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Exploring CRPS Pain, Depression, and Other Factors

Dissertation Oral Defense

Patricia Phillips

on 19 November 2013

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Transcript of Exploring CRPS Pain, Depression, and Other Factors

Patricia Melody Loewit Phillips, M.S.

CRPS and Demographic Factors
Chronic Pain and Depression
CRPS Pain and Comorbid Depression
The History and Diagnosis of CRPS
Contributed By All

Izenburg, Neil. (2012). Teen Health From Nemours. http://kidshealth.org/teen/your_body/body_basics/brain_nervous_system.html#

Campbell, N. A., Reece J. B., Taylor M. R., Simon, E. J., Dickey, J.L. (2009). Nervous System. Wilbur, B. Biology; Concepts & Connections. (564-573). San Francisco, CA: Pearson Benjamin Cummings.
CRPS may be modified by these variables:
Age: Conflicting evidence
Ethnicity: Conflicting evidence
Gender: Conflicting, but females tend to report 3 times more pain and depression than males.
Socioeconomic level: Conflicting
Complex Regional Pain Syndrome (CRPS) was first recognized during U.S. Civil War.
A debilitating condition with constant, burning, seething pain - totally out of poportion to the intiiating event.
No known medical cure.
Frequently comorbid with depression.
1.5 to 6 million Americans suffer from CRPS.

International Association for the Study of Pain (IASP):
Pain out of proportion to initiating event.
One of the following four:
Tissue disorders
Excessive swelling
Movement disorders
Sympathetic involvement

Budapest Criteria:
Pain out of proportion to initiating event.
Doctor observed 2 out of following 4:
Sensory changes.
Vasomotor changes.
Sudomotor or edema changes.
Motor/tropic changes.
Revealed through amelioration techniques:
Electoconvulsive therapy
Pre-existing depression does not lead to CRPS, but CRPS seems to lead to depression.

Revealed through biochemistry:
Omega 3 vs. Omega 6
Elevated substance P
Voltage gated sodium channels
vanHeerden, Dr. I.V. (2007). The Nervous System: Other B Vitamins.
Team Fierce!
Exploring CRPS Pain,
Other Factors
Exploring CRPS Pain , Depression, and Other Factors

CRPS and Biomedical Factors
Very scant research evidence...

Suggested comorbidity:
Migraine headaches
Urinary complications
Inflammatory skin lesions
Total body allodynia
Familial propensity
Weight gain
Virtually no rsearch concerning CRPS and comorbid depression
Must look towards chronic pain and depression for similarities.
The relationship between non-cncerous chronic pain and depression revealed:
Pain patients tended to be depressed.
Preexisting depression tends to effect pain perception.
The relationship between pain and depression appears to be bilateral.
A common brain enzyme exists for both pain and depression.

CRPS Study Amelioration Techniques - General
CRPS etiology unknown.

No known medical cure; therfore, research efforts have concetrated on amelioration techniques.

Two tecniques that achieve pain relief for various periods of time...

CRPS Amelioration Techniques General
CRPS etiology unknown
No known medical cure
Hence, research efforts have concentrated on amelioration methods
Two pain abatement techniques have been successful to ameliorate CRPS pain in some patients for various periods of time.
Primarily a medical and veterinary anesthesia medication, but also a recreational street drug

Ketamine is the strongest NMDA antagonist known

First use for CRPS in UK – abatement for at least 5 months

Few studies of efficacy for CRPS anywhere in the world


Electricity used for pain for at least 2,000 years ago in the Roman Empire

Based on Gate-Control Theory in 1967 , SCS began to be used for pain

Evidence for SCS and CRPS very limited and efficacy not well documented

Electrodes implanted in spine’s epidural space

Frequency adjusted to produce pain relief

Less than ½ of CRPS patients get good relief from the SCS
Patricia Melody Loewit Phillips, M.S.
Health Psycholgy
Ph.D. Candidate
Limited research about these variables
Problem Statement
The precise quantitative relationship between depression and the pain of CRPS is largely unknown

Little is known about differences in the demographic factors of ethnicity, age, gender, and socioeconomic level

Even less information is known concerning comorbid biomedical factors

Longitudinal efficacy of the ketamine infusion therapies and the SCS technique is unknown

Existing knowledge from small scale studies
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