Do Severity Score and Skin Temperature Asymmetry Correlate with the Subjective Pain Score in the Patients with Complex Regional Pain Syndrome?

Background: Complex regional pain syndrome (CRPS) is a neurologic condition that can present with severe pain and dysfunction. Delay in treatment adversely affects outcomes. The purpose of this study is to evaluate patient outcomes as they relate to the time from diagnosis to pain management referral once the diagnosis of CRPS has been made in a closed healthcare system. Methods: A retrospective record review from a closed healthcare system was utilized for CRPS cases from 2010–2019. Demographics, injury pattern, surgeries, pain score, treatment modalities, occupational outcomes, and time to pain management referral were recorded. Results: There were 26 cases of CRPS that met inclusion criteria. The mean time from diagnosis to treatment was 55 days. 16/26 (61.5%) were medically discharged from the military. 23/26 (88.5%) were unable to return to full duty due to CRPS. There was no significant difference in the reported pain scores over time regardless of treatment (p = 0.76). A linear regression demonstrated a significantly higher Visual Analog Scale Pain Score (VAS) over time in patients that were medically discharged (p = 0.022). Conclusions: The mean delay in referral to the pain service was 55 days. The majority of patients (88.5%) did not return to full duty secondary to the diagnosis of CRPS, and 61.5% of patients required medical separation from active duty. Due to the negative impact that the diagnosis of CRPS has on occupational outcomes with a mean delay in referral of 55 days, clinics and providers should set up referral criteria and establish early pain pathways for patients diagnosed with CRPS.

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Poster 314 Complex Regional Pain Syndrome Severity Score: Development of A Clinical Tool For Monitoring Disease Evolution

PM&R ◽

10.1016/j.pmrj.2011.08.342 ◽

2011 ◽

Vol 3 ◽

pp. S281-S281

Author(s):

Anjum Sayyad ◽

Joseph R. Graciosa ◽

R.N. Harden ◽

Geneva Jacobs ◽

Maxine M. Kuroda ◽

...

Keyword(s):

Complex Regional Pain Syndrome ◽

Severity Score ◽

Pain Syndrome ◽

Clinical Tool ◽

Disease Evolution

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CRPS: what’s in a name? Taxonomy, epidemiology, neurologic, immune and autoimmune considerations

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2018-100064 ◽

2019 ◽

Vol 44 (3) ◽

pp. 376-387 ◽

Cited By ~ 5

Author(s):

Michael d‘A Stanton-Hicks

Keyword(s):

Nervous System ◽

Autonomic Nervous System ◽

Complex Regional Pain Syndrome ◽

Severity Score ◽

Clinical Management ◽

Pain Syndrome ◽

Clinical Syndromes ◽

Shed Light ◽

Historical Origins

This account of the condition now termed complex regional pain syndrome (CRPS) spans approximately 462 years since a description embodying similar clinical features was described by Ambroise Paré in 1557. While reviewing its historical origins, the text describes why it became necessary to change the taxonomies of two clinical syndromes with similar pathophysiologies to one which acknowledges this aspect but does not introduce any mechanistic overtones. Discussed at length is the role of the sympathetic component of the autonomic nervous system (ANS) and why its dysfunction has both directly and indirectly influenced our understanding of the inflammatory aspects of CRPS. As the following article will show, our knowledge has expanded in an exponential fashion to include musculoskeletal, immune, autoimmune, central and peripheral nervous system and ANS dysfunction, all of which increase the complexity of its clinical management. A burgeoning literature is beginning to shed light on the mechanistic aspects of these syndromes and the increasing evidence of a genetic influence on such factors as autoimmunity, and its importance is also discussed at length. An important aspect that has been missing from the diagnostic criteria is a measure of disease severity. The recent validation of a CRPS Severity Score is also included.

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Diurnal and Nocturnal Skin Temperature Regulation in Chronic Complex Regional Pain Syndrome

Journal of Pain ◽

10.1016/j.jpain.2014.11.012 ◽

2015 ◽

Vol 16 (3) ◽

pp. 207-213 ◽

Cited By ~ 2

Author(s):

Johanna C.M. Schilder ◽

Sjoerd P. Niehof ◽

Johan Marinus ◽

Jacobus J. van Hilten

Keyword(s):

Skin Temperature ◽

Complex Regional Pain Syndrome ◽

Temperature Regulation ◽

Pain Syndrome

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A comparison of the accuracy of two sets of diagnostic criteria in the early detection of complex regional pain syndrome following surgical treatment of distal radial fractures

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193412469142 ◽

2012 ◽

Vol 38 (6) ◽

pp. 609-615 ◽

Cited By ~ 6

Author(s):

A. Żyluk ◽

H. Mosiejczuk

Keyword(s):

Surgical Treatment ◽

Complex Regional Pain Syndrome ◽

Severity Score ◽

International Association ◽

Pain Syndrome ◽

Distal Radial Fracture ◽

Radial Fracture ◽

Distal Radial Fractures ◽

Need For Treatment ◽

Severity Scores

A total of 120 patients were examined for the presence of symptoms of complex regional pain syndrome after surgical treatment of a distal radial fracture. The patients were assessed at six weeks and 71 of them were also assessed at 12 weeks. The International Association for the Study of Pain criteria and the complex regional pain syndrome severity score were used to make the diagnosis. At six weeks, ten patients (8.3%) met the criteria of complex regional pain syndrome in both the International Association for the Study of Pain and complex regional pain syndrome scores. At 12 weeks six patients (8.4%) met International Association for the Study of Pain and two (2.8%) patients the complex regional pain syndrome severity score criteria. Only one of the patients diagnosed with complex regional pain syndrome required treatment for the complex regional pain syndrome. In all the other patients the features of complex regional pain syndrome settled spontaneously. Our results suggest that complex regional pain syndrome after distal radius fractures occurs less frequently than was previously reported. The International Association for the Study of Pain criteria and the complex regional pain syndrome severity scores showed similar sensitivity in early diagnosis of complex regional pain syndrome, but both are poor indicators of the need for treatment.

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