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Complex regional pain syndrome

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745:(EMG) and nerve conduction studies (NCS) are important ancillary tests in CRPS because they are among the most reliable methods of detecting nerve injury. They can be used as one of the primary methods to distinguish between CRPS types I and II, which differ based on evidence of actual nerve damage. EMG and NCS are also among the best tests for ruling in or out alternative diagnoses. CRPS is a "diagnosis of exclusion", which requires that no other diagnosis can explain the patient's symptoms. This is very important to emphasise because patients otherwise can be given a wrong diagnosis of CRPS when they actually have a treatable condition that better accounts for their symptoms. An example is severe carpal tunnel syndrome (CTS), which can often present in a very similar way to CRPS. Unlike CRPS, CTS can often be corrected with surgery to alleviate the pain and avoid permanent nerve damage and malformation. 695:), skin lotions, physical therapy, and other diagnostic procedures in the days prior to testing. Patients may also be required to discontinue certain pain medications and sympathetic blockers. After a patient arrives at a thermographic laboratory, he or she is allowed to reach thermal equilibrium in a 16–20 °C, draft-free, steady-state room wearing a loose fitting cotton hospital gown for approximately twenty minutes. A technician then takes infrared images of both the patient's affected and unaffected limbs, as well as reference images of other parts of the patient's body, including his or her face, upper back, and lower back. After capturing a set of baseline images, some labs further require the patient to undergo cold-water autonomic-functional-stress-testing to evaluate the function of their 680:'s efficacy as a reliable tool for diagnosing CRPS. Although CRPS may, in some cases, lead to measurably altered blood flow throughout an affected region, many other factors can also contribute to an altered thermographic reading, including the patient's smoking habits, use of certain skin lotions, recent physical activity, and prior history of trauma to the region. Also, not all patients diagnosed with CRPS demonstrate such "vasomotor instability"—particularly those in the later stages of the disease. Thus, thermography alone cannot be used as conclusive evidence for—or against—a diagnosis of CRPS and must be interpreted in light of the patient's larger medical history and prior diagnostic studies. 1017:
irreversible. The prognosis is worse with the chronic "cold" form of CRPS and with CRPS affecting the upper extremities. Disuse of the limb after an injury or psychological distress related to an injury are also associated with a poorer prognosis in CRPS. Some cases of CRPS may resolve spontaneously (with 74% of patients in a population-based study in Minnesota undergoing complete resolution of symptoms, often spontaneously), but others may develop chronic pain for many years. Once one is diagnosed with CRPS, should it go into remission, the likelihood of it resurfacing after going into remission is significant. Taking precautions and seeking immediate treatment upon any injury is important.
1069:(NINDS), a part of the National Institutes of Health, supports and conducts research on the brain and central nervous system, including research relevant to RSDS, through grants to major medical institutions across the country. NINDS-supported scientists are working to develop effective treatments for neurological conditions and ultimately, to find ways of preventing them. Investigators are studying new approaches to treat CRPS and intervene more aggressively after traumatic injury to lower the patient's chances of developing the disorder. In addition, NINDS-supported scientists are studying how signals of the sympathetic nervous system cause pain in CRPS patients. Using a technique called 473:) receptor has significant involvement in the CNS sensitization process. It is also hypothesized that elevated CNS glutamate levels promote wind-up and CNS sensitization. In addition, there exists experimental evidence demonstrating the presence of NMDA receptors in peripheral nerves. Because immunological functions can modulate CNS physiology, a variety of immune processes have also been hypothesized to contribute to the initial development and maintenance of peripheral and central sensitization. Furthermore, trauma-related cytokine release, exaggerated neurogenic inflammation, sympathetic afferent coupling, adrenoreceptor pathology, glial cell activation, cortical reorganisation, and 74: 1057:
use to describe this condition, based on the theory that sympathetic hyperactivity was involved in the pathophysiology. In 1959, Noordenbos observed in causalgia patients that "the damage of the nerve is always partial." Misuse of the terms, as well as doubts about the underlying pathophysiology, led to calls for better nomenclature. In 1993, a special consensus workshop held in Orlando, Florida, provided the umbrella term "complex regional pain syndrome", with causalgia and RSD as subtypes.
988:—interruption of the affected portion of the sympathetic nervous system—can be used as a last resort in patients with impending tissue loss, edema, recurrent infection, or ischemic necrosis. However, little evidence supports these permanent interventions to alter the pain symptoms of the affected patients, and in addition to the normal risks of surgery, such as bleeding and infection, sympathectomy has several specific risks, such as adverse changes in how nerves function. 699:'s peripheral vasoconstrictor reflex. This is performed by placing a patient's unaffected limb in a cold water bath (approximately 20 °C) for five minutes while collecting images. In a normal, intact, functioning autonomic nervous system, a patient's affected extremity will become colder. Conversely, warming of an affected extremity may indicate a disruption of the body's normal thermoregulatory vasoconstrictor function, which may sometimes indicate underlying CRPS. 327: 319: 446:(where the brain changes and adapts with constant pain signals); CRPS is the result of an "aberrant response to tissue injury". The "underlying neuronal matrix" of CRPS is seen to involve cognitive and motor as well as nociceptive processing; pinprick stimulation of a CRPS affected limb was painful (mechanical hyperalgesia) and showed a "significantly increased activation" of not just the 814:. In a retrospective cohort (unblinded, non-randomised and with intention-to-treat) of fifty patients diagnosed with CRPS, the subjective pain and body perception scores of patients decreased after engagement with a two-week multidisciplinary rehabilitation programme. The authors call for randomised controlled trials to probe the true value of multidisciplinary programs for CRPS patients. 997:
pain and/or pain at the amputation site. As in any other chronic pain syndrome, the brain likely becomes chronically stimulated with pain, and late amputation may not work as well as it might be expected. In a survey of 15 patients with CRPS type 1, 11 responded that their lives were better after amputation.
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from the Greek words for heat and for pain. Contrary to what is commonly accepted, it emerges that these causalgias were certainly major by the importance of the vasomotor and sudomotor symptoms but stemmed from minor neurological lesions. In the 1940s, the term reflex sympathetic dystrophy came into
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No specific test is available for CRPS, which is diagnosed primarily through observation of the symptoms. However, thermography, sweat testing, X-rays, electrodiagnostics, and sympathetic blocks can be used to build up a picture of the disorder. Diagnosis is complicated by the fact that some patients
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was strikingly present in patients and is statistically linked to RSD. This may be involved in its pathology by enhancing sympathetic activity, vasoconstriction, or by some other unknown neurotransmitter-related mechanism. This hypothesis was based on a retrospective analysis of 53 patients with RSD,
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Both EMG and NCS involve some measure of discomfort. EMG involves the use of a tiny needle inserted into specific muscles to test the associated muscle and nerve function. Both EMG and NCS involve very mild shocks that in normal patients are comparable to a rubber band snapping on the skin. Although
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Research into treating the condition with mirror visual feedback is being undertaken at the Royal National Hospital for Rheumatic Disease in Bath. Patients are taught how to desensitize in the most effective way, then progress to using mirrors to rewrite the faulty signals in the brain that appear
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No randomized study in medical literature has studied the response with amputation of patients who have failed the above-mentioned therapies and who continue to be in pain. Nonetheless, on average, about half of the patients will have resolution of their pain, while half will develop phantom limb
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therapy uses a mirror box, or a stand-alone mirror, to create a reflection of the normal limb such that the patient thinks they are looking at the affected limb. Movement of this reflected normal limb is then performed so that it looks to the patient as though they are performing movement with the
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Patients are frequently classified into two groups based upon temperature: "warm" or "hot" CRPS in one group and "cold" CRPS in the other group. The majority of patients (about 70%) have the "hot" type, which is said to be an acute form of CRPS. Cold CRPS is said to be indicative of a more chronic
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have a controversial place in treatment of CRPS. These drugs must be prescribed and monitored under close supervision of a physician as they can quickly lead to physical dependence and addiction. To date so far, no long-term studies of oral opioid use in treating neuropathic pain, including CRPS,
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Diagnosis is primarily based on clinical findings. The original diagnostic criteria for CRPS adopted by the International Association for the Study of Pain (IASP) in 1994 have now been superseded in both clinical practice and research by the "Budapest Criteria" which were created in 2003 and have
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of affected patients. By testing various hypotheses, these researchers hope to discover the unique mechanism that causes the spontaneous pain of CRPS, and that discovery may lead to new ways of blocking pain. Other studies to overcome chronic pain syndromes are discussed in the pamphlet "Chronic
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The signs and symptoms of CRPS usually manifest near the injury site. The most common symptoms are extreme pain, including burning, stabbing, grinding, and throbbing. The pain is out of proportion to the severity of the initial injury. Moving or touching the limb is disproportionately painful
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The prognosis in CRPS is improved with early and aggressive treatment; with the risk of chronic, debilitating pain being reduced with the early treatment. If treatment is delayed, however, the disorder can quickly spread to the entire limb, and changes in bone, nerve, and muscle may become
914:: cells involved in the resorption of bone. Bone remodeling (via osteoclast activity in resorption of bone) is thought to sometimes be hyperactive in CRPS. It is hypothesized that bone resorption causes acidification of the intercellular milieu which, in turn, activates nerves involved in 857:
is a therapy that uses low-voltage electrical signals to provide pain relief through electrodes that are placed on the surface of the skin. Evidence supports its use in treating pain and edema associated with CRPS, but it does not seem to increase functional ability in CRPS patients.
