Musculoskeletal Ultrasonography to Distinguish Muscle Changes in Complex Regional Pain Syndrome Type 1 from Those of Neuropathic Pain: An Observational Study

Vas, Lakshmi; Pai, Renuka

doi:10.1111/papr.12338

Cited by 17 publications

(17 citation statements)

References 48 publications

(70 reference statements)

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“…45 In a small observational study in 2016, musculoskeletal ultrasonography (MSK US) was used to characterise physical differences in muscle tissue in CRPS patients. 46 This study concluded that muscles affected by CRPS have significant myoglobular distortion, while muscles affected by chronic neuropathic pain were structurally normal. 46 However, a much larger study would be needed to validate using MSK US as a useful diagnostic modality.…”

Section: Other Diagnostic Toolsmentioning

confidence: 85%

Complex regional pain syndrome: a narrative review for the practising clinician

Shim

Rose

Halle

et al. 2019

British Journal of Anaesthesia

155

152

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Complex regional pain syndrome (CRPS) is a life-altering condition that usually affects the extremities after a trauma or nerve injury. The physiologic changes that occur as a result of the inciting injury are complex, as the name of the syndrome implies. The pain and disability associated with CRPS often lead to psychological co-morbidities that create a vicious cycle of pain, isolation, and depression. We review recent developments in the understanding of CRPS and advancements in management of this syndrome. Further research in targeting specific mechanisms involved in the pathophysiology of CRPS should lead to prevention of this condition.

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Section: Other Diagnostic Toolsmentioning

confidence: 85%

Complex regional pain syndrome: a narrative review for the practising clinician

Shim

Rose

Halle

et al. 2019

British Journal of Anaesthesia

155

152

View full text Add to dashboard Cite

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“…The common clinical features shared by neuropathic pain and CRPS hinder a pure clinical diagnosis [6]. Distinguishing between both of them is essential as the latter causes greater disabilities [99]. To differentiate them, an ultrasound examination can be performed, as the muscular architecture is preserved in neuropathic pain but not in CRPS [99].…”

Section: Medical Treatmentmentioning

confidence: 99%

Treatment of Neuropathic Pain in Brachial Plexus Injuries

Saiz-Sapena¹,

Vanaclocha‐Vanaclocha²,

Ortiz-Criado³

et al. 2019

Treatment of Brachial Plexus Injuries

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Brachial plexus injuries are commonly followed by chronic pain, mostly with neuropathic characteristics. This is due to peripheral nerve lesions, particularly nerve root avulsions, as well as upper limb amputations, and complex regional pain syndrome (CRPS). The differential diagnosis between CRPS and neuropathic pain is essential as the treatment is different for each of them. Medical treatments are the first step, but for refractory cases there are two main types of surgical alternatives: ablative techniques and neuromodulation. The first group involves destruction of the posterior horn deafferented neurons and usually provides a better pain control but has a 10% complication rate. The second group provides pain control with function preservation but with limited effectiveness. Each case has to be thoroughly evaluated to apply the treatment modality best suited for it. due to iatrogenia [8][9][10][11][12][13][14][15][16], particularly during lymph node biopsy [17, 18] or treatment of some malignancies [19]. The pain is chronic [20], persistent [7], constant [21], burning [22] and throbbing [17], with paroxysmal discharges [3, 6, 23], particularly upon gentle rubbing the affected area [4].The pain is distributed in the distal areas of the upper limb, covering several dermatomes, mostly the caudal ones [24] and particularly the hand [5, 17, 23, 25]. The paroxysmal pain is felt in the arm [26]. Allodynia, hypersensitivity and electric-like discharges are present at the border between the normal and affected dermatomes [17,[26][27][28][29], particularly between T 1 and T 2 at the posterior aspect of the elbow [26].The pain severity correlates with the magnitude of the brachial plexus injury [2,3] and to the number of avulsed nerve roots [2-4, 21, 26, 30-33], particularly when the lower roots are affected [24,34,35]. Nevertheless, Bertelli et al. [21] found that in isolated C 8 and T 1 nerve root avulsions, there was no pain at all.The pain does not appear immediately after the injury but a few days later [24] and no longer than 3 months after it [5, 6, 24, 26,35,36].The neuropathic pain can be associated with phantom [37] or stump pain [38] in case of upper limb amputation, or to complex regional pain syndrome (CRPS) [6], inducing a complex pain condition rather difficult to control [19,30,31].Self-mutilation has been described in 5-29% of obstetric brachial plexus injury cases [39,40].The quality of life is seriously impaired with sleep disorders, family troubles, unemployment, chronic depression and social withdrawal [2, 5, 6, 17, 21,[41][42][43][44]. Additionally, the chronic pain is a further hindrance to comply with a good rehabilitation programme, impairing a possible functional recovery [6,45,46]. Among all the disabilities induced by the brachial plexus injury, the pain has been found to be the symptom that most negatively affects the quality of life [47].Treatment of this chronic pain can be troublesome, as the response to the different treatment modalities is poor and not all of them allow preservatio...

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“…[ 35 ] We believe that it plays a major role in the causation of complex regional pain syndrome as well. [ 36 37 38 39 ] We have also proposed neuromyopathy in the pain of interstitial cystitis[ 40 ] and in “writer's cramp.”[ 41 ]…”

Section: Discussionmentioning

confidence: 99%

A new perspective of neuromyopathy to explain intractable pancreatic cancer pains; Dry needling as an effective adjunct to neurolytic blocks

Vas¹,

Phanse²,

Pai³

2016

Indian J Palliat Care

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We present a new perspective of neuromyopathy in pancreatic cancer pain (PCP) referral to bodywall; proposal of new rationale to include ultrasound guided dry needling (USGDN) of body wall muscles as an effective adjunct to neurolytic coeliac plexus block (NCPB) or splanchnic nerve radiofrequency ablation (SRF) for comprehensive interventional management. Methods: PCP response to SRF in 2 patients and NCPB in 3 patients was documented on numerical rating scale (NRS) on post procedure days 3 and 15. If the residual pain was >5 NRS on day 15, USGDN of abdominal and back muscles was started on a thrice weekly basis. The response to USGDN documented on day 30 after approximately 6 sessions of DN, showed a significant pain reduction (0-2 NRS) with 50% reduction of pre-treatment opioid consumption. This was sustained at 6 months or till their demise. Convergence of visceral and somatic nerves at the dorsal horn (viscerosomatic neurons) causes referral of visceral pain to the back and abdominal muscles. This leads to formation of myofascial trigger points (MTrPs) in the muscles which sets up a parallel network of sensitized peripheral and central motor nociceptive processing (neuromyopathy). USGDN specifically addressed the MTrPs that develop as an epiphenomenon of self-perpetuating neuromyopathy while SRF/NCPB, analgesics and neuromodulators could address only visceral nociceptive afferents (pain mediated through celiac plexus) which forms a meagre 10% of the total spinal cord afferent input. Thus, we conclude that combination of neuromyopathy and viscerosomatic convergence in PCP indicate a specific role for DN as an adjunct to SRF/NCPB in our patients

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Musculoskeletal Ultrasonography to Distinguish Muscle Changes in Complex Regional Pain Syndrome Type 1 from Those of Neuropathic Pain: An Observational Study

Cited by 17 publications

References 48 publications

Complex regional pain syndrome: a narrative review for the practising clinician

Complex regional pain syndrome: a narrative review for the practising clinician

Treatment of Neuropathic Pain in Brachial Plexus Injuries

A new perspective of neuromyopathy to explain intractable pancreatic cancer pains; Dry needling as an effective adjunct to neurolytic blocks

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