Complex Regional Pain Syndrome

Multimodal Treatment ◽

Pain Syndrome ◽

Signs And Symptoms ◽

Burning Pain ◽

Patient Responsiveness ◽

Common Clinical Finding ◽

Interventional Therapies ◽

Complex regional pain syndrome (CRPS) is a challenging pain condition with incompletely elucidated pathophysiology, most often affecting a single extremity after an inciting injury. The most common clinical finding is burning pain out of proportion to any identifiable initiating event, with a combination of sensory, vasomotor, sudomotor, and motor/trophic signs and symptoms. The management of CRPS emphasizes early diagnosis and aggressive multimodal treatment based on physical therapy, psychological therapy, and pain management with frequent reassessments of patient progression. In order to prevent permanent life-altering disability, all modalities including interventional therapies should be escalated in tandem, based on assessments of patient responsiveness. Clinicians should consider escalating therapy frequently if no improvement is observed, and introducing psychological evaluation if symptoms persist. Lastly, the use of interventional techniques such as sympathetic blocks or spinal cord stimulation should be employed early in refractory cases.

Pediatric Complex Regional Pain Syndrome: Stellate Ganglion and Lumbar Sympathetic Blocks

Pediatric Anesthesia Procedures ◽

10.1093/med/9780190685188.003.0012 ◽

2021 ◽

pp. 167-174

Author(s):

Sarah Choxi

Keyword(s):

Early Recognition ◽

Multidisciplinary Treatment ◽

Stellate Ganglion ◽

Pain Syndrome ◽

Signs And Symptoms ◽

Nerve Blocks ◽

Distal Extremity ◽

Peripheral Nerve Blockade ◽

Complex regional pain syndrome (CRPS) is a chronic, localized pain condition following an injury, typically affecting a distal extremity. Although the pathophysiology of CRPS is unclear, multiple mechanisms are implicated, including peripheral and central sensitization as well as sympathetically mediated pain. Peripheral nerve blockade can treat the somatic component of CRPS pain, while sympathetic blockade may alleviate pain that is sympathetically mediated. Signs and symptoms manifest as abnormal sensory, motor, vasomotor, and sudomotor changes that are disproportionate to the inciting event. Early recognition of the signs and symptoms, followed by rapid implementation of a multidisciplinary treatment approach—including physical therapy, psychotherapy, pharmacotherapy, and sympathetic nerve blocks, is a major factor in improving outcome and preventing treatment-resistant CRPS.

Complex Regional Pain Syndrome

Acute Pain Medicine ◽

10.1093/med/9780190856649.003.0018 ◽

2019 ◽

pp. 262-270

Author(s):

Steven R. Hanling ◽

Ian M. Fowler ◽

C. Ryan Phillips

Keyword(s):

Chronic Pain ◽

Pain Syndrome ◽

Signs And Symptoms ◽

Pain Medication ◽

Channel Blockers ◽

Chronic Pain Condition ◽

Ion Channel Blockers ◽

Budapest Criteria ◽

Complex regional pain syndrome (CRPS) is a chronic pain condition that typically occurs after injury to a limb or directly to a nerve. Progression of the disease can result in multiple debilitating symptoms including pain disproportionate to the inciting event. The Budapest criteria cateforize the constellation of signs and symptoms of CRPS (sensory, vasomotor, sudomotor/edema, and motor/trophic changes) and are used to diagnose the syndrome. Treatments include rehabilitation (physical and occupation therapy), multimodal pain medication (medications that target neuropathic pain such as antidepressants, membrane stabilizers, and ion channel blockers), interventional treatments (sympathetic blocks, infusion catheters, neuromodulation), and psychological therapy.

Outcomes of Sympathetic Blocks in the Management of Complex Regional Pain Syndrome

Anesthesiology ◽

10.1097/aln.0000000000002899 ◽

2019 ◽

Vol 131 (4) ◽

pp. 883-893 ◽

Cited By ~ 2

Author(s):

Jianguo Cheng ◽

Vafi Salmasi ◽

Jing You ◽

Michael Grille ◽

Dongsheng Yang ◽

...