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Type I, formerly known as reflex sympathetic dystrophy (RSD), Sudeck's atrophy, or algoneurodystrophy, does not exhibit demonstrable nerve lesions. As the vast majority of patients diagnosed with CRPS have this type, it is most commonly referred to in medical literature as type
462:. In contrast to previous thoughts reflected in the name RSD, it appears that there is reduced sympathetic nervous system outflow, at least in the affected region (although there may be sympatho-afferent coupling). Wind-up (the increased sensation of pain with time) and 749:
these tests can be very useful in CRPS, thorough informed consent must be obtained prior to the procedure, particularly in patients experiencing severe allodynia. In spite of the utility of the test, these patients may wish to decline the procedure to avoid discomfort.
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appears to be an effective therapy in the management of patients with CRPS type I (level A evidence) and type II (level D evidence). Although they improve patient pain and quality of life, evidence is unclear regarding effects on mental health and general functioning.
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or partial paralysis, and/or changes to the skin and bones. It may initially affect one limb and then spread throughout the body; 35% of affected individuals report symptoms throughout the body. Two types are thought to exist: CRPS type 1 (previously referred to as
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Vaneker M, Wilder-Smith OH, Schrombges P, de Man-Hermsen I, Oerlemans HM (May 2005). "Patients initially diagnosed as "warm" or "cold" CRPS 1 show differences in central sensory processing some eight years after diagnosis: a quantitative sensory testing study".
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Complex regional pain syndrome is uncommon, and its cause is not clearly understood. CRPS typically develops after an injury, surgery, heart attack, or stroke. Investigators estimate that 2–5% of those with peripheral nerve injury, and 13–70% of those with
423:) released from peripheral nerves. This release may be caused by inappropriate cross-talk between sensory and motor fibers at the affected site. CRPS is not a psychological illness, yet pain can cause psychological problems, such as anxiety and 2773:
Gulevich SJ, Conwell TD, Lane J, Lockwood B, Schwettmann RS, Rosenberg N, Goldman LB (March 1997). "Stress infrared telethermography is useful in the diagnosis of complex regional pain syndrome, type I (formerly reflex sympathetic dystrophy)".
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which showed that 68% of patients were smokers, compared to only 37% of the control population. The results are preliminary and are limited by their retrospective nature. 7% of people who have CRPS in one limb later develop it in another limb.
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have been performed. The consensus among experts is that opioids should not be a first-line therapy and should be considered only after all other modalities (e.g., non-opioid medications, physical therapy, and procedures) have been trialed.
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Lewis JS, Kellett S, McCullough R, Tapper A, Tyler C, Viner M, Palmer S (November 2019). "Body Perception Disturbance and Pain Reduction in Longstanding Complex Regional Pain Syndrome Following a Multidisciplinary Rehabilitation Program".
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Bazika-Gerasch B, Maier C, Kumowski N, Fiege C, Kaisler M, Vollert J, Dietrich JW (June 2019). "Compared to limb pain of other origin, ultrasonographic osteodensitometry reveals loss of bone density in complex regional pain syndrome".
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CRPS affects both adults and children, and the number of reported CRPS cases among adolescents and young adults has been increasing, with a recent observational study finding an incidence of 1.16/100,000 among children in Scotland.
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The Netherlands has the most comprehensive program of research into CRPS, as part of a multimillion-Euro initiative called TREND. German and Australian research teams are also pursuing better understanding and treatments for CRPS.
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improve without treatment. A delay in diagnosis and/or treatment for this syndrome can result in severe physical and psychological problems. Early recognition and prompt treatment provide the greatest opportunity for recovery.
771:. Prognosis is not favourable for cold CRPS patients; longitudinal studies suggest these patients have "poorer clinical pain outcomes and show persistent signs of central sensitisation correlating with disease progression". 3631:
Taylor RS, Van Buyten JP, Buchser E (February 2006). "Spinal cord stimulation for complex regional pain syndrome: a systematic review of the clinical and cost-effectiveness literature and assessment of prognostic factors".
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Zollinger PE, Tuinebreijer WE, Breederveld RS, Kreis RW (July 2007). "Can vitamin C prevent complex regional pain syndrome in patients with wrist fractures? A randomized, controlled, multicenter dose-response study".
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Visnjevac O, Costandi S, Patel BA, Azer G, Agarwal P, Bolash R, Mekhail NA (April 2017). "A Comprehensive Outcome-Specific Review of the Use of Spinal Cord Stimulation for Complex Regional Pain Syndrome".
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Goebel, A; Birklein, F; Brunner, F; Clark, JD; Gierthmühlen, J; Harden, N; Huygen, F; Knudsen, L; McCabe, C; Lewis, J; Maihöfner, C; Magerl, W; Moseley, GL; Terkelsen, A; Thomassen, I; Bruehl, S (2021).
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that densely innervate bone and causes pain. Therefore, inhibiting bone resorption and remodeling is thought to help with regard to CRPS pain. CRPS involving high levels of bone resorption, as seen on
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Type II, formerly known as causalgia, has evidence of obvious nerve damage. Despite evidence of nerve injury, the cause or the mechanisms of CRPS type II are as unknown, as the mechanisms of type I.
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approved its use in February 2016. The ACCURATE Study demonstrated superiority of dorsal root ganglion stimulation over spinal (dorsal column) stimulation in the management of CRPS and causalgia.
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anesthetic, appears promising as a treatment for CRPS. It may be used in low doses if other treatments have not worked. No benefit on either function or depression, however, has been seen.
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Maihöfner C, Forster C, Birklein F, Neundörfer B, Handwerker HO (March 2005). "Brain processing during mechanical hyperalgesia in complex regional pain syndrome: a functional MRI study".
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Birklein F, Künzel W, Sieweke N (August 2001). "Despite clinical similarities there are significant differences between acute limb trauma and complex regional pain syndrome I (CRPS I)".
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Bruehl S, Harden RN, Galer BS, Saltz S, Backonja M, Stanton-Hicks M (January 2002). "Complex regional pain syndrome: are there distinct subtypes and sequential stages of the syndrome?".
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In order to minimise the confounding influence of external factors, patients undergoing infrared thermographic testing must conform to special restrictions regarding the use of certain
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are present in a wide number of CRPS patients and IgG has been recognized as one of the causes of hypersensitivity that stimulates A and C nociceptors, attributing to the inflammation.
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Ferraro, Michael C.; Cashin, Aidan G.; Wand, Benedict M.; Smart, Keith M.; Berryman, Carolyn; Marston, Louise; Moseley, G. Lorimer; McAuley, James H.; O'Connell, Neil E. (2023-06-12).
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Azari P, Lindsay DR, Briones D, Clarke C, Buchheit T, Pyati S (March 2012). "Efficacy and safety of ketamine in patients with complex regional pain syndrome: a systematic review".
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can also be used to detect changes in bone mineral density. It can also be used to monitor the results of treatment since bone densitometry parameters improve with treatment.
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outlasts the expected recovery time, and may subsequently spread to uninjured areas. The symptoms of types 1 and 2 are the same except type 2 is associated with nerve injury.
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Meena S, Sharma P, Gangary SK, Chowdhury B (May 2015). "Role of vitamin C in prevention of complex regional pain syndrome after distal radius fractures: a meta-analysis".
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The condition currently known as CRPS was originally described by Ambroise Paré. He successfully treated a severe and persistent pain syndrome that occurred to the French
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CRPS can occur at any age, with the average age at diagnosis being 42. It affects both men and women; however, CRPS is three times more frequent in females than males.
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in CRPS. Additionally, this method promises to quantify the bone architecture in the periphery of affected limbs. This method is still under experimental development.
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affected limb. Mirror box therapy appears to be beneficial at least in early CRPS. However, beneficial effects of mirror therapy in the long term is still unproven.
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of complex regional pain syndrome has not yet been defined; CRPS, with its variable manifestations, could be the result of multiple pathophysiological processes.
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are proposed to play important roles. The persistent pain and the perception of nonpainful stimuli as painful are thought to be caused by inflammatory molecules (
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Daly AE, Bialocerkowski AE (April 2009). "Does evidence support physiotherapy management of adult Complex Regional Pain Syndrome Type One? A systematic review".
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Stanton-Hicks M, Jänig W, Hassenbusch S, Haddox JD, Boas R, Wilson P (October 1995). "Reflex sympathetic dystrophy: changing concepts and taxonomy".
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Stanton-Hicks M, Baron R, Boas R, Gordh T, Harden N, Hendler N, et al. (June 1998). "Complex Regional Pain Syndromes: guidelines for therapy".
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Veldman PH, Reynen HM, Arntz IE, Goris RJ (October 1993). "Signs and symptoms of reflex sympathetic dystrophy: prospective study of 829 patients".
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CRPS and is associated with poorer McGill Pain Questionnaire scores, increased central nervous system reorganisation, and a higher prevalence of
259: 1303: 711:), which may be due to disuse of the affected extremity, can be detected through X-ray imagery as early as two weeks after the onset of CRPS. A 1481: 4498: 5259: 854: 803: 535:. They have since been adopted by the IASP. The criteria require there to be pain as well as a history and clinical evidence of sensory, 4292: 4730: 2845:
Eberle T, Doganci B, Krämer HH (February 2009). "Warm and cold complex regional pain syndromes: differences beyond skin temperature?".
