Muscle Hyperalgesia Correlates With Motor Function in Complex Regional Pain Syndrome Type 1

At present it is unclear if disturbed sensory processing plays a role in the development of the commonly observed motor impairments in patients with complex regional pain syndrome (CRPS). This study aims to investigate the relation between sensory and motor functioning in CRPS patients with and without dystonia. Patients with CRPS of the arm and controls underwent comprehensive quantitative sensory testing and kinematic analysis of repetitive finger movements. Both CRPS groups showed thermal hypoesthesia to cold and warm stimuli and hyperalgesia to cold stimuli. A decreased pressure pain threshold reflecting muscle hyperalgesia emerged as the most prominent sensory abnormality in both patient groups and was most pronounced in CRPS patients with dystonia. Moreover, the decreased pressure pain threshold was the only nociceptive parameter that related to measures of motor function in both patients and controls. CRPS patients with dystonia had an increased 2-point discrimination as compared to controls and CRPS patients without dystonia. This finding was also reported in other types of dystonia and has been associated to cortical reorganization in response to impaired motor function. We hypothesize that increased sensitivity of the circuitry mediating muscle nociception may play a crucial role in impaired motor control in CRPS

Muscle Hyperalgesia Correlates With Motor Function in Complex Regional Pain Syndrome Type 1

At present it is unclear if disturbed sensory processing plays a role in the development of the commonly observed motor impairments in patients with complex regional pain syndrome (CRPS). This study aims to investigate the relation between sensory and motor functioning in CRPS patients with and without dystonia. Patients with CRPS of the arm and controls underwent comprehensive quantitative sensory testing and kinematic analysis of repetitive finger movements. Both CRPS groups showed thermal hypoesthesia to cold and warm stimuli and hyperalgesia to cold stimuli. A decreased pressure pain threshold reflecting muscle hyperalgesia emerged as the most prominent sensory abnormality in both patient groups and was most pronounced in CRPS patients with dystonia. Moreover, the decreased pressure pain threshold was the only nociceptive parameter that related to measures of motor function in both patients and controls. CRPS patients with dystonia had an increased 2-point discrimination as compared to controls and CRPS patients without dystonia. This finding was also reported in other types of dystonia and has been associated to cortical reorganization in response to impaired motor function. We hypothesize that increased sensitivity of the circuitry mediating muscle nociception may play a crucial role in impaired motor control in CRPS

Reliability and validity of the range of motion scale (roms) in patients with abnormal postures

© 2015 American Academy of Pain Medicine. Objective: Sustained abnormal postures (i.e., fixed dystonia) are the most frequently reported motor abnormalities in complex regional pain syndrome (CRPS), but these symptoms may also develop after peripheral trauma without CRPS. Currently, there is no valid and reliable measurement instrument available to measure the severity and distribution of these postures. The range of motion scale (ROMS) was therefore developed to assess the severity based on the possible active range of motion of all joints (arms, legs, trunk, and neck), and the present study evaluates its reliability and validity. Methods: Inter- and intra-rater reliability of the ROMS was determined in 16 patients with abnormal sustained postures, who were videotaped following a standard video protocol in a university hospital. The recordings were rated by a panel of international experts. In addition, 30 patients were clinically tested with both the Burke-Fahn-Marsden (BFM) scale as well as the ROMS to assess construct validity. Results: Inter-rater reliability for total ROMS scores showed an intra-class correlation coefficient (ICC) of 0.85. The majority of the scores for the separate joints (13 out of 18) demonstrated an almost perfect agreement with ICCs ranging from 0.81 to 0.94; of the other items, one showed fair, one moderate, and three substantial agreement. The ICCs for the intra-rater reliability ranged from moderate to almost perfect (0.68-0.98). Spearman's correlation coefficients between corresponding body areas as measured with the ROMS or BFM were all above 0.82. Conclusion: The ROMS is a reliable and valid instrument to evaluate the severity and distribution of sustained abnormal postures

Reliability and Validity of the Range of Motion Scale (ROMS) in Patients with Abnormal Postures

