Complex regional Pain Syndrome Presented by: Frishta Ahmadi, COTA/L, MSOT

Hello, class.

I've been assigned, um, to report to you all about

complex regional pain syndrome.

C r P s on.

Without further ado, I shall begin.

So what exactly is C.

R. P s?

It's an abnormal, sympathetic response to trauma surgery or disease,

which results in excess and prolonged pain and inflammation.

And it has three different stages acute stage, this trophic

stage and a traffic stage.

Um, fun fact it was previously known as RSD reflects

sympathetic dystrophy and cause alga.

Um, there are two types of C R.

P S, E c ps one and Sierra ps two

and they're mainly differentiated, um, by whether the inciting incident

includes a defendable nerve injury or not.

So C.

R. P s does have a variant course ranging from

mild and self limiting to chronic disease, which impairs activities

of daily living and health related quality of life.

Um, mostly RPS is caused by damage to our dysfunction

of injured peripheral sensory neurons, which then has secondary effects

on the spinal cord in the brain.

So, as we've learned, um, the CNS is composed of

the brain and spinal cord, and the pianists involves, uh,

nerves. Signaling from the brain and spinal cord to all

other parts of the body.

It's actually unclear why some people develop therapy s, um,

while others with similar trauma do not.

On which is a little confusing.

And also in more than 90% of cases, C R

P s is actually triggered by nerve trauma or injury

to the affected limb that damages the thinnest sensory and

on and on the nerve fibers.

So what population is affected by C.

R. P s?

Um, it can be found in Children.

Um, but most frequently occurs in adults with a peak

around age 40.

Intense effect females three times more than males.

It is rare in the elderly who have less inflammation

after injury.

And in young Children who heal so quickly and completely

the diagnosis of C.

R. P s and pediatrics.

Um, I found this was actually a little like, super

interesting, Um, that the pediatric population is increasingly common, especially

among female adolescents.

Um, the pain experience of adolescents with C.

R. P s is best understood using the bio psycho

social framework and the most effective treatment programs target biological,

psychological and social factors.

I think it's also noteworthy to mention that the parent

child diet that develops when the child has yes is

complex and characterized as, um, by significant psychological distress and

effective parenting and also poor coping.

So what testing is done to verify C.

R. P s?

Um syrupy s is a clinical diagnosis made mainly through

careful history, review of symptoms and physical examination of the

patient, for which diagnostic criteria, including the Orlando criteria for

C. R.

P s and the Budapest Clinical diagnostic criteria for syrupy

s um, by the a S P, which stands for

International Association of the Study of Pain.

Um, the I S P was actually the first organization,

uh, to enter c r P s and it's taxonomy

as a diagnostic entity, um, and arrived at four conditions

uh, four conditions on which to base a diagnosis One,

um, was in initiating event or cause of a mobilization.

The second is continuing pain Al Adonia or hyper allergy

Zia. Disproportionate to the inciting event.

The third is evidence at sometimes or sometime of oedema

changes in skin, blood flow or abnormal pseudo motor activity

in the painful region.

And finally, the fourth.

The diagnosis is actually excluded by the existence of other

conditions that might account for the pain and dysfunction.

Um, and the I s P was actually the one

who subdivided syrupy s and to type one, which is

without major nerve damage and type two with major nerve

damage. So some symptoms Pain definitely deep.

Taking cold burning or increased skin sensitivity.

Um, abnormal swelling.

Abnormal, uh, skin color changes would have mentioned before.

Um, abnormal skin temperature, um, sweating, limited range.

Emotional weakness on.

So just going back a little bit, um, the skin

over the effective area maybe thickened.

Um it may appear shiny or tight.

Um, and it might change color presenting maybe bluish or

purplish as circulation to the area changes.

There may also be abnormal hair growth like darker on

dhe, coarser in texture, um to all or just some

of the affected area, as well as abnormal nail growth,

which could include like rigid nails, yellow colored thickened nails.

Um, and as the condition progresses, many patients this is

actually really important.

Many patients begin to dissociate from their affected extremity as

if it no longer belongs to them.

Um, they may be self conscious about the changes in

physical appearance or unsure how to explain the condition, toe

others when they don't fully understand it themselves.

Um, on unremitting, uh, pain increases underlying fear and anxiety

of more malicious yet undiagnosed disease process.

So when symptoms persist, patients experience permanent impairment and disability,

which can lead to a loss of or so suspension

from work.

Um, change in occupation and psychological disorders.

Um, therefore, early recognition, along with prompt treatment, is important

for minimizing permanent loss of function.

Um, and also the the benefits of, um, early diagnosis

and initiation of treatment, um, is because early C.

R. P s is actually easier to treat and the

prognosis is usually better, and full recovery can be expected

within a reasonable time.

Now, in contrast, chronic C.

R. P s, in most cases is disabling, um, condition

with poor prognosis and limited treatment options.

So early recognition, um, of C.

R. P s, along with trump treatment is important to

minimize permanent loss of function.