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Schwartzman RJ, Alexander GM, Grothusen JR (May 2011). "The use of ketamine in complex regional pain syndrome: possible mechanisms".
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Moseley LG, Zalucki NM, Wiech K (July 2008). "Tactile discrimination, but not tactile stimulation alone, reduces chronic limb pain".
2009:"Subanesthetic ketamine infusion therapy: a retrospective analysis of a novel therapeutic approach to complex regional pain syndrome" 653:
Evidence of decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes (hair, nail, skin)
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Graded motor imagery appears to be useful for people with CRPS-1. Graded motor imagery is a sequential process that consists of (a)
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Bussa M, Guttilla D, Lucia M, Mascaro A, Rinaldi S (July 2015). "Complex regional pain syndrome type I: a comprehensive review".
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Abu-Arafeh H, Abu-Arafeh I (August 2016). "Complex regional pain syndrome in children: incidence and clinical characteristics".
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Kondo H, Takeuchi S, Togari A (March 2013). "β-Adrenergic signaling stimulates osteoclastogenesis via reactive oxygen species".
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Bergadano A, Moens Y, Schatzmann U (May 2006). "Continuous extradural analgesia in a cow with complex regional pain syndrome".
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A prior concept of CRPS having three stages is no longer in wide use. The trend is now to consider distinct sub-types of CRPS.
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Physical and occupational therapy have low-quality evidence to support their use. Physical therapy interventions may include
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Complex regional pain syndrome in adults: UK guidelines for diagnosis, referral and management in primary and secondary care
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is sometimes also credited with inventing the name "causalgia". However, this term was actually coined by Mitchell's friend
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resulting from the release of certain pro-inflammatory chemical signals from surrounding nerve cells; hypersensitization of
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appear to be harmful. Evidence for sympathetic nerve blocks generally is insufficient to support their use. Intramuscular
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responsible for this condition. However, while CRPS can go into remission, the chance of it reoccurring is significant.
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Scintigraphy, plain radiographs, and magnetic resonance imaging may all be useful diagnostically. Patchy osteoporosis (
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Pöyhiä R, Vainio A (January 2006). "Topically administered ketamine reduces capsaicin-evoked mechanical hyperalgesia".
17: 1653: 466:(CNS) sensitization are key neurologic processes that appear to be involved in the induction and maintenance of CRPS. 1219:
Schwartzman, R.J.; Erwin, K.L.; Alexander, G.M. (May 2009). "The natural history of complex regional pain syndrome".
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Wasner G, Schattschneider J, Baron R (July 2002). "Skin temperature side differences--a diagnostic tool for CRPS?".
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Stengel M, Binder A, Baron R (2007). "Update on the diagnosis and management of complex regional pain syndrome".
1049: 458:(bilateral) but also the associative-somatosensory cortices (contralateral), frontal cortices, and parts of the 5007: 3782: 730:-based osteodensitometry (ultrasonometry) may be potential future radiation-free technique to identify reduced 501: 451: 5101: 4443:"A Shocking Accusation of Munchausen by Proxy Leads to a Mom's Death by Suicide: 'I Want Justice' (Exclusive)" 2050:"A pilot open-label study of the efficacy of subanesthetic isomeric S(+)-ketamine in refractory CRPS patients" 5522: 5069: 508: 3256: 1847:
Lohnberg JA, Altmaier EM (June 2013). "A review of psychosocial factors in complex regional pain syndrome".
5702: 5517: 4710: 5079: 5059: 2632:"Validation of proposed diagnostic criteria (the "Budapest Criteria") for Complex Regional Pain Syndrome" 2556:"Validation of proposed diagnostic criteria (the "Budapest Criteria") for Complex Regional Pain Syndrome" 708: 532: 528: 262:(IASP) divides CRPS into two types based on the presence or absence of measurable nerve pathophysiology. 1371:"The Valencia consensus-based adaptation of the IASP complex regional pain syndrome diagnostic criteria" 5418: 5245: 5208: 2821: 497: 434:(inflammation mediated by nerve cells), nociceptive sensitisation (which causes extreme sensitivity or 3806: 5658: 5512: 5446: 5133: 4754: 4722: 2362:"Skeletal parasympathetic innervation communicates central IL-1 signals regulating bone mass accrual" 2134:"Immune regulation of central nervous system functions: from sickness responses to pathological pain" 459: 386:(paralysis of one side of the body) will develop CRPS. In addition, some studies have indicated that 3423:"Intramuscular botulinum toxin in complex regional pain syndrome: case series and literature review" 2992: 2236: 5748: 5608: 5480: 5307: 5159: 5138: 4626: 3283:"Treatment of complex regional pain syndrome: an updated systematic review and narrative synthesis" 1754:
Pawelka S, Fialka V, Ernst E (January 1993). "Reflex sympathetic dystrophy and cigarette smoking".
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Harden RN, Oaklander AL, Burton AW, Perez RS, Richardson K, Swan M, et al. (February 2013).
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Marinus J, Moseley GL, Birklein F, Baron R, Maihöfner C, Kingery WS, van Hilten JJ (July 2011).
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Must display at least one sign at time of evaluation in two or more of the following categories
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symptoms. Although it can vary widely, the classic presentation occurs when severe pain from a
4677: 3123:"Interventions for treating pain and disability in adults with complex regional pain syndrome" 2630:
Harden NR, Bruehl S, Perez RS, Birklein F, Marinus J, Maihofner C, et al. (August 2010).
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Harden NR, Bruehl S, Perez RS, Birklein F, Marinus J, Maihofner C, et al. (August 2010).
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Koffler SP, Hampstead BM, Irani F, Tinker J, Kiefer RT, Rohr P, Schwartzman RJ (August 2007).
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of the affected limb may detect these changes even sooner and can almost confirm the disease.
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Evidence of temperature asymmetry (>1 °C) and/or skin color changes and/or asymmetry
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Bajayo A, Bar A, Denes A, Bachar M, Kram V, Attar-Namdar M, et al. (September 2012).
2321:"Autoantibodies produce pain in complex regional pain syndrome by sensitizing nociceptors" 2319:
Cuhadar U, Gentry C, Vastani N, Sensi S, Bevan S, Goebel A, Andersson DA (December 2019).
481:) are all factors which have been implicated in the pathophysiology of CRPS. In addition, 442:
dysfunction (blood flow problems which cause swelling and discolouration) and maladaptive
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Australasian anaesthesia 2011: invited papers and selected continuing education lectures
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Taylor SS, Noor N, Urits I, Paladini A, Sadhu MS, Gibb C, et al. (December 2021).
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PAIN Problems pertaining to the transmission of nerve impulses which give rise to pain
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Reports of temperature asymmetry and/or skin color changes and/or skin color asymmetry
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Complex regional pain syndrome is a multifactorial disorder with clinical features of
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evidence of neuropathology in the affected limb. This accounts for about 90% of CRPS.
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Kiefer RT, Rohr P, Ploppa A, Nohé B, Dieterich HJ, Grothusen J, et al. (2008).
1919: 1876: 1833: 1705: 1639: 1386: 1248: 5736: 5423: 4261: 4224: 4164: 4137: 4117: 4067: 4030: 4022: 3954: 3802: 3794: 3755: 3685: 3641: 3566: 3558: 3508: 3465: 3393: 3389: 3385: 3344: 3294: 3222: 3199: 3179: 3142: 3138: 3134: 3095: 3057: 3045: 3041: 2997: 2941: 2898: 2874: 2854: 2783: 2739: 2696: 2651: 2643: 2575: 2567: 2520: 2477: 2467: 2428: 2391: 2381: 2332: 2305: 2285: 2261: 2241: 2194: 2145: 2098: 2061: 2020: 1899: 1856: 1813: 1763: 1728: 1685: 1619: 1571: 1561: 1520: 1512: 1450: 1442: 1390: 1382: 1340: 1275: 1228: 1193: 1159: 1070: 1053: 969: 742: 684: 343: 205: 4688: 4368: 4169: 4152: 149:; ketamine infusions; lidocaine infusions; implantable pharmaceuticals; amputation 5668: 5650: 5629: 5603: 5572: 5507: 5433: 4631: 3645: 3226: 1232: 883: 867: 515: 443: 387: 367: 351: 228: 209: 82: 73: 5783: 5565: 5560: 5502: 5359: 5064: 5030: 4878: 4767: 4642: 4071: 3719:
Brucăr M (1969). "The cleavable hydatiform polycystic pseudotumoural disease".
3183: 2902: 2647: 2571: 2432: 2366:
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1903: 1566: 1516: 1130: 1115: 1073:, these investigators are able to record and measure neural activity in single 907: 843: 482: 455: 142: 102: 4578: 4026: 3783:"Therapy-resistant complex regional pain syndrome type I: to amputate or not?" 3372:
O'Connell NE, Wand BM, Gibson W, Carr DB, Birklein F, Stanton TR (July 2016).
3299: 3282: 3001: 2945: 2245: 2199: 2182: 1860: 1345: 1328: 5839: 5808: 5337: 5116: 4976: 4940: 4151:
McCabe CS, Haigh RC, Ring EF, Halligan PW, Wall PD, Blake DR (January 2003).
3867:
Lloyd EC, Dempsey B, Romero L (July 2021). "Complex Regional Pain Syndrome".
