• Title/Summary/Keyword: complex regional pain syndrome

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Complex Regional Pain Syndrome followed by Artery and Vein Puncture -A report of 2 cases- (동정맥 천자 후 발생한 복합부위통증증후군의 치료 -증례보고-)

  • Ahn, Gyu Yul;Han, Kyung Ream;Lee, Hyun Tak;Kim, Yeui Seok;Kim, Chan
    • The Korean Journal of Pain
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    • v.20 no.1
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    • pp.66-70
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    • 2007
  • No definitive etiology or risk factors have been identified that predispose individuals to developing complex regional pain syndrome (CRPS). We experienced two cases of CRPS developed after arterial and venous puncture which were done in regular medical work. A 35-years old female patient was suffered from pain and allodynia with swelling at right hand and wrist after radial artery puncture for monitoring of blood pressure during general anesthesia. A 24-years old male patient had pain and swelling with allodynia at the right fingers and arm after median cubital vein puncture for blood sampling. They did not have proper pain management as CRPS patients in the past weeks and months after their pain occurred. They were diagnosed as CRPS and started undergoing various interventional procedures, which led to improve their pain condition. Our cases suggest that CRPS could develop without any proved tissue damage in routine medical practice. In conclusion, health care workers should be educated in knowledge about the uncommon medical condition and proper consultation to pain specialist when it happens.

Do Severity Score and Skin Temperature Asymmetry Correlate with the Subjective Pain Score in the Patients with Complex Regional Pain Syndrome?

  • Jeon, Seung Gyu;Choi, Eun Joo;Lee, Pyung Bok;Lee, Young Jae;Kim, Min Soo;Seo, Joung Hwa;Nahm, Francis Sahngun
    • The Korean Journal of Pain
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    • v.27 no.4
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    • pp.339-344
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    • 2014
  • Background: The diagnostic criteria of complex regional pain syndrome (CRPS) have mainly focused on dichotomous (yes/no) categorization, which makes it difficult to compare the inter-patient's condition and to evaluate the intra-patient's subtle severity over the course of time. To overcome this limitation, many efforts have been made to create laboratory methods or scoring systems to reflect the severity of CRPS; measurement of the skin temperature asymmetry is one of the former, and the CRPS severity score (CSS) is one of the latter. However, there has been no study on the correlations among the CSS, temperature asymmetry and subjective pain score. The purpose of this study was to evaluate whether there is any correlation between the CSS, skin temperature asymmetry and subjective pain score. Methods: Patients affected with CRPS in a unilateral limb were included in this study. After making a diagnosis of CRPS according to the Budapest criteria, the CSS and skin temperature difference between the affected and unaffected limb (${\Delta}T$) was measured in each patient. Finally, we conducted a correlation analysis among the CSS, ${\Delta}T$ and visual analogue scale (VAS) score of the patients. Results: A total of 42 patients were included in this study. There was no significant correlation between the ${\Delta}T$ and VAS score (Spearman's rho = 0.066, P = 0.677). Also, the CSS and VAS score showed no significant correlation (Spearman's rho = 0.163, P = 0.303). Conclusions: The ${\Delta}T$ and CSS do not seem to reflect the degree of subjective pain in CRPS patients.

The Effect of Spinal Cord Stimulation in Patients with Complex Regional Pain Syndrome (복합부위통증증후군 환자에서 척수자극술의 효능)