All right, a couple of assessments that could be used

for this population on dhe.

This made me giggle because I remembered um o t.

3 20 when we first were introduced to the c

o p m andi.

Also, the bus the visual analog scale.

Um, rehabilitation is known as the single most important treatment

for C.

R. P s keeping the painful limb or body part

moving improves blood flow and lessons Circulatory symptoms, um as

well as maintains, flexibility, strength and function.

So rehabilitating the affected limb helps prevent and reverse secondary

spinal cord and brain changes associated with this use and

chronic pain.

And yea, occupational therapy can help people learn new ways

to become active and return toe work and daily tests

like we normally dio um, with our patients.

What really?

All of our patients, um and the O.

T s goal is to improve function through various treatment

modalities and facilitate reengagement in safe occupations on also, it's

important. Um, that's to know that special vocational rehabilitation training

is usually started in the later stages of the therapy

program, Um, including progressive stress loading and work hardening.

Um, and even though the goal of O.

T. Is always to ensure the client satisfaction with given

therapy on the client's functional outcomes, from what I've read,

the existing literature fails to address the issue of how

satisfied clients.

Diagnosis therapy s, um, And their hand, um were with

the therapy that they actually was received.

Okay. Also, it z important thio talk about the stress

loading protocol.

It is comprised of two components grabbing and carrying each

component engages, um, the affected extremity inconsistent weight bearing activities

with small range of movement for gradual, uh, for gradually

increasing periods of time thes activities quote unquote load the

affected joints or extremity.

And in turn, this provides inhibitory appropriate effective input to

the nervous system through the use of the pressure.

So through that weight bearing and three, the key to

stress loading is provided providing as much force or weight

bearing, um as can be consistently tolerated during scrubbing, carrying

gradually increasing the frequency and duration of these activities throughout

the day.

Um, loading and loading the affected area, um to tolerance

and gradually increasing the frequency and duration of weight bearing

activities enables the nervous system toe acclimated to the stimuli.

Um, in this acclamation, progressively desensitize is the height and

pain response and allows the nervous system to quote unquote

like remodel itself.

Um, and the nervous system shifts from recognizing stimulus.

Um presented as threatening to accepting it as a normal

sensation once again, so affected, um, specific areas of occupation

effect that may be affected with Judas e r.

P s.

I basically put everything on If you're in pain, whether

it's and your upper Lawrence Tremonti, you might have difficulty

getting yourself trust.

Um, you might have a difficult time doing ideals or

taking care of a pet or a child or cooking

or, um, even rest and sleep.

You know, I don't know about you guys, but if

I'm ever in pain, it's not so simple.

Thio, get the sleep.

Um, which will go into a little bit later about

the contraindications, because sleep deprivation can aggravate symptoms.

Um, Also work play leisure, social participation.

Um, like, as mentioned before, C r P s can

lead to psychological issues, which is understandable.

Um, and also difficult.

Very difficult for the patient as well.

Yeah, alright.

Client factors.

Um, I put down values, beliefs, spirituality, body functions.

Um, basically, because all these will most likely be affected.

Um, if not one or two or all, um definitely

does have may have, um, effect on someone's values.

Um, there beliefs even you know, like, Why is this

happening to me?

Or spirituality like Why is this happening to me?

Body functions Obviously, it's a given on emotionally, definitely temperament,

personality, their energy and drive touch functions.

Pain sensitive sensitivity.

Um, it's actually important for patients to understand and embrace

their role in the recovery process.

The therapist can coach, mentor and design treatment.

But if the patients are on able or unwilling to

follow through with regular participation and treatment exercises, um, activities

outside of designated therapy sessions the results, the results will

end up being minimal.

So empowering patients to understand their condition and take control

of treatment minimizes apprehension and also builds report.

Um, the more actively patients participate in treatment planning and

the more compliant they are with individualized home programs, the

greater the chance that will regain function and manage pain,

engaging in or working toward functional activities that are most

meaningful to the patient.

Um, can I help them overcome fear of movement and

distract them also from the pain associated with activity?

All right, precautions and contraindications associated with your PS.

Um, so certain behaviors, um, seemed to aggravate the symptoms

and turn making C R p s more difficult to

treat. Uh, individuals with c r.

A. P s are strongly advised to avoid a mobilization,

smoking, excessive alcohol, caffeine and state declaration, which is kind

of hard to say sleep preparation, especially when it may

be difficult to go to sleep because of the pain.

Right? So, um, because of the complex nature of C.

R. P s, there may be a bunch of different

healthcare professionals that would be involved in patient care.

And, um, it would include an occupational therapist who can

help the patient improve skills that they need for daily

activities. Physiotherapist to help improve movement of coordination Pain relief

specialist, a doctor or another health care professional training, pain

relief psychologists especially trained mental health professional who can help

manage and understand some of emotional impact association.

Complex regional Pain Syndrome Presented by: Frishta Ahmadi, COTA/L, MSOT

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