3053: 2472: 1136: 1127:
Radene Marie Cook, former Los Angeles radio broadcaster, artist, and advocate
985: 839: 568: 550:
To make a clinical diagnosis all four of the following criteria must be met:
478: 408: 404: 126: 3924: 2386: 1212: 1181: 1139:, American business tycoon, aviator, inventor, filmmaker, and philanthropist 5586: 5548: 5413: 5396: 5391: 5354: 5276: 5143: 5089: 4922: 4842: 4786: 4273: 4238: 4178: 4079: 4058:
Evans JA (March 1947). "Reflex sympathetic dystrophy; report on 57 cases".
3966: 3880: 3814: 3697: 3653: 3580: 3520: 3477: 3438: 3407: 3374:"Local anaesthetic sympathetic blockade for complex regional pain syndrome" 3358: 3308: 3234: 3191: 3156: 3107: 3071: 3009: 2953: 2910: 2887: 2866: 2751: 2708: 2665: 2589: 2532: 2491: 2440: 2405: 2346: 2297: 2253: 2208: 2159: 2110: 2075: 2034: 1911: 1868: 1825: 1740: 1631: 1585: 1534: 1464: 1404: 1289: 1240: 1205: 895: 879: 677: 620: 493: 416: 347: 247: 197: 193: 141:
Physical therapy (more effective with early diagnosis); medications (e.g.,
122: 4129: 4044: 3767: 3732: 2795: 1775: 1697: 81:
Leg of an individual (left) with complex regional pain syndrome following
5364: 5312: 5237: 4809: 4672: 3798: 2289: 1431:"Clinical features and pathophysiology of complex regional pain syndrome" 1103: 1074: 1005: 940: 915: 911: 600:
Reports of decreased range of motion and/or motor dysfunction (weakness,
420: 146: 4561: 4196: 3099: 886:
injections may benefit people with symptoms localized to one extremity.
5595: 5441: 5408: 5347: 5342: 5120: 4855: 4832: 4694: 3689: 2007:
Correll GE, Maleki J, Gracely EJ, Muir JJ, Harbut RE (September 2004).
871: 835: 822: 727: 658:
There is no other diagnosis that better explains the signs and symptoms
383: 339: 160: 154: 98: 4752: 3562: 3512: 3349: 3332: 3121:
O'Connell NE, Wand BM, McAuley J, Marston L, Moseley GL (April 2013).
1817: 1262:
Harden, R.N.; Bruehl, S.; Stanton-Hicks, M.; Wilson, P.R. (May 2007).
782:
supplementation may be useful in prevention of the syndrome following
5535: 5213: 4683: 4648: 4588: 3260: 2274: 1264:"Proposed new diagnostic criteria for complex regional pain syndrome" 1008:, despite evidence of very low quality, is proposed to relieve pain. 932: 920: 779: 712: 624: 540: 536: 474: 447: 439: 435: 412: 359: 250:
and pediatrics, and is generally considered a subset of CRPS type I.
118: 94: 5285: 4705: 4107: 2978:
Shah A, Kirchner JS (June 2011). "Complex regional pain syndrome".
1094:
CRPS has also been described in non-human animals, such as cattle.
972:
that is effective in the management of focal neuropathic pain. The
944: 936: 875: 783: 768: 692: 688: 643:
Evidence of edema and/or sweating changes and/or sweating asymmetry
605: 164: 4653: 3781:
Bodde MI, Dijkstra PU, den Dunnen WF, Geertzen JH (October 2011).
1889: 3921:"RSDSA :: Reflex Sympathetic Dystrophy Syndrome Association" 3895:"Complex Regional Pain Syndrome (CRPS): Management and Treatment" 3420: 807: 219:
Usually starting in a single limb, CRPS often first manifests as
130: 2509: 554:
Continuing pain, which is disproportionate to any inciting event
5451: 4573: 4546: 4537: 3780: 3120: 1261: 601: 543:, and motor or trophic changes. It is also stated that it is a 266:
International Association for the Study of Pain Classification
2222:
Birklein F (February 2005). "Complex regional pain syndrome".
806:, progressive weight bearing, graded tactile desensitization, 326: 318: 30:"CRPS" redirects here. For common redundant power supply, see 5697: 5029: 3498: 3281:
Duong S, Bravo D, Todd KJ, Finlayson RJ, Tran Q (June 2018).
2973: 2971: 1721:
Physical Medicine and Rehabilitation Clinics of North America
587: 363: 224: 3084: 2421:
American Journal of Physiology. Endocrinology and Metabolism
1304:"Amplified Musculoskeletal Pain Syndrome (AMPS) in Children" 3745: 3371: 2931: 2818:"Reflex Sympathetic Dystrophy Clinical Practice Guidelines" 2772: 2180: 1428: 676:
Presently, established empirical evidence suggests against
470: 220: 201: 114: 3674: 3330: 2968: 2934:
European Journal of Orthopaedic Surgery & Traumatology
2729: 2456:"The Physiology of Bone Pain. How Much Do We Really Know?" 1367: 427:. Often, impaired social and occupational function occur. 3455: 3421:
Kharkar S, Ambady P, Venkatesh Y, Schwartzman RJ (2011).
2629: 2606:
Essentials of Physical Medicine and Rehabilitation E-Book
2553: 2318: 1803: 1218: 973: 794:
Treatment of CRPS often involves a number of modalities.
469:
Compelling evidence shows that the N-methyl-D-aspartate (
4251: 2006: 1550:"Disuse Osteoporosis: Clinical and Mechanistic Insights" 1501:"Complex Regional Pain Syndrome: A Comprehensive Review" 55:
Algodystrophy; Amplified musculoskeletal pain syndrome;
4150: 3630: 3599:
National Institute of Neurological Disorders and Stroke
3280: 1938:"Complex regional pain syndrome (CRPS), a brief review" 1675: 1498: 1067:
National Institute of Neurological Disorders and Stroke
923:, is more likely to respond to bisphosphonate therapy. 5075:
Hereditary neuropathy with liability to pressure palsy
4144: 3787:
The Journal of Bone and Joint Surgery. American Volume
3027: 2278:
The Journal of Bone and Joint Surgery. American Volume
1609: 1482:"Complex regional pain syndrome - Symptoms and causes" 1078:
Pain: Hope Through Research", published by the NINDS.
906:
As of 2013, high-quality evidence supports the use of
399:
Inflammation and alteration of pain perception in the
2686: 4551: 4289:"Paula Abdul: Putting the Spotlight on Rare Disease" 3944: 3544: 2359: 2047: 1182:"Complex regional pain syndrome: mystery explained?" 1142:
Maya Kowalski, subject of the 2023 documentary film
292:
reflex sympathetic dystrophy, RSD, Sudeck's atrophy
3169: 2844: 2840: 2838: 2602: 2418: 1931: 1929: 1788: 1719:Yu D (August 2004). "Shoulder pain in hemiplegia". 4387:"Actor Shin Dong Wook suffering from rare disease" 3866: 3611: 3212: 1849:Journal of Clinical Psychology in Medical Settings 1753: 855:Transcutaneous Electrical Nerve Stimulation (TENS) 850:Transcutaneous Electrical Nerve Stimulation (TENS) 362:). Other findings are aspects of disuse including 5107:Chronic inflammatory demyelinating polyneuropathy 590:and/or sweating changes and/or sweating asymmetry 304:evidence of neuropathology in the affected limb. 5806: 3545:Niesters M, Martini C, Dahan A (February 2014). 2835: 1926: 1846: 1476: 1474: 1424: 1422: 334:Clinical features of CRPS have been found to be 3547:"Ketamine for chronic pain: risks and benefits" 2820:. Rsdfoundation.org. 2003-01-01. Archived from 2603:Frontera WR, Silver JK, Rizzo TD (2014-09-05). 2453: 1156:Cynthia Toussaint, author and media personality 260:International Association for the Study of Pain 4513:"Rolstoelatlete Marieke Vervoort is overleden" 4441:Etienne, Vanessa; Roedel, Abby (7 June 2023). 