  • Kim, Won Young;Moon, Dong Eon;Choi, Jin Hwan;Park, Chong Min;Han, Seong Min;Kim, Shi Hyeon
    • The Korean Journal of Pain
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    • v.19 no.2
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    • pp.152-158
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    • 2006
  • Background: Complex regional pain syndrome (CRPS) is a painful, disabling disorder for which no proven treatment has been established. The purpose of this investigation was to assess the evidence of the efficacy of spinal cord stimulation (SCS) in the management of pain in CRPS patients. Methods: Between March 2004 and June 2006, 11 patients with CRPS were treated with SCS. The visual analog scale (VAS) score for pain (0⁣-10) and pain disability index (PDI) were obtained in all patients prior to treatment, and 1, 3 and 6 months post-implantation. Results: All 11 patients, 5 men and 6 women, with a median age and duration of CRPS of 44 years and 48.8 months, respectively, successfully received a lead implantation for SCS. The mean VAS pain score prior to the treatment was 85.5 out of 100 mm. After SCS implantation, the mean VAS pain scores were 49.5, 57.0 and 56.0 at 1, 3 and 6 months after the procedure, respectively. The mean pain score for allodynia was decreased by 50%, with a significant reduction of the PDI also observed after the treatment. Conclusions: Our current study suggests that SCS implantation is a safe and effective method in the management of CRPS patients.

Implantable Intrathecal Drug Delivery Pump in Complex Regional Pain Syndrome Patient -A case report- (복합부위통증증후군 환자에게 시행한 매몰식 펌프를 이용한 지주막하강 내 약물투입 -증례보고-)

  • Seo, Kyung Soo;Han, Kyung Ream;Kim, Sae Young;Park, Kyeong Eon;Kim, Chan
    • The Korean Journal of Pain
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    • v.22 no.1
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    • pp.74-77
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    • 2009
  • Implantable intrathecal pump is one of the therapeutic options for intractable pain. A 24-year-old male with complex regional pain syndrome was suffering from right lower extremity pain. He had all modalities of treatment including spinal cord stimulator. However, his pain had been worse in the past 6 months. His visual analogue pain scale (VAS) was 8-10 and he could not sit or walk. Only opioid was thought to be effective. Then, intrathecal pump was considered. We estimated the minimal effective dose of spinal morphine before implantation. 0.3 mg of morphine was injected intrathecally as a starting dose. Dosage had been increased up to 0.8 mg in 10 days. His VAS score decreased from 8 to 5. He could sleep without pain and walk with crutch. Therefore, intrathecal pump was inserted. He could tolerate to pain. This case suggests that intrathecal morphine delivery can provide effective treatment for intractable non-malignant pain.

Comparison of the Two Impairment Classes Publicized by the American Medical Association in Complex Regional Pain Syndrome Patients (복합부위통증증후군 환자에서 미국의사협회 영구장애평가지침에서 제시된 장애등급 평가방법의 비교)

  • Shin, Hwa Yong;Choi, Yong Min;Nahm, Francis Sahngun;Park, Seong Joo;Koo, Mi Suk;Suh, Jeong Hun;Sim, Sung Eun;Jo, Ji Yon;Lee, Sang Chul;Kim, Yong Chul
    • The Korean Journal of Pain
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    • v.20 no.2
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    • pp.148-153
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    • 2007
  • Background: Complex regional pain syndrome (CRPS) is not regarded as an impairment in Korea. Guidelines for rating this impairment are under development by the Korean Academy of Medical Science based on that of the American Medical Association (AMA). However, no studies have been done on the validity of these guidelines in Korea. We therefore evaluated the validity of these guidelines using the criteria from the chapter on the central and peripheral nervous system (CNS-PNS class) and the worksheet for calculating total pain-related impairment score (TPRIS class). Methods: TPRIS and CNS-PNS classes were calculated through interviews of 28 CRPS patients. The correlation between the two classes was calculated. Results: TPRIS class and CNS-PNS class were well correlated (r = 0.593, P < 0.05). Conclusions: Both TPRIS or CNS-PNS classes were well correlated and could be used for evaluation of impairment. However, the CNS-PNS class is simpler and quicker to complete.