ObjectiveSustained abnormal postures (i.e., fixed dystonia) are the most frequently reported motor abnormalities in complex regional pain syndrome (CRPS), but these symptoms may also develop after peripheral trauma without CRPS. Currently, there is no valid and reliable measurement instrument available to measure the severity and distribution of these postures. The range of motion scale (ROMS) was therefore developed to assess the severity based on the possible active range of motion of all joints (arms, legs, trunk, and neck), and the present study evaluates its reliability and validity. MethodsInter- and intra-rater reliability of the ROMS was determined in 16 patients with abnormal sustained postures, who were videotaped following a standard video protocol in a university hospital. The recordings were rated by a panel of international experts. In addition, 30 patients were clinically tested with both the Burke-Fahn-Marsden (BFM) scale as well as the ROMS to assess construct validity. ResultsInter-rater reliability for total ROMS scores showed an intra-class correlation coefficient (ICC) of 0.85. The majority of the scores for the separate joints (13 out of 18) demonstrated an almost perfect agreement with ICCs ranging from 0.81 to 0.94; of the other items, one showed fair, one moderate, and three substantial agreement. The ICCs for the intra-rater reliability ranged from moderate to almost perfect (0.68-0.98). Spearman's correlation coefficients between corresponding body areas as measured with the ROMS or BFM were all above 0.82. ConclusionThe ROMS is a reliable and valid instrument to evaluate the severity and distribution of sustained abnormal postures

Reliability and Validity of the Range of Motion Scale (ROMS) in Patients with Abnormal Postures

ObjectiveSustained abnormal postures (i.e., fixed dystonia) are the most frequently reported motor abnormalities in complex regional pain syndrome (CRPS), but these symptoms may also develop after peripheral trauma without CRPS. Currently, there is no valid and reliable measurement instrument available to measure the severity and distribution of these postures. The range of motion scale (ROMS) was therefore developed to assess the severity based on the possible active range of motion of all joints (arms, legs, trunk, and neck), and the present study evaluates its reliability and validity. MethodsInter- and intra-rater reliability of the ROMS was determined in 16 patients with abnormal sustained postures, who were videotaped following a standard video protocol in a university hospital. The recordings were rated by a panel of international experts. In addition, 30 patients were clinically tested with both the Burke-Fahn-Marsden (BFM) scale as well as the ROMS to assess construct validity. ResultsInter-rater reliability for total ROMS scores showed an intra-class correlation coefficient (ICC) of 0.85. The majority of the scores for the separate joints (13 out of 18) demonstrated an almost perfect agreement with ICCs ranging from 0.81 to 0.94; of the other items, one showed fair, one moderate, and three substantial agreement. The ICCs for the intra-rater reliability ranged from moderate to almost perfect (0.68-0.98). Spearman's correlation coefficients between corresponding body areas as measured with the ROMS or BFM were all above 0.82. ConclusionThe ROMS is a reliable and valid instrument to evaluate the severity and distribution of sustained abnormal postures

Severe postpartum hemorrhage increases risk of posttraumatic stress disorder: a prospective cohort study

Purpose: To evaluate whether severe postpartum hemorrhage (PPH) is a risk factor for posttraumatic stress disorder (PTSD). Severe PPH can be experienced as a traumatic event. PTSD leads to negative mental health effects. Knowing risk factors for PTSD during childbirth offers opportunities for early interventions, which may prevent the development of PTSD. Materials and methods: In this prospective study, we compared two groups of participants; women with ≥2000 mL of blood loss (severe PPH, patients) and women with ≤500 mL of blood loss (controls). Participants were screened for PTSD using the PCL-5 four to six weeks after delivery. Positive screening was followed by the CAPS-5 to diagnose PTSD. Results: We included 187 PPH patients and 121 controls. Median PCL-5 scores were higher for PPH patients (5.0) than controls (4.0, p = 0.005). Thirteen PPH patients (7.0%) and two controls (1.7%) scored ≥32 on the PCL-5, indicative of probable PTSD (OR 4.45, 95% CI 0.99-20.06, p = 0.035). Significant more PPH patients than controls met criteria for a clinical diagnosis of PTSD on the CAPS-5 (n = 10, 5.6% vs n = 0, 0.0%; p = 0.007). Conclusions: There is a significant and clinically relevant increased risk for developing PTSD after severe PPH. Gynecologists and midwives are advised to screen for PTSD at postpartum follow-up visits to prevent long-term negative mental health effects. Clinical Trial Registration: NL50273.100.14