Keyword(s):

Spinal Cord ◽

Pain Relief ◽

Success Rate ◽

Spinal Cord Stimulation ◽

Pain Syndrome ◽

Pain Reduction ◽

Secondary Outcome ◽

Predictive Values ◽

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Sympathetic dysfunction may be present in complex regional pain syndrome, and sympathetic blocks are routinely performed in practice. To investigate the therapeutic and predictive values of sympathetic blocks, the authors test the hypotheses that sympathetic blocks provide analgesic effects that may be associated with the temperature differences between the two extremities before and after the blocks and that the effects of sympathetic blocks may predict the success (defined as achieving more than 50% pain reduction) of spinal cord stimulation trials. Methods The authors performed a retrospective study of 318 patients who underwent sympathetic blocks in a major academic center (2009 to 2016) to assess the association between pain reduction and preprocedure temperature difference between the involved and contralateral limbs. The primary outcome was pain improvement by more than 50%, and the secondary outcome was duration of more than 50% pain reduction per patient report. The authors assessed the association between pain reduction and the success rate of spinal cord stimulation trials. Results Among the 318 patients, 255 were diagnosed with complex regional pain syndrome and others with various sympathetically related disorders. Successful pain reduction (more than 50%) was observed in 155 patients with complex regional pain syndrome (155 of 255, 61%). The majority of patients (132 of 155, 85%) experienced more than 50% pain relief for 1 to 4 weeks or longer. The degree and duration of pain relief were not associated with preprocedure temperature parameters with estimated odds ratio of 1.03 (97.5% CI, 0.95–1.11) or 1.01 (97.5% CI, 0.96–1.06) for one degree decrease (P = 0.459 or 0.809). There was no difference in the success rate of spinal cord stimulation trials between patients with or without more than 50% pain relief after sympathetic blocks (35 of 40, 88% vs. 26 of 29, 90%, P > 0.990). Conclusions The authors conclude that sympathetic blocks may be therapeutic in patients with complex regional pain syndrome regardless of preprocedure limb temperatures. The effects of sympathetic blocks do not predict the success of spinal cord stimulation.

246 THE COST-EFFECTIVENESS OF SPINAL CORD STIMULATION FOR COMPLEX REGIONAL PAIN SYNDROME

European Journal of Pain Supplements ◽

10.1016/s1754-3207(10)70251-0 ◽

2010 ◽

Vol 4 (S1) ◽

pp. 71-72

Author(s):

M.A. Kemler ◽

J.H. Raphael ◽

R.S. Taylor ◽

A. Bentley

Keyword(s):

Spinal Cord ◽

Cost Effectiveness ◽

Spinal Cord Stimulation ◽

Pain Syndrome ◽

The Cost

Effect of spinal cord stimulation in Type I complex regional pain syndrome with 2 rare severe cutaneous manifestations

Journal of Neurosurgery ◽

10.3171/2008.4.17506 ◽

2009 ◽

Vol 110 (2) ◽

pp. 274-278

Author(s):

Kim Rijkers ◽

Jasper van Aalst ◽

Erkan Kurt ◽

Marc A. Daemen ◽

Emile A. M. Beuls ◽

...

Keyword(s):

Spinal Cord ◽

Female Patient ◽

Spinal Cord Stimulation ◽

Scientific Literature ◽

Pain Syndrome ◽

Type I ◽

Syndrome Type ◽

Cutaneous Manifestations ◽

Giant Bullae

The authors present the case of a 49-year-old female patient with complex regional pain syndrome–Type I (CRPSI) who was suffering from nonhealing wounds and giant bullae, which dramatically improved after spinal cord stimulation (SCS). The scientific literature concerning severe cutaneous manifestations of CRPS-I and their treatment is reviewed. Nonhealing wounds and bullae are rare manifestations of CRPS-I that are extremely difficult to treat. Immediate improvement of both wounds and bullae after SCS, such as in this case, has not been reported previously in literature. Considering the rapidly progressive nature of these severe skin manifestations, immediate treatment, possibly with SCS, is mandatory.