Successful removal of permanent spinal cord stimulators in patients with complex regional pain syndrome after complete relief of pain

  • Lee, Su Jung;Yoo, Yeong Min;You, Jun A;Shin, Sang Wook;Kim, Tae Kyun;Abdi, Salahadin;Kim, Kyung Hoon
    • The Korean Journal of Pain
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    • v.32 no.1
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    • pp.47-50
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    • 2019
  • Background: It is uncommon for patients who have received a permanent implant to remove the spinal cord stimulator (SCS) after discontinuation of medication in complex regional pain syndrome (CRPS) due to their completely painless state. This study evaluated CRPS patients who successfully removed their SCSs. Methods: This 10-year retrospective study was performed on patients who had received the permanent implantation of an SCS and had removed it 6 months after discontinuation of stimulation, while halting all medications for neuropathic pain. Age, sex, duration of implantation, site and type of CRPS, and their return to work were compared between the removal and non-removal groups. Results: Five (12.5%, M/F = 4/1) of 40 patients (M/F = 33/7) successfully removed the permanent implant. The mean age was younger in the removal group ($27.2{\pm}6.4$ vs. $43.5{\pm}10.7$ years, P < 0.01). The mean duration of implantation in the removal group was $34.4{\pm}18.2$ months. Two of 15 patients (13.3%) and 3 of 25 patients (12%) who had upper and lower extremity pain, respectively, had removed the implant. The implants could be removed in 5 of 27 patients (18.5%) with CRPS type 1 (P < 0.01). All 5 patients (100%) who removed their SCS returned to work, while only 5 of 35 (14.3%) in the non-removal group did (P < 0.01). Conclusions: Even though this study had limited data, younger patients with CRPS type 1 could remove their SCSs within a 5-year period and return to work with complete pain relief.

Effectiveness of Cold Stress Thermography in the Diagnosis of Complex Regional Pain Syndrome Type 1 (복합부위통증증후군 1형 환자에서 한냉부하 적외선체열촬영의 유용성 평가)

  • Park, Eun Jung;Han, Kyung Ream;Chae, Yun Jeong;Jeong, Won Ho;Kim, Chan
    • The Korean Journal of Pain
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    • v.19 no.2
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    • pp.159-163
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    • 2006
  • Background: Despite the enormous amount of basic research on neuropathic pain, there is the lack of an objective diagnostic test for complex regional pain syndrome (CRPS). The aim of this study was to evaluate the usefulness of cold stress thermography in the diagnosis of CRPS. Methods: The study involved 12 patients with CRPS type 1, according to the IASP criteria, who were compared with 15 normal healthy volunteers. All subjects underwent thermographic examination under baseline conditions at $21^{\circ}C$. A cold stress test (CST; $10^{\circ}C$ water for 1 minute) was then applied to both hands below the wrists, immediate, and after 10 and 20 minutes. Results: The temperature asymmetry between the patients with CRPS and the volunteers showed significant discrimination at the baseline and after a 20 minute recovery period from the CST. Among the study subjects having temperature asymmetry of both hands of less than $1^{\circ}C$ (8 out of 12 CRPS patients and 14 out of 15 volunteer), 7 (87.5%) of the 8 CRPS patients and 3 (21%) of the 14 volunteers showed a temperature difference of more than $1^{\circ}C$ after the 20 minute recovery period. The actual temperature values during the four periods did not discriminate between the patients with CRPS and the volunteers. Conclusions: Thermography, under the CST, could be a more objective test for the diagnosis of CRPS. A temperature asymmetry greater than $1^{\circ}C$ during the 20 minute recovery period following CST provides strong diagnostic information about CRPS, with both high sensitivity and specificity.

Lower Motor Weakness and Complex Regional Pain Syndrome of Lower Limb in the Patient of Frontotemporal Dementia: A Case Report (이마관자엽 치매 환자에서 나타난 하지 근력 저하와 복합부위 통증증후군에 대한 증례 보고)

