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Assessment of Complex Regional Pain Syndrome Dr. Candy McCabe  Consultant Nurse arc Senior Lecturer in Rheumatology Nursing Royal National Hospital for Rheumatic Diseases  & School for Health, University of Bath, Bath The North British Pain Association 2008
Rene Descartes 1596-1650 “ I think therefore I am” Jean-Jacques Rousseau, 1712-1778 “ I FEEL  therefore I am”
Silas Weir Mitchell 1829-1914 Turner’s Lane Hospital, Philadelphia
IASP Current diagnostic criteria ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Stanton-Hicks M, Janig W, et al. Pain, 1995; 63: 127-133 .
IASP SIG proposed revised  diagnostic criteria   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Galer et al., 1998. Pain; 14:48-54 Bruehl et al., 1999. Pain; 81:147-54
Presentation of CRPS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object]
Case study-limb perception ,[object Object],[object Object],[object Object],[object Object]
McCabe et al. Rheumatology 2003 Referred Sensations in CRPS
Halligan PW et al. BMJ 1999 Referred Sensations in Amputees
[object Object],[object Object],[object Object],[object Object],Cortical reorganisation in CRPS
Wilder Penfield
Motor assessment ,[object Object],[object Object],[object Object],[object Object],[object Object]
Motor abnormalities in CRPS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Summary  CRPS Altered Perceptions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Galer &  Jensen. J Pain Symptom Manage 1999. Forderreüther et al. Pain 2004.  McCabe et al. Pain 2005;  Lewis et al. Pain 2007, McCabe & Blake. Rheumatology in press
Summary ,[object Object],[object Object],[object Object],[object Object]
Sensory events are analysed in terms of appropriate motor response. Von Holst & Mittelstaedt; 1950.  Wolpert et al.; 1995, Frith et al.; 2000 Baseline information
Motor simulation network and motor planning Von Holst & Mittelstaedt; 1950.  Wolpert et al.; 1995, Frith et al.; 2000 Baseline information MSN
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],When sensory input and motor output conflict? McCabe et al Rheumatology 2005 Sensorimotor conflict
CRPS and sensory-motor conflict   Baseline information MSN Corrupted Imagined or actual movements will cause a range of sensory/motor disturbances
Access to the basic building blocks Snyder AW, Mitchell DJ. Proc.R.Soc. Lond. 1999;2666:587-592.
Link to current clinical signs? Foreshortened limbs/ Altered body perception? Autotomy/ desire for amputation?
Link to current clinical signs? Increased peri-personal space Farné A, Làdavas E. Neuropreport 2000; 85:1645-1649.
Correcting motor sensory mismatch – 3 potential target areas Von Holst & Mittelstaedt; 1950.  Wolpert et al.; 1995, Frith et al.; 2000 Baseline information MSN
Sensorimotor integration ,[object Object],[object Object],[object Object]
Multidisciplinary inpatient and outpatient service at the RNHRD ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Acknowledgements ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Email: c.mccabe@bath.ac.uk ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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Assessment of Complex Regional Pain Syndrome

  • 1. Assessment of Complex Regional Pain Syndrome Dr. Candy McCabe Consultant Nurse arc Senior Lecturer in Rheumatology Nursing Royal National Hospital for Rheumatic Diseases & School for Health, University of Bath, Bath The North British Pain Association 2008
  • 2. Rene Descartes 1596-1650 “ I think therefore I am” Jean-Jacques Rousseau, 1712-1778 “ I FEEL therefore I am”
  • 3. Silas Weir Mitchell 1829-1914 Turner’s Lane Hospital, Philadelphia
  • 4.
  • 5.
  • 6.
  • 7.
  • 8.
  • 9. McCabe et al. Rheumatology 2003 Referred Sensations in CRPS
  • 10. Halligan PW et al. BMJ 1999 Referred Sensations in Amputees
  • 11.
  • 13.
  • 14.
  • 15.
  • 16.
  • 17. Sensory events are analysed in terms of appropriate motor response. Von Holst & Mittelstaedt; 1950. Wolpert et al.; 1995, Frith et al.; 2000 Baseline information
  • 18. Motor simulation network and motor planning Von Holst & Mittelstaedt; 1950. Wolpert et al.; 1995, Frith et al.; 2000 Baseline information MSN
  • 19.
  • 20. CRPS and sensory-motor conflict Baseline information MSN Corrupted Imagined or actual movements will cause a range of sensory/motor disturbances
  • 21. Access to the basic building blocks Snyder AW, Mitchell DJ. Proc.R.Soc. Lond. 1999;2666:587-592.
  • 22. Link to current clinical signs? Foreshortened limbs/ Altered body perception? Autotomy/ desire for amputation?
  • 23. Link to current clinical signs? Increased peri-personal space Farné A, Làdavas E. Neuropreport 2000; 85:1645-1649.
  • 24. Correcting motor sensory mismatch – 3 potential target areas Von Holst & Mittelstaedt; 1950. Wolpert et al.; 1995, Frith et al.; 2000 Baseline information MSN
  • 25.
  • 26.
  • 27.

Notas del editor

  1. Thank you to David and the other organisers of today