4.3 Complex Regional Pain Syndrome

Question 1

Outline Signs and Symptoms

Diagnosis of CPRS

Answer 1

Ongoing pain
Disproportionate to original
insult or injury

1 Sign present from >=2 subset

1 Symptom from each subset

Question 2

Signs + Symptoms

Answer 2

1. Sensory
2. Motor / Trophic
3. Sudomotor
4. Vasomotor

Question 3

1. Sensory

Answer 3

Sx: allodynia / hyperalgesia

Sy: Hyperaesthesia

Question 4

2. Motor / Trophic

Answer 4

Decreased ROM 
Weakness
Skin
Hair
Nail changes

Question 5

3. Sudomotor

Answer 5

Hyper or hypo-hydrosis

Asymmetry sweating +/or Oedema

Question 6

4. Vasomotor

Answer 6

Change skin colour

Asymmetry kin colour +/ Temperature

Question 7

CRPS Rx

Answer 7

Aims provide symptomatic pain relief

+

Improve daily life

1. Pharmacological
2. Physical
3. Regional Techniques
4. Surgical techniques

Question 8

Pharmacological

Answer 8

1. Simple analgesia
2. Opioids
3. Antidepressants
   Anticonculsants
4. Calcitonin
5. Free radical scavengers
   Reduce inflammatory tissue damage
   Vit C / Topical dimethylsulphoxide
   Iv NAC

Question 9

2. Physical

Answer 9

1. PhysiotTx
   improve function and limit pain
2. Motor imagery training
   Mirror usage
   correct inappropriate cortical remapping
3. TENS
   Non invasive neuromod

Question 10

3. Regional techniques

Answer 10

1. Intrathecal drugs
   Op / clon
2. Preop pre emptive RA
   Lowers incidence and recurrence CRPS
3. Regional nerve block
   brachial or lumbar plexus
   consider catheter and infusion
4. Sympathetic Block
   IVRA
   Stellate ganglion

Question 11

4. Surgical techniques

Answer 11

1. Thoracic or lumbar sympathectomy
2. Spinal Cord stimulation
   implanted epidural electrode system
3. Limb amputation
   last resort
   irreversible infection / ischaemia

Question 12

5. Psychological

Answer 12

May be somatoform if exagg sy or sx

Aware yellow flags
anorexia / bullimia
consider Pysch r/b