ABSTRACT
BACKGROUND: Complex regional pain syndrome (CRPS) type I is a symptom complex of severe, chronic limb pain, often associated with allodynia, vasomotor, and sudomotor changes. Optimal management of this condition is not well understood. The role of a traditional, comprehensive pain management program with long-term follow-up has not been evaluated. OBJECTIVE: To define the benefit of the interdisciplinary approach in patients with CRPS type I. DESIGN: Prospective, case series, outcomes evaluation. METHODS: Patients with a diagnosis of CRPS type I entering the University Pain Center's intensive, outpatient pain management program were enrolled in an objective assessment study through the duration of the program, with a follow-up of 2 years. This program involved 4 weeks of interdisciplinary management comprised of 20 sessions of physical therapy, 20 sessions of occupational therapy, 12 sessions of water therapy, 20 sessions of group psychotherapy, stellate ganglion blocks, and drug therapy. OUTCOME MEASURES: Specific objective measurements of upper extremity function, sensation and strength over time, and functional status 2 years after program completion. RESULTS: Upper extremity weight tolerance increased dramatically by 29-pounds (p<0.05). Function improved, with a 35 inch-pound gain in BTE (Baltimore Therapeutic Equipment) extension (p<0.005) and a 50 inch-pound increase in flexion (p<0.02). Jebsen-Taylor multifunctional testing (fine and gross motor skills) normalized from 72 to 48 seconds (p<0.04). Stable anxiety levels despite increased patient effort implied improved pain tolerance. At the 2-year follow up, 75% of the patients were employed. CONCLUSION: Patients with CRPS type I may benefit from a 4-week outpatient pain management program emphasizing rehabilitation.
Subject(s)
Machado-Joseph Disease/complications , Machado-Joseph Disease/diagnosis , REM Sleep Behavior Disorder/complications , REM Sleep Behavior Disorder/diagnosis , Clonazepam/therapeutic use , Electromyography , GABA Modulators/therapeutic use , Humans , Machado-Joseph Disease/genetics , Male , Middle Aged , Motor Activity , Neurologic Examination , PolysomnographyABSTRACT
Extra-cranial arterial dissection accounts for 10 percent of strokes in young people. Information on safety of thrombolytic administration in this group is limited. The literature, however, does not favor use of thrombolytics for myocardial ischemia when peripheral arterial dissection coexists. Based on the clinical and radiological features, two patients who presented with acute stroke secondary to arterial dissection were considered for thrombolysis. One of them received intra-venous recombinant tissue plasminogen activator (rtPA), and the other patient received intra-arterial rtPA. There were no post thrombolysis complications. This report supports feasibility of administering thrombolytics in acute ischemic strokes resulting from extra-cranial arterial dissection. Future larger studies are necessary to determine the efficacy, safety and long-term outcome in this patient population