  • Lee, Kwang Min;Noh, Se Eung;Joo, Min Cheol;Hwang, Yong;Kim, Ji Hee
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.18 no.12
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    • pp.352-358
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    • 2017
  • Frontotemporal dementia, the second most common cause of early onset dementia, is a neurodegenerative clinical syndrome characterized by progressive deficits in behavior, executive function and language. Although motor symptoms in frontotemporal dementia are represented by motor neuron disease, parkinsonism and progressive supranuclear palsy syndrome, there have been no reports of motor weakness caused by the direct involvement of central motor nervous systems in frontotemporal dementia. Moreover, no association between clinical dementia groups and complex regional pain syndrome has been reported. We diagnosed a rare case with motor weakness and complex regional pain syndrome of lower limbs due to central nervous system lesion in a patient with frontotemporal dementia by magnetic resonance imaging, electrodiagnostic study and three phase bone scan. Following steroid therapy for complex regional pain syndrome, pain was improved. Functional improvement was noted after rehabilitation therapy, including functional electrical stimulation, muscle strengthening exercise and gait training during hospitalization. This case report suggests that rehabilitation therapy for motor weakness in frontotemporal dementia could be effective for improving overall function.

Complex regional pain syndrome in the young male population: a retrospective study of 200 Korean young male patients

  • Lee, Ho-Jin;Lee, Chang-Soon;Yoo, Yongjae;Noh, Jae Mun;Yu, Je Hyuk;Kim, Yong-Chul;Moon, Jee Youn
    • The Korean Journal of Pain
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    • v.32 no.4
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    • pp.292-300
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    • 2019
  • Background: The aim of this study was to investigate the clinical characteristics of complex regional pain syndrome (CRPS) in young male patients in South Korea, especially focusing on the association with military service. Methods: From January 2007 to May 2017, we investigated the electronic medical records of 430 consecutive patients, aged 18 to 30 years, who visited Seoul National University Hospital Pain Center, with a suspected diagnosis of CRPS at the initial visit. The following patient details were available for analysis: demographic and disease-related variables, relevance to military service, medications, and the treatment modalities received. Results: Out of 430 patients, 245 (57.0%) were diagnosed with CRPS, of which, 200 were male patients and 45 were female patients. Of the male patients, 95 (47.5%) developed CRPS during military service. CRPS during military service was more likely to result from sprain/strain, and the incidence of CRPS was significantly higher in the lower extremities in patients from the military service group than in those from the non-military service group. During the follow-up period, 37.9% of male CRPS patients (n = 61/161) were treated successfully. Patients with moderate to severe initial pain intensity, and diagnosed during their military service, showed better outcomes. Conclusions: Our results demonstrated that manifestation of CRPS in the young Korean population was more common in male and among those male CRPS patients, about half the cases developed during the military service period.

Evaluation of YouTube videos as sources of information about complex regional pain syndrome

  • Altun, Aylin;Askin, Ayhan;Sengul, Ilker;Aghazada, Nazrin;Aydin, Yagmur
    • The Korean Journal of Pain
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    • v.35 no.3
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    • pp.319-326
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    • 2022
  • Background: As the internet usage becomes easily accessible, the patients are more frequently searching about diseases and medical/non-medical treatments. Considering that complex regional pain syndrome (CRPS) is a debilitating disease, it is important to check the information that patients are accessing. Therefore, this study aimed to investigate the reliability, sufficiency, and accuracy of the YouTube videos about CRPS. Methods: This study is a descriptive research which is derived by searching videos using the keyword 'complex regional pain syndrome' on YouTube. Relevance-based sequencing was used to sort the videos. Sources and video parameters were documented. To evaluate the accuracy, reliability and content quality of the videos, Global Quality Score, Journal of American Medical Association Benchmark Criteria and Modified DISCERN Questionnaire scales were used. Results: A total of 167 videos were included in this study. The majority of the videos originated from USA (80.2%, n = 134). The median number of views was 639 and the viewing rate was 73.3. Most of the videos had partially sufficient data and the interaction index viewing rate parameters for videos with high content quality were greater than videos with low content quality (P = 0.010, P = 0.014). Conclusions: Our results showed that videos about CRPS on YouTube mostly had partially sufficient data and include intermediate-high quality contents. Moreover, high-content quality videos had higher viewing rates, interaction indexes, number of likes, longer durations, as well as better reliability and accuracy scores. Videos with high quality and reliable content are needed to reduce misinformation about CRPS.