Abnormal movements in complex regional pain syndrome: Assessment of their nature

Abstract

Abnormal movements may be a clinical feature in complex regional pain syndrome (CRPS), but their basic nature is unclear. Between August 1989 and September 1998, patients fulfilling diagnostic criteria for CRPS (I or II) and displaying abnormal movements were entered into a prospective study. Fifty‐eight patients, 39 women and 19 men, met entry criteria; 47 had sustained a minor physical injury at work. The patients exhibited various combinations of dystonic spasms, coarse postural or action tremor, irregular jerks, and, in one case, choreiform movements. Patients underwent rigorous clinical and laboratory evaluation aimed at characterizing their neurological disturbance. Surprisingly, no case of CRPS II but only cases of CRPS type I displayed abnormal movements. In addition to an absence of evidence of structural nerve, spinal cord, or intracranial damage, all CRPS I patients with abnormal movements typically exhibited pseudoneurological (nonorganic) signs. In some cases, malingering was documented by secret surveillance. This study highlights abnormal movements in CRPS as constituting a key clinical feature that differentiates CRPS I from CRPS II. They are consistently of somatoform or malingered origin, signaling an underlying psychoneurological disorder responsible for the entire CRPS profile. © 2000 John Wiley & Sons, Inc. Muscle Nerve 23: 198–205, 2000.

Reflex sympathetic dystrophy: A multidisciplinary approach

“…About half of our cohort recalled an episode of trauma to the affected limb prior to the onset of the RSD, and this has also been reported in other studies (7, 10, 48, 56, 57). This trauma had often been investigated at length before a diagnosis was made and was felt to have contributed to a delay in diagnosis, because nonspecific or spurious laboratory results or diagnostic imaging findings led to further delay in management.…”

Intrinsic brain networks normalize with treatment in pediatric complex regional pain syndrome

“…It is frequently accompanied by blood flow and sweating changes, edema, and trophic changes of the skin and subcutaneous tissue in the affected region (Bruehl et al, 1999). Clinical data support the notion of altered changes in CNS processing in CRPS including pain progression (Maleki et al, 2000), movement disorders (Verdugo and Ochoa, 2000) and altered higher-level functions like poor visuo-spatial perception (Sumitani et al, 2007), neglect-like symptoms (inattention, avoid using affected limb) (Galer et al, 1995; Galer and Jensen, 1999; Frettloh et al, 2006; Maihöfner and Birklein, 2007; Punt et al, 2013), altered perception (Peltz et al, 2011), emotional distress (Nagler, 2010) and cognitive dysfunction (Maihöfner and DeCol, 2007). Functional imaging studies in pediatric CRPS patients (Lebel et al, 2008; Linnman et al, 2013) have indicated abnormal brain activity to mechanical (brush) and thermal allodynia (cold) with larger activity than the normal side in sensorimotor, cingulate, and insula cortices, and decreased activity in prefrontal cortex hippocampal and parahippocampal areas.…”

Needlestick Distal Nerve Injury in Rats Models Symptoms of Complex Regional Pain Syndrome

“…Some are secondary (disuse weakness, atrophy, contractures) and not specific to CRPS. We investigated a primary motor symptom of CRPS, tonic limb dystonia (35), which reportedly affects 1/4 to 1/3 of patients (34,36,37). CRPS/dystonia is different from the childhood-onset dystonias or acquired, adult dystonias that usually affect proximal muscles and are caused by basal ganglia dysfunction.…”