968:Dorsal root ganglion stimulation is a type of 5253: 4738: 4440: 2505: 2503: 2501: 1547: 1471: 1419: 1329:"Diagnosis of complex regional pain syndrome" 236:) and CRPS type 2 (previously referred to as 4163:(1). Oxford University Press (OUP): 97–101. 3206: 2977: 2131: 2088: 1797: 737: 4393: 4315:"Jill Kinmont Boothe is still going strong" 3595:"Complex Regional Pain Syndrome Fact Sheet" 3378:The Cochrane Database of Systematic Reviews 3127:The Cochrane Database of Systematic Reviews 3034:The Cochrane Database of Systematic Reviews 901: 804:transcutaneous electrical nerve stimulation 608:) and/or trophic changes (hair, nail, skin) 5267: 5260: 5246: 4745: 4731: 4210: 4092: 3807:11370/64f97da0-c435-4382-bd23-e0d91dad0c7e 3540: 3538: 2498: 2002: 2000: 1982:. University of Washington. Archived from 1671: 1669: 1667: 1255: 1179: 1089: 956: 72: 4489:Burtt K (13 March 2015). Geehr EC (ed.). 4228: 4168: 4034: 3994:Injuries of Nerves and their Consequences 3570: 3397: 3348: 3326: 3324: 3322: 3320: 3318: 3298: 3163: 3146: 3061: 2991: 2655: 2579: 2481: 2471: 2395: 2385: 2336: 2235: 2198: 2149: 2065: 2024: 1575: 1565: 1524: 1454: 1394: 1344: 1279: 4008: 3987: 3862: 3860: 3858: 3856: 3551:British Journal of Clinical Pharmacology 2268: 2221: 1326: 325: 317: 258:The classification system in use by the 180:, sometimes referred to by the hyponyms 5493:Hypertrophic pulmonary osteoarthropathy 4399: 3535: 1997: 1789:Goebel A, Turner-Stokes LF (May 2012). 1664: 1511:(2) (published 24 June 2021): 875–892. 866:Tentative evidence supports the use of 829: 244:Amplified musculoskeletal pain syndrome 14: 5815:Nerve, nerve root and plexus disorders 5807: 3923:. Rsds.org. 2010-01-21. Archived from 3718: 3315: 3259:. Graded Motor Imagery. Archived from 3114: 2132:Watkins LR, Maier SF (February 2005). 1935: 984:Surgical, chemical, or radiofrequency 662: 240:). It is possible to have both types. 67:: reflex neurovascular dystrophy (RND) 59:: reflex sympathetic dystrophy (RSD); 5241: 5180: 5028: 4765: 4726: 4488: 4402:"Howard Hughes & Pseudoaddiction" 4312: 4057: 3853: 3023: 3021: 3019: 1793:. Royal College of Physicians London. 1605: 1603: 817: 313: 27:Array of painful conditions in humans 4333:"Paralympic ban devastating - Brown" 4254:Veterinary Anaesthesia and Analgesia 2187:Archives of Clinical Neuropsychology 557:Must report at least one symptom in 186:Reflex Neurovascular Dystrophy (RND) 1806:Acta Anaesthesiologica Scandinavica 752: 145:, opioids, muscle relaxers, etc.); 36:Continuous ranked probability score 24: 4766: 3897:. Cleveland Clinic. Archived from 3501:Expert Review of Neurotherapeutics 3016: 2859:10.1212/01.wnl.0000341930.35494.66 2103:10.1097/01.ajp.0000149800.39240.95 1718: 1600: 1333:Annals of Clinical Neurophysiology 1180:Jänig W, Baron R (November 2003). 1041:of Valois after a limb phlebotomy 488:The mechanisms leading to reduced 394: 182:Reflex Sympathetic Dystrophy (RSD) 167:), ketamine or lidocaine infusions 129:, skin temperature abnormalities, 25: 5851: 4527: 253: 4905:lateral cutaneous nerve of thigh 4266:10.1111/j.1467-2995.2005.00245.x 4230:10.1097/00000542-200303000-00048 4213:"Complex regional pain syndrome" 3959:10.1136/archdischild-2015-310233 3947:Archives of Disease in Childhood 3760:10.1097/00002508-199806000-00012 3470:10.2165/11595200-000000000-00000 2788:10.1097/00002508-199703000-00008 2151:10.1111/j.1365-2796.2004.01443.x 2067:10.1111/j.1526-4637.2006.00223.x 2026:10.1111/j.1526-4637.2004.04043.x 1654:"Complex regional pain syndrome" 1281:10.1111/j.1526-4637.2006.00169.x 1097: 979: 786:of the forearm, foot, or ankle. 330:CRPS visible on hands and wrists 34:. For the accuracy measure, see 5554:Infantile cortical hyperostosis 4505: 4482: 4460: 4434: 4379: 4361: 4343: 4325: 4306: 4280: 4245: 4204: 4185: 4101: 4086: 4051: 4002: 3981: 3938: 3913: 3887: 3829: 3774: 3739: 3712: 3668: 3624: 3605: 3587: 3492: 3449: 3414: 3365: 3287:Canadian Journal of Anaesthesia 3274: 3249: 3078: 2925: 2881: 2810: 2766: 2723: 2680: 2623: 2596: 2547: 2525:10.1097/j.pain.0000000000001520 2454:Nencini S, Ivanusic JJ (2016). 2447: 2412: 2353: 2338:10.1097/j.pain.0000000000001662 2312: 2215: 2174: 2125: 2082: 2041: 1968: 1883: 1840: 1782: 1747: 1712: 1646: 1541: 1387:10.1097/j.pain.0000000000002245 1106:, singer, actor, TV personality 1020: 671: 188:, is a rare and severe form of 5488:Complex regional pain syndrome 5199:Complex regional pain syndrome 5008:Template:Cranial nerve disease 4700:Complex regional pain syndrome 4534:Complex regional pain syndrome 4472:British Paralympic Association 4400:Tennant F (July–August 2007). 4355:British Paralympic Association 3997:. Philadelphia: JB Lippincott. 3390:10.1002/14651858.CD004598.pub4 3139:10.1002/14651858.CD009416.pub2 3046:10.1002/14651858.CD009416.pub3 1548:Rolvien, T; Amling, M (2022). 1492: 1361: 1320: 1296: 1173: 1133:, South Korean actor and model 861: 702: 174:Complex regional pain syndrome 47:Complex regional pain syndrome 13: 1: 5070:Hereditary spastic paraplegia 2744:10.1016/s0304-3959(01)00470-5 2701:10.1016/s0304-3959(01)00309-8 1733:10.1016/S1047-9651(03)00130-X 1624:10.1016/s0304-3959(01)00387-6 1447:10.1016/S1474-4422(11)70106-5 1198:10.1016/S1474-4422(03)00584-5 1166: 991: 774: 722: 509:secondary hyperparathyroidism 4543:Reflex sympathetic dystrophy 4122:10.1016/0304-3959(95)00110-E 4009:Richards RL (January 1967). 3748:The Clinical Journal of Pain 3646:10.1016/j.ejpain.2005.02.004 3227:10.1016/j.ejpain.2008.05.003 2776:The Clinical Journal of Pain 2609:. Elsevier Health Sciences. 2138:Journal of Internal Medicine 2091:The Clinical Journal of Pain 1768:10.1016/0363-5023(93)90273-6 1690:10.1016/0140-6736(93)92877-V 1233:10.1097/AJP.0b013e31818ecea5 1221:The Clinical Journal of Pain 1162:, Belgian Paralympic athlete 1153:, British paralympic cyclist 1011: 789: 521: 234:reflex sympathetic dystrophy 7: 5820:Syndromes of unknown causes 5080:Familial amyloid neuropathy 5055:Charcot–Marie–Tooth disease 4211:Raja SN, Grabow TS (2003). 