Diferencias diagnósticas en el Síndrome de Dolor Regional Complejo Diagnostic Differences about Complex Regional Pain Syndrome Albert Dominguez Arasa

1. Complex Regional Pain
Syndrome
CRPS
Albert Domínguez Arasa
PT at CROMa Grenoble ( France)
dominguezarasa@gmail.com

2. Complex Regional Pain Syndrome
A little bit of history…
Diagnosis of CRPS
What do our patients know?

3. Complex Regional Pain Syndrome
Mitchel et all. 1864 Pain and sympathetic disturbances in soldiers
with gunshot. CAUSALGIA
Südeck 1901 German surgeon describes loss of bone
arquitecture , SÜDECKS ATROPHY
… + 64 names in English ( Veldman 1996 )
reflex symathetic dystrophy (RSD)
IASP 1995 CRPS I No nervous damage
CRPS II Nervous damage

4. Complex Regional Pain Syndrome
Skin ?
Muscle ?
Bone ?
Ligaments ?

5. Complex Regional Pain Syndrome
Continued and disproportionate Pain to the injury
One symptom in 3of 4 categories
One sign in 2of 4 categories
No other diagnosis that better explains de symptoms
Sensory : hyperaestesia –allodynia
Vasomotor: temperature – colour
Sudomotor: oedema – sweating
Motor/Trophy: ROM – dystonia -
tremor - nails – air.
Budapest Criteria for CRPS (2010)

6. Complex Regional Pain Syndrome
DIAGONOSIS ONLY
WITH RX ?
DIAGNOSIS ONLY WITH
RX ?

7. Complex Regional Pain Syndrome

8. Complex Regional Pain Syndrome
What do our patients know?
7
patients
3 women
Age : 42,6
Wrist fracture, sprained wrist, CTS
4 man
Age: 51
Wrist fracture, wrist arthrodesis, sprained thump

9. Complex Regional Pain Syndrome
Do you know what CRPS is ?
-3/7 negative answers
-4/7 positive answers
What that means for you?
- PAIN or heavy pain !!!
- Algodystrophie or algoneurodystrophie

10. Complex Regional Pain Syndrome
Which of the following names sounds familiar
for you ?
Causalgia 1/7
Südek 1/7
reflex sympathetic dystrophy 3/7
Complex regional pain syndrome 2/7
Others: “Algo-neuro-dystrophie” , shoulder-hand syndrome, CRPS

11. Complex Regional Pain Syndrome
Who was the first health care professional who
has reported about CRPS ?
Surgeon 4/7
GP 2/7
PT 1/7
In the diagnosis of CRPS which were the most
relevant factors for detection?
RX 0/7
Scintigraphy 4/7
Simptoms + test 2/7
Only simptoms 1/7

12. Complex Regional Pain Syndrome
Which aspects of everyday life are more affected by
CRPS ?
“le geste simple du quotidien” daily simple gest
-take, lift, hold, eat, cut, wash, dress, drive, writing...
DASH or quick DASH questionnaires

13. Complex Regional Pain Syndrome
Have you ever done a research on Google to find
information about CRPS ?
Yes 3/7
No 4/7
If you have questions about CRPS, what is your
preference when looking for information.
Health care professional 7/7
Internet 0/7
Other patients 2/7

14. Complex Regional Pain Syndrome
References:
Berklein F, Rowbotham M. Does pain change de brain? Neurology 2005;65:666-667
Weber M, Birkelin F. Comlex Regional Pain Syndrome an actual survey. Expert Rev
Neurotherapeuthics 2001;1(1) 100-109
Field J. Complex Regional Pain Syndrome: a rewiew. JHS (eur) 2013 0(0) 1-11
Moseley G.L. Graded Motor Imagery is effective for long standing CRPS: a randomised controled
trial. Pain 108 (2004) 192-198.
Koban M, Leis S, et all. Tissue Hypoxia in complex regional pain syndrome. Pain 104 ( 2003) 149-157
Marnius J, Moseley G L, et all. Clinical Features and pathophysiology of complex regional pain
sindrome.
www.thelancet/neurology vol. 10 July 2011. 637-648
Birklein F, Riedl B, et all. Neurological findings in complex regional pain syndromes – analysis of
145 cases. Acta nerologica escandinavica. 2000: 101: 262 – 269
Moseley L. Graded motor imagery for pathologic pain: A randomized controlled trial. Neurologi
2006;67;2129-2134

15. Complex Regional Pain
Syndrome
Albert Domínguez Arasa
dominguezarasa@gmail.com
dominguezarasa.wordpres.com
Twitter: @dominguez_arasa