Following are definitions for terms commonly used in the
diagnosis and treatment of CRPS.
Allodynia - Pain produced by normally non-painful
stimulation such as touch, gentle pressure, cold or gentle joint movement.
Analgesia - Pain relief.
Atrophy - Wasting of tissue due to cell degeneration.
In CRPS, this may involve skin, subcutaneous tissue, muscle or bone.
Biochemical - Refers to those chemical processes
involving human biological function.
Bone scan - A test used to check altered blood flow
to bone. A common problem in CRPS. This test becomes positive in 60 percent of
CRPS patients.
Carpel Tunnel Syndrome - A constellation of pain,
numbness or weakness in the hand due to compression of the median nerve in the
wrist. This may be associated with CRPS.
Causalgia - Severe burning pain in association with
injury to a nerve.
Cerebral - Pertaining to the major portions of the
brain.
Cervical - Pertaining to the bones of the neck
(C1-C7), the spinal cord and the nerve roots (C1-C8).
Dystrophy - Progressive changes in tissue often due
to loss of nutrition (blood flow).
Drug addiction - A behavior disorder characterized by
drug-seeking behavior and the use of drugs for other than medical
indications.
Drug dependency - The situation where a patient may
come to feel the absolute need for a drug (psychological dependency) or will
experience withdrawal symptoms if the drug is taken away (physical dependency).
Edema (swelling) - A visible accumulation of fluid in tissue.
Electro-Muscular Stimulation (EMS) - A
technique used to relax muscles or to cause them to contract through the
application of electrical current.
Etiology - The cause of a specific illness.
Health care provider - Refers to anyone delivering
medical services, including physicians, nurses, chiropractors and physical
therapists.
Infrared thermography - A means of measuring heat
emission from various parts of the body. Heat emission becomes abnormal at some
time in 90% of CRPS patients.
Lesion - A discrete (localized) area of pathology
(disease).
Lumbar - Pertaining to the bones of the lower back
(L1-L5), nerve roots (L1-L5 and S1) and soft tissues (e.g., muscles, tendons,
ligaments, joints) in this area. Note the spinal cord is not included here
because it ends at the L1 or vertebral body.
Multidisciplinary - Refers to the delivery of medical
services by a team of different medical specialists (e.g., physician, nurse,
psychologist, physical therapist).
Nerve blocks - A technique to create anesthesia, or
pain relief, in a nerve or nerve root by temporarily interfering with its
function. There are other techniques that also create reversible changes to
nerves (e.g., radio frequency stimulation), resulting in longer periods of pain
relief than is possible with local anesthetics. Irreversible blocks done with
surgery or chemicals, called nerve ablation, is listed as a neurectomy or rhizotomy. When any part of the sympathetic nervous system is blocked, the
technique is called a sympathetic block (temporary) or sympathectomy
(permanent.)
Osteoporosis - Thinning (demineralization) of bone.
Pathology - Organ disease identified by structural
change in tissue.
Placebo effect - The situation where a patient gets a
good response to a treatment intervention that is unexpected and not easily
explained. The placebo effect is inherent in all medical treatment and may
simply reflect the body's ability to respond favorable if both the patient and
the doctor believe a treatment or procedure is going to work. While the
response mechanism is unknown, it is not imaginary.
Selective Tissue Conductance (STC) - A very
specialized test of sympathetic activity in the body. This is generally
unavailable.
Syndrome - A combination of recognizable signs and
symptoms that form a distinct clinical picture, as opposed to a recognizable
disease (e.g., CRPS is a syndrome, while diabetes is a disease).
Thoracic - Pertaining to the bones of the thoracic
(T1-T12), spinal cord, and nerve roots (T1-T12), along with the organs of the
chest cavity (e.g., lungs).
Transcutaneous Electrical Stimulation (TENS) - A
technique used to deliver electrical current to the body. This is generally
done using battery operated generators connected to pads applied to the skin.
Vertebral - The major bones of the spine.
Drug types used in CRPS treatment
Analgesics - Any drug that reduces pain.
Anti-arrhythmics - Drugs with similarities to local
anesthetics. These are rarely used and have significant side effects.
Anti-depressants - A class of drugs that may reduce
neuropathic or central pain as well as help depression and sleep disturbance.
Anti-epileptic drugs - All share the ability to
induce electrical activity in nerve cells. These are often the drugs of choice
for neuropathic or central pain (e.g., Neurontin, Topamax, Lyrica).
Local anesthetics - Used for nerve blocks and/or
reduction in regional pain. These can
be taken orally, intravenously or transdermally (skin patches).
Muscle relaxants - Drugs that reduce pain from muscle
spasms. They may cause drowsiness.
Narcotics - A class of drugs that act like morphine
in reducing pain.
Non-Steroidal Anti-inflammatory Drugs (NSAIDs) - A
class of drugs that inhibit inflammation (e.g., aspirin, ibuprofen, Celebrex) but are not
steroids (such as prednisone).
Sedatives, tranquilizers and anti-anxiety drugs - A
large class of drugs sometimes used for the treatment of emotional problems
associated with pain.
Selective Seratonin Re-uptake Inhibitors (SSRIs) -
Used both as antidepressants and as analgesics (e.g., Prozac).
Nervous System Divisions
Autonomic nervous system - Those nerves and nerve
chains in the body that supply blood vessels, sweat glands and visceral organs
such as the heart. The autonomic nervous system has two divisions: sympathetic
and para-sympathetic. The former may become abnormally involved in CRPS (thus
the old term reflex sympathetic dystrophy).
Central nervous system - The brain and spinal cord.
Peripheral nervous system - All nerve roots and
nerves (motor and sensory) that supply the muscles of the body and transmit
information about sensation (including pain) to the central nervous system.
Pain Types
Central pain - Pain associated with injuries or
changes in functions in the spinal cord and/or brain.
Chronic pain - Constant pain that either persists
beyond an obvious injury and/or is associated with an ongoing painful condition (e.g., cancer,
arthritis).
Intractable pain - Pain that is resistant to
treatment.
Neuropathic pain - Pain that is associated with
demonstratable nerve and/or central nervous system changes.
Nociceptive pain - A normal and expected pain
response to injury.