4170:10.1093/rheumatology/keg041 4060:Annals of Internal Medicine 1756:The Journal of Hand Surgery 1124:, British paralympic fencer 1118:, British paralympic archer 1060: 889: 709:post-traumatic osteoporosis 214:neurotropic viral infection 10: 5856: 5691:Legg–Calvé–Perthes disease 5209:Nerve compression syndrome 4415:(7): 12–29. Archived from 4072:10.7326/0003-4819-26-3-417 3184:10.1016/j.pain.2007.10.021 2903:10.1016/j.pain.2005.02.031 2648:10.1016/j.pain.2010.04.030 2572:10.1016/j.pain.2010.04.030 2433:10.1152/ajpendo.00191.2012 1904:10.1016/j.pain.2004.12.001 1567:10.1007/s00223-021-00836-1 1517:10.1007/s40122-021-00279-4 1032: 951: 926: 797: 163:); muscle relaxers (e.g., 147:sympathetic nerve blockade 29: 5830:Neurocutaneous conditions 5759: 5733: 5676: 5667: 5659:Osteochondritis dissecans 5649: 5642: 5617: 5594: 5585: 5465: 5432: 5382: 5323: 5293: 5284: 5275: 5191: 5187: 5181: 5176: 5152: 5134:Pectoralis minor syndrome 5115: 5088: 5045: 5041: 5024: 4997: 4975: 4957: 4939: 4921: 4903: 4896: 4869: 4841: 4808: 4785: 4778: 4774: 4761: 4755:peripheral nervous system 4753:Diseases relating to the 4663: 4555: 4409:Practical Pain Management 4027:10.1017/s0025727300011789 3869:American Family Physician 3300:10.1007/s12630-018-1091-5 3002:10.1016/j.fcl.2011.03.001 2946:10.1007/s00590-014-1573-2 2246:10.1007/s00415-005-0737-8 2200:10.1016/j.acn.2007.05.005 1861:10.1007/s10880-012-9322-3 1346:10.14253/acn.2022.24.2.35 738:Electrodiagnostic testing 460:anterior cingulate cortex 153: 137: 108: 88: 80: 71: 51: 46: 5703:Osgood–Schlatter disease 5609:Relapsing polychondritis 5481:Osteonecrosis of the jaw 5308:Osteitis fibrosa cystica 5160:Alcoholic polyneuropathy 5139:Thoracic outlet syndrome 3634:European Journal of Pain 3380:(Submitted manuscript). 3215:European Journal of Pain 2473:10.3389/fphys.2016.00157 1112:, US ski slalom champion 1000: 902:Bisphosphonate treatment 697:autonomic nervous system 505:autonomic nervous system 376: 322:Severe CRPS of right arm 32:Redundancy (engineering) 5419:Paget's disease of bone 5370:Vertebral osteomyelitis 5102:Guillain–Barré syndrome 5060:Dejerine–Sottas disease 4861:Cheiralgia paresthetica 4313:Crowe J (22 May 2011). 3721:Romanian Medical Review 2460:Frontiers in Physiology 2387:10.1073/pnas.1206061109 1090:In other animal species 962:Spinal cord stimulation 957:Spinal cord stimulators 454:(bilateral) areas, and 432:neurogenic inflammation 342:; dysfunction of local 178:CRPS Type 1 and Type 2) 159:Anticonvulsants (e.g., 5825:Chronic pain syndromes 5269:Bone and joint disease 5204:Mononeuritis multiplex 5129:Brachial plexus injury 5035:Polyradiculoneuropathy 4959:superior gluteal nerve 4931:Tarsal tunnel syndrome 4913:Meralgia paraesthetica 4818:Ulnar nerve entrapment 4795:Carpal tunnel syndrome 4097:. Amsterdam: Elsevier. 4011:"The term 'causalgia'" 3257:"Graded Motor Imagery" 2980:Foot and Ankle Clinics 1980:Courses.washington.edu 561:following categories. 545:diagnosis of exclusion 527:been found to be more 464:central nervous system 401:central nervous system 366:, stiffness (limited 331: 323: 5749:Scheuermann's disease 5625:Slipping rib syndrome 5447:Hajdu–Cheney syndrome 5219:Peripheral neuropathy 5094:demyelinating disease 4828:Ulnar tunnel syndrome 4422:on September 25, 2007 4351:"Gemma Collis-McCann" 4199:on December 24, 2009. 4093:Noordenbos W (1959). 1727:(3): vi–vii, 683–97. 1435:The Lancet. Neurology 812:contrast bath therapy 623:(to pinprick) and/or 329: 321: 5542:Aneurysmal bone cyst 5498:Nonossifying fibroma 4967:Trendelenburg's sign 4373:U.S. Pain Foundation 3799:10.2106/JBJS.J.01329 2290:10.2106/JBJS.F.01147 2224:Journal of Neurology 1327:Young-Do, K (1970). 1186:The Lancet Neurology 878:. Nerve blocks with 838:reconstruction, (b) 830:Graded motor imagery 732:bone mineral density 490:bone mineral density 83:tibial bone fracture 4985:Piriformis syndrome 4871:long thoracic nerve 4491:"Cynthia Toussaint" 4369:"Radene Marie Cook" 2378:2012PNAS..10915455B 2372:(38): 15455–15460. 1986:on 14 February 2005 1964:on 3 February 2015. 1684:(8878): 1012–1016. 1122:Gemma Collis-McCann 1110:Jill Kinmont Boothe 1050:Silas Weir Mitchell 663:Diagnostic adjuncts 267: 5774:Kienböck's disease 5530:Skeletal fluorosis 5476:Avascular necrosis 4800:Ape hand deformity 4664:External resources 4519:. 22 October 2019. 3841:www.worksafebc.com 3690:10.1111/papr.12513 1046:American Civil War 818:Mirror box therapy 350:; and maladaptive 332: 324: 314:Signs and symptoms 274:Clinical findings 265: 18:Algoneurodystrophy 5802: 5801: 5798: 5797: 5794: 5793: 5638: 5637: 5581: 5580: 5513:Fibrous dysplasia 5378: 5377: 5235: 5234: 5231: 5230: 5227: 5226: 5172: 5171: 5168: 5167: 5020: 5019: 5016: 5015: 4993: 4992: 4892: 4891: 4851:Radial neuropathy 4720: 4719: 3793:(19): 1799–1805. 3563:10.1111/bcp.12094 3513:10.1586/ern.11.31 3350:10.1111/pme.12033 3100:10.1093/pm/pnz176 3094:(11): 2213–2219. 2616:978-0-323-22272-3 2331:(12): 2855–2865. 1954:978-0-9775174-7-3 1936:Howard W (2012). 1818:10.1111/aas.12489 1554:Calcif Tissue Int 1145:Take Care of Maya 1006:Cannabidiol (CBD) 717:Bone densitometry 559:three of the four 477:damage (e.g., by 450:(contralateral), 388:cigarette smoking 311: 310: 196:disorder causing 190:neuroinflammatory 171: 170: 41:Medical condition 16:(Redirected from 5847: 5764: 5740: 5708:Blount's disease 5681: 5674: 5673: 5647: 5646: 5592: 5591: 5457:Gorham's disease 5424:Hypophosphatasia 5331: 5301: 5291: 5290: 5282: 5281: 5262: 5255: 5248: 5239: 5238: 5189: 5188: 5178: 5177: 5065:Refsum's disease 5043: 5042: 5026: 5025: 4949:Morton's neuroma 4901: 4900: 4783: 4782: 4776: 4775: 4763: 4762: 4747: 4740: 4733: 4724: 4723: 4553: 4552: 4521: 4520: 4509: 4503: 4502: 4497:. Archived from 4486: 4480: 4479: 4474:. Archived from 4464: 4458: 4457: 4455: 4453: 4438: 4432: 4431: 4429: 4427: 4421: 4406: 4397: 4391: 4390: 4383: 4377: 4376: 4365: 4359: 4358: 4347: 4341: 4340: 4339:. 20 April 2014. 4329: 4323: 4322: 4310: 4304: 4303: 4301: 4300: 4291:. Archived from 4284: 4278: 4277: 4249: 4243: 4242: 4232: 4223:(3): 1254–1260. 4208: 4202: 4200: 4195:. Archived from 4193:"TREND homepage" 4189: 4183: 4182: 4172: 4148: 4142: 4141: 4105: 4099: 4098: 4090: 4084: 4083: 4055: 4049: 4048: 4038: 4006: 4000: 3998: 3985: 3979: 3978: 3942: 3936: 3935: 3933: 3932: 3917: 3911: 3910: 3908: 3906: 3901:on 7 August 2020 3891: 3885: 3884: 3864: 3851: 3850: 3848: 3847: 3833: 3827: 3826: 3778: 3772: 3771: 3743: 3737: 3736: 3716: 3710: 3709: 3672: 3666: 3665: 3628: 3622: 3621: 3609: 3603: 3602: 3591: 3585: 3584: 3574: 3542: 3533: 3532: 3496: 3490: 3489: 3453: 3447: 3446: 3441:. Archived from 3418: 3412: 3411: 3401: 3369: 3363: 3362: 3352: 3328: 3313: 3312: 3302: 3278: 3272: 3271: 3269: 3268: 3253: 3247: 3246: 3210: 3204: 3203: 3167: 3161: 3160: 3150: 3118: 3112: 3111: 3082: 3076: 3075: 3065: 3025: 3014: 3013: 2995: 2975: 2966: 2965: 2929: 2923: 2922: 2885: 2879: 2878: 2842: 2833: 2832: 2830: 2829: 2814: 2808: 2807: 2770: 2764: 2763: 2727: 2721: 2720: 2684: 2678: 2677: 2659: 2627: 2621: 2620: 2600: 2594: 2593: 2583: 2551: 2545: 2544: 2519:(6): 1261–1269. 2507: 2496: 2495: 2485: 2475: 2451: 2445: 2444: 2427:(5): E507–E515. 2416: 2410: 2409: 2399: 2389: 2357: 2351: 2350: 2340: 2316: 2310: 2309: 2284:(7): 1424–1431. 