Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- dor crônica
- dor do membro com radiação
- alodinia e hiperalgesia
- alterações no esquema corporal
- edema
- alterações tróficas na pele e na unha
- eritema ou aparência azulada
- alterações locais ou assimetria na sudorese
- fraqueza muscular
Other diagnostic factors
- tremores
- postura distônica
- contraturas
- perda sensorial em distribuição em luva ou meia
- alterações locais no crescimento capilar
- bolhas na pele
Risk factors
- trauma
- imobilização
- sexo feminino
Diagnostic investigations
1st investigations to order
- nenhum exame é necessário: o diagnóstico é clínico.
Investigations to consider
- eletromiografia
- estudos da condução nervosa com eletrodos de superfície
- biópsia por punção cutânea
- radiografia do membro afetado
- cintilografia óssea com tecnécio-99m
- absorciometria por dupla emissão de raios X (DEXA)
- TC quantitativa
- RNM
- estudos vasculares
- bloqueios do nervo simpático
- bloqueios anestésicos seletivos ou regionais intravenosos
Emerging tests
- teste autonômico
Treatment algorithm
síndrome da dor regional complexa (CRPS) precoce (dentro de 6 meses a partir do início)
síndrome da dor regional complexa (CRPS) crônica (>6 meses desde o início)
Contributors
Authors
Anuj Aggarwal, MD
Clinical Assistant Professor
Anesthesiology, perioperative and pain medicine
Stanford University
Redwood City
CA
Disclosures
AA declares that he has no competing interests.
Acknowledgements
Dr Anuj Aggarwal would like to gratefully acknowledge Dr Nicholas Shenker, Dr Gaurav Chhabra, and Dr Steven H. Horowitz, previous contributors to this topic.
Disclosures
NS is medical adviser to Cambridge Nutraceuticals with stock options. He has received consultancy fees from Roche to provide unrestricted sponsored educational meetings, and grants from Versus Arthritis, the National Institute for Health Research Clinical Research Network, and the Medical Research Council. NS is an author of references cited in this topic. GC has been sponsored by Medtronic, Boston Scientific, Abbott, Nevro, Stimwave, and Polar Medical for attending various conferences and cadaveric workshops relevant to pain medicine and neuromodulation. GC is an associate examiner for the European Society of Regional Anaesthesia & Pain Therapy European Diploma of Pain Medicine exam and is also the regional advisor for pain medicine for the South West Severn deanery. SHH declares that he has no competing interests.
Peer reviewers
Andre Tomasino, MD
Department of Neurological Surgery
Weill Cornell Medical College
New York-Presbyterian Hospital
New York
NY
Disclosures
AT declares that he has no competing interests.
Ari Weinreb, MD, PhD
Associate Chief of Rheumatology
VA Greater Los Angeles Healthcare System
Associate Professor of Medicine
David Geffen School of Medicine
UCLA
Los Angeles
CA
Disclosures
AW declares that he has no competing interests.
Jonathan Berman, MBBS
Consultant in Pain Management and Anaesthesia
Pain Management Department
Royal National Orthopaedic Hospital NHS Trust
Middlesex
UK
Disclosures
JB has been reimbursed by Pfizer for lectures given at Pfizer-sponsored meetings and courses.
Differentials
- Infecção
- Comprometimento arterial
- Patologia óssea
More DifferentialsGuidelines
- Complex regional pain syndrome: practical diagnostic and treatment guidelines, 5th edition
- Neuropathic pain in adults: pharmacological management in non-specialist settings
More Guidelines
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