netherlands. CRPS patients were identified from the records and validated through examination by the investigator (IASP criteria) or through specialist confirmation. Cases were matched to controls on age, gender and injury type. All diagnoses prior to the index date were assessed by manual review of the medical records. Some pre-specified medical conditions were studied for their association with CRPS, whereas all other diagnoses, grouped by pathogenesis, were tested in a hypothesis-generating approach. Of the identified 259 CRPS patients, 186 cases (697 controls) were included, based on validation by the investigator during a visit (102 of 134 visited patients) or on specialist confirmation (84 of 125 unvisited patients). A medical history of migraine (OR: 2.43, 95% CI: 1.18-5.02) and osteoporosis (OR: 2.44, 95% CI: 1.17-5.14) was associated with CRPS. In a recent history (1-year before CRPS), cases had more menstrual cycle-related problems (OR: 2.60, 95% CI: 1.16-5.83) and neuropathies (OR: 5.7; 95% CI: 1.8-18.7). In a sensitivity analysis, including only visited cases, asthma (OR: 3.0; 95% CI: 1.3-6.9) and CRPS were related. Psychological factors were not associated with CRPS onset. Because of the hypothesis-generating character of this study, the findings should be confirmed by other studies. Ó

Pain Practice, 2004

There are numerous treatments for complex regional pain syndrome (CRPS). These treatments are varied in scope and include pain management therapies, psychological therapies, and physiotherapy. Treatment guidelines have been published in the past, but little information exists as to how clinicians utilize these guidelines. Moreover, there has been a paradigm shift from the older "reflex sympathetic dystrophy" (RSD) nomenclature, with largely sympathetic block driven diagnosis and therapy to more recent trends towards more inclusive "CRPS" diagnostic criteria and multidisciplinary treatment. There remains controversy regarding the selection of various techniques, and the timing of advancement through the treatment algorithm to the more aggressive, interventional techniques. We set out to determine current CRPS treatment practices of interventional pain specialists. The authors developed a 36-item, 15-20-minute questionnaire. This questionnaire was sent to 453 interventional pain specialists. One-hundred-five surveys were returned, with 100 being complete. Eighty-three percent of our respondents were practicing anesthesiology pain specialists who on average treat 14.9 (SD = 16.8) CRPS patients per month. Our survey results revealed the use of a treatment algorithm for CRPS that consists of treatment using medical therapies (pharmacologic, blocks, catheters, and implantable devices), psychological therapies, and physiotherapy in a coordinated fashion. The trend among our survey respondents is to utilize increasingly interventional techniques after a failed 2- to 4-week trial of any one particular therapy.

2004

espanolDemanda de seda granadina por los grandes centros manufactureros italianos a fines del siglo XIV y en la primera mitad del XV, en especial a traves de las cuentas de Francesco Spinola q. Pietri, mercader genoves en el emirato de Granada. Puntos de aprovisionamiento de seda y proveedores a los que acude, especialmente en Granada, Malaga, Almeria, Almunecar y las Alpujarras. EnglishDemand for Granada's silk in the large Italian manufacturing centers at the end of the fourteenth century and during the first half of the fifteenth century, particularly through the accounts of Francesco Spinola Pietri, genevan merchant in the Emirate of Granada. Places for obtaining silk and suppliers frequenting them, especially in Granada, Malaga, Almeria, Almunecar and the Alpujarras Mountains.

2008 IEEE/IAS Industrial and Commercial Power Systems Technical Conference, 2008

This paper was written by a Working Group of the IEEE Power System Relay Committee to provide guidance to the industry to better coordinate generator protection with generator control. The paper discusses specific calculation methods that can be used to insure generator protection and excitation system control are fully coordinated. It also specifically addresses the coordination of relays with generator full load capability and machine steady state stability limits. Because of recent blackouts, NERC (North American Electric Reliability Council) is developing standards [1-3] for the coordination of generator protection and control. This paper provides practical guidance on providing this coordination.