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CHRONIC REGIONAL PAIN SYNDROME - Coggle Diagram
CHRONIC REGIONAL PAIN SYNDROME
DEFINITION
chronic persistent pain
known as
Reflex Sympathetic Dystrophy
Causalgia
Algodystrophy
Sudeck's atrophy
Post traumatic dystrophy
PATHOPHYSIOLOGY
when nerve is excited , its endings release chemicals
these chemicals cause opening of blood vessels (vasodilation)
this allow the fluid leak from blood vessel goes to surrounding tissues
-it cause inflammation /swelling leads to more stimulation of sensory nerve fibres
this will lower the pain threshold . (neurogenic inflammation)
its shows swelling, redness and warmth of the skin and increased the senstivity to pain
as the symptoms go untreated , the affected area can became cool, have hair loss, have brittle / crack nails
can lead to muscle atrophy/ loss of bone density(calcium)
can decreased blood supply to the affected tissue
STAGES
Stage 1 : painful,tender,swollen,sweating,red, increase hair&nail growth
Stage 2 : burning pain,allodynia(pain) , hyperalgesia ( increase pain)
Stage 3 : permanent by dystrophy / defective growth of bones/tissues
ETIOLOGY
develop after injuries ( fracture, surgery,stroke,crush injuries)
work injury
often affect lower extremities( 60) - upper extremities (40)
RISK FACTOR
Trauma
Immobilisation
Injection/surgery
stressfull life
genetic
smoking
CLINICAL FEATURES
burning/arching pain
skin sensitivity/discoloration
swelling
sweating&temperature changes
dystrophy bones and muscles
INVESTIGATION
budapest criteria
infrared
sweat testing
radiographic testing
3 phase bone scan (type 1)
bone densitometry
MRI
sympathetic block
Physical examination
taking history
autonomic dysfunction
motor dysfunction
sensory dysfunction
SUBTYPES
Type 1 : caused by injury to tissues (RSD)
Type 2 : caused by damage to a nerve (causalgia)
MANAGEMENT
Conservative
oral pain-relieving medications
antidepressant
transcutaneous electrical nerve stimulation (TENS)
transcranial magnetic stimulation
Surgical
spinal cord stimulation
radiofrequency ablation
amputation