2272: 2266: 2265: 2239: 2219: 2213: 2212: 2202: 2178: 2172: 2171: 2153: 2129: 2123: 2122: 2086: 2080: 2079: 2069: 2045: 2039: 2038: 2028: 2004: 1995: 1994: 1992: 1991: 1972: 1966: 1965: 1963: 1957:. Archived from 1942: 1933: 1924: 1923: 1887: 1881: 1880: 1844: 1838: 1837: 1801: 1795: 1794: 1786: 1780: 1779: 1751: 1745: 1744: 1716: 1710: 1709: 1673: 1662: 1661: 1650: 1644: 1643: 1618:(1–2): 119–124. 1607: 1598: 1597: 1579: 1569: 1545: 1539: 1538: 1528: 1505:Pain and Therapy 1496: 1490: 1489: 1478: 1469: 1468: 1458: 1426: 1417: 1416: 1398: 1381:(9): 2346–2348. 1365: 1359: 1358: 1348: 1324: 1318: 1317: 1315: 1314: 1308:Cleveland Clinic 1300: 1294: 1293: 1283: 1259: 1253: 1252: 1216: 1210: 1209: 1177: 1160:Marieke Vervoort 1071:microneurography 1054:Robley Dunglison 970:neurostimulation 931:Opioids such as 743:Electromyography 685:vasoconstrictors 514:In summary, the 344:vasoconstriction 268: 264: 76: 44: 43: 21: 5855: 5854: 5850: 5849: 5848: 5846: 5845: 5844: 5805: 5804: 5803: 5790: 5760: 5755: 5734: 5729: 5723:Sever's disease 5677: 5663: 5651:Osteochondritis 5634: 5630:Tietze syndrome 5613: 5604:Costochondritis 5577: 5573:Pycnodysostosis 5508:Stress fracture 5461: 5434:Bone resorption 5428: 5374: 5324: 5319: 5294: 5271: 5266: 5236: 5223: 5183: 5164: 5148: 5111: 5084: 5037: 5012: 4989: 4971: 4953: 4935: 4917: 4888: 4865: 4837: 4804: 4770: 4757: 4751: 4721: 4716: 4715: 4659: 4658: 4564: 4530: 4525: 4524: 4511: 4510: 4506: 4487: 4483: 4468:"Rachel Morris" 4466: 4465: 4461: 4451: 4449: 4439: 4435: 4425: 4423: 4419: 4404: 4398: 4394: 4385: 4384: 4380: 4367: 4366: 4362: 4349: 4348: 4344: 4331: 4330: 4326: 4311: 4307: 4298: 4296: 4287: 4285: 4281: 4250: 4246: 4209: 4205: 4191: 4190: 4186: 4149: 4145: 4106: 4102: 4091: 4087: 4056: 4052: 4015:Medical History 4007: 4003: 3986: 3982: 3943: 3939: 3930: 3928: 3919: 3918: 3914: 3904: 3902: 3893: 3892: 3888: 3865: 3854: 3845: 3843: 3835: 3834: 3830: 3779: 3775: 3744: 3740: 3717: 3713: 3673: 3669: 3629: 3625: 3614:Adv Pain Manage 3610: 3606: 3593: 3592: 3588: 3543: 3536: 3497: 3493: 3454: 3450: 3419: 3415: 3384:(7): CD004598. 3370: 3366: 3329: 3316: 3279: 3275: 3266: 3264: 3255: 3254: 3250: 3211: 3207: 3168: 3164: 3133:(4): CD009416. 3119: 3115: 3083: 3079: 3040:(6): CD009416. 3026: 3017: 2993:10.1.1.483.1324 2976: 2969: 2930: 2926: 2897:(1–2): 204–11. 2886: 2882: 2843: 2836: 2827: 2825: 2816: 2815: 2811: 2771: 2767: 2728: 2724: 2685: 2681: 2628: 2624: 2617: 2601: 2597: 2552: 2548: 2508: 2499: 2452: 2448: 2417: 2413: 2358: 2354: 2317: 2313: 2273: 2269: 2237:10.1.1.483.1324 2220: 2216: 2179: 2175: 2130: 2126: 2087: 2083: 2046: 2042: 2005: 1998: 1989: 1987: 1974: 1973: 1969: 1961: 1955: 1940: 1934: 1927: 1898:(1–2): 93–103. 1888: 1884: 1845: 1841: 1802: 1798: 1787: 1783: 1752: 1748: 1717: 1713: 1674: 1665: 1652: 1651: 1647: 1608: 1601: 1546: 1542: 1497: 1493: 1480: 1479: 1472: 1427: 1420: 1366: 1362: 1325: 1321: 1312: 1310: 1302: 1301: 1297: 1260: 1256: 1217: 1213: 1192:(11): 687–697. 1178: 1174: 1169: 1100: 1092: 1063: 1039:King Charles IX 1035: 1023: 1014: 1003: 994: 982: 959: 954: 929: 908:bisphosphonates 904: 892: 868:bisphosphonates 864: 832: 820: 800: 792: 777: 755: 740: 725: 705: 674: 665: 524: 516:pathophysiology 502:parasympathetic 444:neuroplasticity 397: 395:Pathophysiology 379: 368:range of motion 352:neuroplasticity 316: 256: 229:range of motion 210:physical trauma 143:anticonvulsants 42: 39: 28: 23: 22: 15: 12: 11: 5: 5853: 5843: 5842: 5837: 5832: 5827: 5822: 5817: 5800: 5799: 5796: 5795: 5792: 5791: 5789: 5788: 5787: 5786: 5784:Panner disease 5778: 5777: 5776: 5767: 5765: 5757: 5756: 5754: 5753: 5752: 5751: 5743: 5741: 5731: 5730: 5728: 5727: 5726: 5725: 5720: 5718:Köhler disease 5712: 5711: 5710: 5705: 5695: 5694: 5693: 5684: 5682: 5671: 5665: 5664: 5662: 5661: 5655: 5653: 5644: 5640: 5639: 5636: 5635: 5633: 5632: 5627: 5621: 5619: 5615: 5614: 5612: 5611: 5606: 5600: 5598: 5589: 5583: 5582: 5579: 5578: 5576: 5575: 5570: 5569: 5568: 5566:Melorheostosis 5561:Osteosclerosis 5558: 5557: 5556: 5546: 5545: 5544: 5532: 5527: 5526: 5525: 5520: 5510: 5505: 5503:Pseudarthrosis 5500: 5495: 5490: 5485: 5484: 5483: 5478: 5469: 5467: 5463: 5462: 5460: 5459: 5454: 5449: 5444: 5438: 5436: 5430: 5429: 5427: 5426: 5421: 5416: 5411: 5406: 5405: 5404: 5394: 5388: 5386: 5380: 5379: 5376: 5375: 5373: 5372: 5367: 5362: 5360:Brodie abscess 5357: 5352: 5351: 5350: 5345: 5334: 5332: 5321: 5320: 5318: 5317: 5316: 5315: 5304: 5302: 5288: 5279: 5273: 5272: 5265: 5264: 5257: 5250: 5242: 5233: 5232: 5229: 5228: 5225: 5224: 5222: 5221: 5216: 5211: 5206: 5201: 5195: 5193: 5185: 5184: 5174: 5173: 5170: 5169: 5166: 5165: 5163: 5162: 5156: 5154: 5150: 5149: 5147: 5146: 5141: 5136: 5131: 5125: 5123: 5113: 5112: 5110: 5109: 5104: 5098: 5096: 5086: 5085: 5083: 5082: 5077: 5072: 5067: 5062: 5057: 5051: 5049: 5039: 5038: 5031:Polyneuropathy 5022: 5021: 5018: 5017: 5014: 5013: 5011: 5010: 5003: 5001: 4999:Cranial nerves 4995: 4994: 4991: 4990: 4988: 4987: 4981: 4979: 4973: 4972: 4970: 4969: 4963: 4961: 4955: 4954: 4952: 4951: 4945: 4943: 4937: 4936: 4934: 4933: 4927: 4925: 4919: 4918: 4916: 4915: 4909: 4907: 4898: 4894: 4893: 4890: 4889: 4887: 4886: 4884:Backpack palsy 4881: 4879:Winged scapula 4875: 4873: 4867: 4866: 4864: 4863: 4858: 4853: 4847: 4845: 4839: 4838: 4836: 4835: 4830: 4825: 4823:Froment's sign 4820: 4814: 4812: 4806: 4805: 4803: 4802: 4797: 4791: 4789: 4780: 4772: 4771: 4768:Mononeuropathy 4759: 4758: 4750: 4749: 4742: 4735: 4727: 4718: 4717: 4714: 4713: 4702: 4691: 4680: 4668: 4667: 4665: 4661: 4660: 4657: 4656: 4645: 4634: 4623: 4596: 4581: 4565: 4560: 4559: 4557: 4556:Classification 4550: 4549: 4540: 4529: 4528:External links 4526: 4523: 4522: 4504: 4501:on 2015-06-27. 4481: 4478:on 2012-09-01. 4459: 4433: 4392: 4378: 4360: 4342: 4324: 4305: 4279: 4260:(3): 189–192. 4244: 4217:Anesthesiology 4203: 4184: 4143: 4116:(1): 127–133. 4100: 4085: 4066:(3): 417–426. 4050: 4001: 3980: 3953:(8): 719–723. 3937: 3912: 3886: 3852: 3828: 3773: 3754:(2): 155–166. 3738: 3711: 3684:(4): 533–545. 3667: 3623: 3604: 3586: 3557:(2): 357–367. 3534: 3507:(5): 719–734. 3491: 3464:(3): 215–228. 3448: 3445:on 2015-02-03. 3433:(5): 419–424. 3427:Pain Physician 3413: 3364: 3343:(2): 180–229. 3314: 3293:(6): 658–684. 3273: 3248: 3205: 3178:(3): 600–608. 3162: 3113: 3077: 3015: 2967: 2940:(4): 637–641. 2924: 2880: 2834: 2809: 2765: 2738:(1–2): 19–26. 2722: 2695:(2): 165–171. 2679: 2642:(2): 268–274. 2622: 2615: 2595: 2566:(2): 268–274. 2546: 2497: 2446: 2411: 2352: 2311: 2267: 2230:(2): 131–138. 2214: 2193:(6): 719–729. 2173: 2144:(2): 139–155. 2124: 2081: 2040: 2019:(3): 263–275. 1996: 1967: 1953: 1925: 1882: 1855:(2): 247–254. 1839: 1812:(6): 685–697. 1796: 1781: 1762:(1): 168–169. 1746: 1711: 1663: 1645: 1599: 1560:(5): 592–604. 1540: 1491: 1470: 1441:(7): 637–648. 1418: 1360: 1319: 1295: 1274:(4): 326–331. 1254: 1227:(4): 273–280. 