Скачать презентацию Complex Regional Pain Syndrome CRPS Sean S Armin Скачать презентацию Complex Regional Pain Syndrome CRPS Sean S Armin

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Complex Regional Pain Syndrome (CRPS) Sean S. Armin, M. D. Department of Neurosurgery, Loma Complex Regional Pain Syndrome (CRPS) Sean S. Armin, M. D. Department of Neurosurgery, Loma Linda University Medical Center

Introduction to CRPS • Confusing terminology: Reflex Sympathetic Dystrophy – CRPS I Causalgia – Introduction to CRPS • Confusing terminology: Reflex Sympathetic Dystrophy – CRPS I Causalgia – CRPS II Other previous names: algodystrophy mineures, mimo-causalgia, sympathalgia, post-traumatic spreading neuralgia, Sudek’s atrophy, Shoulder-hand syndrome, Sympathetically-maintained pain (SMP) • Long recognized clinical entity: Bernard and Weir Mitchell (1800’s) • Still no clearly identified pathophysiology • Sympathetic nervous system: etiology vs. epiphenomenon

Complex Regional Pain Syndrome I vs. II Harden, et al: Clin J Pain, 22: Complex Regional Pain Syndrome I vs. II Harden, et al: Clin J Pain, 22: 415– 419, 2006 Sensitivity: 0. 98 Specificity: 0. 36 Bruehl, et al: Pain, 81: 147– 154, 1999

Proposed Modified Dx Criteria for CRPS Proposed Modified Clinical Dx Criteria At least one Proposed Modified Dx Criteria for CRPS Proposed Modified Clinical Dx Criteria At least one Sx in 3 of 4 categories At least one Sx in 2 of 4 categories Sensitivity: 0. 70 Specificity: 0. 95 Sensitivity: 0. 85 Harden, et al: Clin J Pain, 22: 415– 419, 2006 Specificity: 0. 69

Quisel, et al: J Family Practice, 54: 524– 532, 2005 Quisel, et al: J Family Practice, 54: 524– 532, 2005

Clinical Presentation Wasner, et al: Spinal Cord, 41: 65– 71, 2003 Simpson: Lancet Neurology, Clinical Presentation Wasner, et al: Spinal Cord, 41: 65– 71, 2003 Simpson: Lancet Neurology, 3: 142, 2004

Quisel, et al: J Family Practice, 54: 524– 532, 2005 Quisel, et al: J Family Practice, 54: 524– 532, 2005

Clinical Presentation Vacariu: Disability & Rehab, 24: 435– 442, 2002 Harden, et al: Clin Clinical Presentation Vacariu: Disability & Rehab, 24: 435– 442, 2002 Harden, et al: Clin J Pain, 22: 415– 419, 2006

Quisel, et al: J Family Practice, 54: 524– 532, 2005 Quisel, et al: J Family Practice, 54: 524– 532, 2005

Peripheral Response to Injury Teasdall, et al: Clin Sports Med, 23: 145 -155, 2004 Peripheral Response to Injury Teasdall, et al: Clin Sports Med, 23: 145 -155, 2004

Pathophysiology Wasner, et al: Spinal Cord, 41: 65– 71, 2003 Pathophysiology Wasner, et al: Spinal Cord, 41: 65– 71, 2003

Pathophysiology Wasner, et al: Spinal Cord, 41: 65– 71, 2003 Pathophysiology Wasner, et al: Spinal Cord, 41: 65– 71, 2003

Pathophysiology Wasner, et al: Spinal Cord, 41: 65– 71, 2003 Pathophysiology Wasner, et al: Spinal Cord, 41: 65– 71, 2003

Pathophysiology Teasdall, et al: Clin Sports Med, 23: 145 -155, 2004 Pathophysiology Teasdall, et al: Clin Sports Med, 23: 145 -155, 2004

Mechanism-Based Pharmacotherapy Ribbers, et al: Arch Phy Med Rehabil, 84: 141– 146, 2003 Mechanism-Based Pharmacotherapy Ribbers, et al: Arch Phy Med Rehabil, 84: 141– 146, 2003

Quisel, et al: J Family Practice, 54: 524– 532, 2005 Quisel, et al: J Family Practice, 54: 524– 532, 2005

Spinal Cord Stimulation Study Methodologies Grabow, et al: Clinical J. Pain, 19: 371– 383, Spinal Cord Stimulation Study Methodologies Grabow, et al: Clinical J. Pain, 19: 371– 383, 2003

Spinal Cord Stimulation Study Outcomes Grabow, et al: Clinical J. Pain, 19: 371– 383, Spinal Cord Stimulation Study Outcomes Grabow, et al: Clinical J. Pain, 19: 371– 383, 2003

Spinal Cord Stimulation Randomized Trial Kemler, et al: Ann Neurol, 55: 13– 18, 2004 Spinal Cord Stimulation Randomized Trial Kemler, et al: Ann Neurol, 55: 13– 18, 2004

Complex Psychosical/Behavioral Interaction Deterioration Miller: Orthoped Nursing, 22: 91– 99, 2003 Turner-Stokes: Disability & Complex Psychosical/Behavioral Interaction Deterioration Miller: Orthoped Nursing, 22: 91– 99, 2003 Turner-Stokes: Disability & Rehab, 24: 939– 947, 2002