Sudomotor/edema
3
Edema and/or sweating changes and/or sweating asymmetry.
Motor/trophic
4 Decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes (hair/nail/skin). Note. R. Norman Harden, Stephen Bruehl, Michael Stanton-Hicks, Peter R. Wilson; Proposed New Diagnostic Criteria for Complex Regional Pain Syndrome, Note. Pain Medicine, 8(4), 1 May 2007, Pages 326–331, https://doi.org/10.1111/j.1526-4637.2006.00169.x.
CRPS can take a long time to diagnose, leading to impaired function, client distress, and dissatisfaction with the medical system. Tests that can assist with the diagnosis include thermography (a test to show temperature changes and lack of blood supply in the affected limb), limb magnetic resonance imaging (MRI), bone scans, nerve conduction studies, ischemia tests, and X-rays (Birklein & Dimova, 2017). Unfortunately, there is no cure for CRPS. There is also little evidence to support specific treatments for this debilitating condition. The limited number of clients, the differences in and changes to the diagnostic criteria, the varied nature of the symptoms and the fact that it is unknown whether remission is due to Fibromyalgia Fibromyalgia is characterized as a musculoskeletal disorder with widespread pain accompanied by fatigue, as well as memory, sleep, and emotional and mental distress (Centers for Disease Control and Prevention, 2018). The prevalence of fibromyalgia in the general population is approximately 0.2% to 6.6% worldwide, including 6.4% of the U.S. population (Marques, Santo, Berssaneti, Matsutani, & Yuan, 2017). This updated literature review found the prevalence in women to be between 2.4% and 6.8%, between 0.7% and 11.4% for those living in urban areas and 0.01% and 5.2% for those living in rural areas (Marques et al., 2017). The American College of Rheumatology has updated established criteria for the diagnosis of fibromyalgia (Wolfe et al., 2010). In the Widespread Pain Index (WPI), clients indicate the number of painful body regions. In the Symptom Severity (SS) scale, the person rates symptom severity on a scale of 0 to 3 (with a higher number indicating more severe symptoms) for fatigue, waking unrefreshed, cognitive symptoms, and somatic (physical) symptoms (such as muscle pain, irritable bowel syndrome, muscle weakness, headache, pain/cramps in the abdomen) (Wolfe et al., 2010). Patients are deemed to have met the diagnostic criteria for fibromyalgia if their scores on the WPI and SS are higher than 7 and 5, respectively, or if their scores on the WPI are lower (3 to 6) but their scores on the SS are higher than 9; their symptoms have presented consistently for a minimum of 3 months at a similar level of intensity; and they have no other disorder that would account for the pain they are experiencing (Wolfe et al., 2010). Individuals with fibromyalgia often experience additional symptoms of sleep disorders, paresthesia, tenderness, stiffness, mood disturbances, and anxiety (Sommer, 2010; Wolfe et al., 2010). Recovery is unusual for those with fibromyalgia so, the focus on treatment tends to be management of the symptoms (Kwiatek, Considerations for pain across the life span Pediatric chronic pain has become an increasingly recognized clinical problem (Linhares et al., 2012; Liossi & Howard, 2016). Although the prevalence of pediatric pain is relatively high, ranging between 20% and 46% worldwide, it continues to be under recognized and undertreated (King et al., 2011; Stanford, Chambers, Biesanz, & Chen, 2008; Walther-Larsen et al., 2017). Reyes and Brown (2016) completed a study looking at what Canadian occupational therapy practitioners know about pain and found that there was a limited understanding of how children experience pain. The ability to report pain improves for most children as they develop the ability to communicate. However, for those who experience cognitive or communication limitations or are otherwise restricted in the ability to express themselves, reporting pain becomes unreliable (Sekhon, Fashler,
treatment or spontaneously occurs makes it difficult to study (Palmer, 2015). Recommended treatments include physical and occupational therapy (edema control, desensitization, contrast baths, sensory reeducation, and graded strengthening), psychotherapy (in particular, cognitive behavioral therapy [CBT]), medications (including pain medicines, steroids, certain blood pressure medicines, bone loss medicines, and antidepressants), and certain invasive techniques (nerve blocks, pain pump, stimulator; Palmer, 2015). Because clients and their families often do not know anyone else with the disease and feel isolated and misunderstood, local support groups can be of great help to this population (See the Resources section). 2017). Unfortunately, responsiveness to fibromyalgia therapies varies, with only 30% to 50% of individuals experiencing clinically significant improvements of their symptoms (Staud, 2010). Treatment approaches include self-management skills training, exercise, and pharmaceutical approaches. Self- management involves education, coping skills training. and use of cognitive behavioral approaches to address changes in thinking and behavior (Kwiatek, 2017). Helpful exercise activities include aerobic exercise, muscle strength training, stretching, and aerobic exercise (Sosa-Reina et al., 2017). In addition, exercise-based complementary and alternative medicine (CAM) interventions including tai chi, qigong, and yoga have been found to help patients with fibromyalgia (Lauche, Cramer, Häuser, Dobos, & Langhorst, 2015). In addition the use of mind/ body CAM interventions such as meditation, mindfulness-based stress reduction, and guided imagery all have a positive effect on the symptoms of fibromyalgia (Lauche et al., 2015). The use of CAM in pain management will be discussed in a later section. Currently, there are three types of FDA-approved drugs for fibromyalgia, and medical management is found to be only partially successful (Macfarlane et al., 2016). These include an antiepileptic drug (pregabalin) and two serotonin-norepinephrine reuptake inhibitors (SNRIs) (Forte et al., 2015). Antidepressants, analgesics, opioid analgesics, anti-inflammatories, and muscle relaxants are used off-label for the treatment of fibromyalgia in the United States (Forte et al., 2015). According to Stutts et al. (2009), one factor underlying the varied responses to treatment using pharmaceutical and nonpharmaceutical approaches may be the client’s high expectations of efficacy of treatment. The authors advise healthcare professionals to incorporate those expectations into treatment plans, provide education, and set realistic goals with clients. Versloot, Lee, & Craig, 2017). When reviewing the evidence for children’s experiences of postoperative pain management, Sng et al. (2017) found that children are able to communicate to their parents that they were in pain and provide accurate information on the intensity of the pain. Children did need the parent to advocate for pain management, as the child is less likely to share this information with nursing or other staff. The causes for the pain can be due to a chronic condition, injury, surgery, and can occur without a definitive cause or explanation. Depending on the condition, there are indicators for some interventions. Nerve blocks are often used with children who experience cancer pain, phantom limb pain, and CRPS. Pain caused by spasticity may be treated with baclofen and juvenile
Page 85
Book Code: SWUS1524B
EliteLearning.com/Social-Work
Powered by FlippingBook