1211: 1171: 1170: 1168: 1165: 1164: 1163: 1157: 1154: 1148: 1140: 1134: 1131:Shin Dong-wook 1128: 1125: 1119: 1116:Danielle Brown 1113: 1107: 1099: 1096: 1091: 1088: 1062: 1059: 1034: 1031: 1022: 1019: 1013: 1010: 1002: 999: 993: 990: 981: 978: 958: 955: 953: 950: 928: 925: 903: 900: 891: 888: 863: 860: 844:mirror therapy 831: 828: 819: 816: 799: 796: 791: 788: 776: 773: 764: 763: 760: 754: 753:Classification 751: 739: 736: 724: 721: 704: 701: 673: 670: 664: 661: 660: 659: 656: 655: 654: 644: 634: 628: 611: 610: 609: 591: 577: 571: 555: 523: 520: 483:autoantibodies 396: 393: 378: 375: 340:pain receptors 315: 312: 309: 308: 305: 298: 294: 293: 290: 283: 279: 278: 275: 272: 255: 254:Classification 252: 169: 168: 157: 151: 150: 139: 135: 134: 112: 106: 105: 103:anesthesiology 92: 86: 85: 78: 77: 69: 68: 53: 49: 48: 40: 26: 9: 6: 4: 3: 2: 5852: 5841: 5838: 5836: 5833: 5831: 5828: 5826: 5823: 5821: 5818: 5816: 5813: 5812: 5810: 5785: 5782: 5781: 5779: 5775: 5772: 5771: 5769: 5768: 5766: 5763: 5758: 5750: 5747: 5746: 5745: 5744: 5742: 5739: 5738: 5732: 5724: 5721: 5719: 5716: 5715: 5713: 5709: 5706: 5704: 5701: 5700: 5699: 5696: 5692: 5689: 5688: 5686: 5685: 5683: 5680: 5675: 5672: 5670: 5666: 5660: 5657: 5656: 5654: 5652: 5648: 5645: 5641: 5631: 5628: 5626: 5623: 5622: 5620: 5616: 5610: 5607: 5605: 5602: 5601: 5599: 5597: 5593: 5590: 5588: 5584: 5574: 5571: 5567: 5564: 5563: 5562: 5559: 5555: 5552: 5551: 5550: 5547: 5543: 5540: 5539: 5538: 5537: 5533: 5531: 5528: 5524: 5521: 5519: 5516: 5515: 5514: 5511: 5509: 5506: 5504: 5501: 5499: 5496: 5494: 5491: 5489: 5486: 5482: 5479: 5477: 5474: 5473: 5471: 5470: 5468: 5464: 5458: 5455: 5453: 5450: 5448: 5445: 5443: 5440: 5439: 5437: 5435: 5431: 5425: 5422: 5420: 5417: 5415: 5412: 5410: 5407: 5403: 5400: 5399: 5398: 5395: 5393: 5390: 5389: 5387: 5385: 5381: 5371: 5368: 5366: 5363: 5361: 5358: 5356: 5353: 5349: 5346: 5344: 5341: 5340: 5339: 5338:Osteomyelitis 5336: 5335: 5333: 5330: 5328: 5322: 5314: 5311: 5310: 5309: 5306: 5305: 5303: 5300: 5298: 5292: 5289: 5287: 5283: 5280: 5278: 5274: 5270: 5263: 5258: 5256: 5251: 5249: 5244: 5243: 5240: 5220: 5217: 5215: 5212: 5210: 5207: 5205: 5202: 5200: 5197: 5196: 5194: 5190: 5186: 5179: 5175: 5161: 5158: 5157: 5155: 5151: 5145: 5142: 5140: 5137: 5135: 5132: 5130: 5127: 5126: 5124: 5122: 5118: 5117:Radiculopathy 5114: 5108: 5105: 5103: 5100: 5099: 5097: 5095: 5091: 5087: 5081: 5078: 5076: 5073: 5071: 5068: 5066: 5063: 5061: 5058: 5056: 5053: 5052: 5050: 5048: 5044: 5040: 5036: 5032: 5027: 5023: 5009: 5005: 5004: 5002: 5000: 4996: 4986: 4983: 4982: 4980: 4978: 4977:sciatic nerve 4974: 4968: 4965: 4964: 4962: 4960: 4956: 4950: 4947: 4946: 4944: 4942: 4941:plantar nerve 4938: 4932: 4929: 4928: 4926: 4924: 4920: 4914: 4911: 4910: 4908: 4906: 4902: 4899: 4895: 4885: 4882: 4880: 4877: 4876: 4874: 4872: 4868: 4862: 4859: 4857: 4854: 4852: 4849: 4848: 4846: 4844: 4840: 4834: 4831: 4829: 4826: 4824: 4821: 4819: 4816: 4815: 4813: 4811: 4807: 4801: 4798: 4796: 4793: 4792: 4790: 4788: 4784: 4781: 4777: 4773: 4769: 4764: 4760: 4756: 4748: 4743: 4741: 4736: 4734: 4729: 4728: 4725: 4712: 4708: 4707: 4703: 4701: 4697: 4696: 4692: 4690: 4686: 4685: 4681: 4679: 4675: 4674: 4670: 4669: 4666: 4662: 4655: 4651: 4650: 4646: 4644: 4640: 4639: 4635: 4633: 4629: 4628: 4624: 4622: 4618: 4614: 4610: 4606: 4605: 4601: 4597: 4595: 4591: 4590: 4586: 4582: 4580: 4576: 4575: 4571: 4567: 4566: 4563: 4558: 4554: 4548: 4544: 4541: 4539: 4535: 4532: 4531: 4518: 4514: 4508: 4500: 4496: 4492: 4485: 4477: 4473: 4469: 4463: 4448: 4444: 4437: 4418: 4414: 4410: 4403: 4396: 4388: 4382: 4375:. 2017-12-02. 4374: 4370: 4364: 4356: 4352: 4346: 4338: 4334: 4328: 4320: 4316: 4309: 4295:on 2015-06-02 4294: 4290: 4283: 4275: 4271: 4267: 4263: 4259: 4255: 4248: 4240: 4236: 4231: 4226: 4222: 4218: 4214: 4207: 4198: 4194: 4188: 4180: 4176: 4171: 4166: 4162: 4158: 4154: 4147: 4139: 4135: 4131: 4127: 4123: 4119: 4115: 4111: 4104: 4096: 4089: 4081: 4077: 4073: 4069: 4065: 4061: 4054: 4046: 4042: 4037: 4032: 4028: 4024: 4020: 4016: 4012: 4005: 3996: 3995: 3990: 3984: 3976: 3972: 3968: 3964: 3960: 3956: 3952: 3948: 3941: 3927:on 2010-03-24 3926: 3922: 3916: 3900: 3896: 3890: 3882: 3878: 3874: 3870: 3863: 3861: 3859: 3857: 3842: 3838: 3832: 3824: 3820: 3816: 3812: 3808: 3804: 3800: 3796: 3792: 3788: 3784: 3777: 3769: 3765: 3761: 3757: 3753: 3749: 3742: 3734: 3730: 3726: 3722: 3715: 3707: 3703: 3699: 3695: 3691: 3687: 3683: 3679: 3678:Pain Practice 3671: 3663: 3659: 3655: 3651: 3647: 3643: 3640:(2): 91–101. 3639: 3635: 3627: 3619: 3615: 3608: 3600: 3596: 3590: 3582: 3578: 3573: 3568: 3564: 3560: 3556: 3552: 3548: 3541: 3539: 3530: 3526: 3522: 3518: 3514: 3510: 3506: 3502: 3495: 3487: 3483: 3479: 3475: 3471: 3467: 3463: 3459: 3452: 3444: 3440: 3436: 3432: 3428: 3424: 3417: 3409: 3405: 3400: 3395: 3391: 3387: 3383: 3379: 3375: 3368: 3360: 3356: 3351: 3346: 3342: 3338: 3337:Pain Medicine 3334: 3327: 3325: 3323: 3321: 3319: 3310: 3306: 3301: 3296: 3292: 3288: 3284: 3277: 3263:on 2014-01-02 3262: 3258: 3252: 3244: 3240: 3236: 3232: 3228: 3224: 3221:(4): 339–53. 3220: 3216: 3209: 3201: 3197: 3193: 3189: 3185: 3181: 3177: 3173: 3166: 3158: 3154: 3149: 3144: 3140: 3136: 3132: 3128: 3124: 3117: 3109: 3105: 3101: 3097: 3093: 3089: 3088:Pain Medicine 3081: 3073: 3069: 3064: 3059: 3055: 3051: 3047: 3043: 3039: 3035: 3031: 3024: 3022: 3020: 3011: 3007: 3003: 2999: 2994: 2989: 2986:(2): 351–66. 2985: 2981: 2974: 2972: 2963: 2959: 2955: 2951: 2947: 2943: 2939: 2935: 2928: 2920: 2916: 2912: 2908: 2904: 2900: 2896: 2892: 2884: 2876: 2872: 2868: 2864: 2860: 2856: 2853:(6): 505–12. 2852: 2848: 2841: 2839: 2824:on 2013-11-02 2823: 2819: 2813: 2805: 2801: 2797: 2793: 2789: 2785: 2781: 2777: 2769: 2761: 2757: 2753: 2749: 2745: 2741: 2737: 2733: 2726: 2718: 2714: 2710: 2706: 2702: 2698: 2694: 2690: 2683: 2675: 2671: 2667: 2663: 2658: 2653: 2649: 2645: 2641: 2637: 2633: 2626: 2618: 2612: 2608: 2607: 2599: 2591: 2587: 2582: 2577: 2573: 2569: 2565: 2561: 2557: 2550: 2542: 2538: 2534: 2530: 2526: 2522: 2518: 2514: 2506: 2504: 2502: 2493: 2489: 2484: 2479: 2474: 2469: 2465: 2461: 2457: 2450: 2442: 2438: 2434: 2430: 2426: 2422: 2415: 2407: 2403: 2398: 2393: 2388: 2383: 2379: 2375: 2371: 2367: 2363: 2356: 2348: 2344: 2339: 2334: 2330: 2326: 2322: 2315: 2307: 2303: 2299: 2295: 2291: 2287: 2283: 2279: 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Index

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Redundancy (engineering)
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tibial bone fracture
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pain
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Text is available under the Creative Commons Attribution-ShareAlike License. Additional terms may apply.