complex regional pain syndrome

Question 1

CRPS types

Answer 1

I pain without identifiable nerve lesion
II identifiable nerve injury or compression
III other (ex fibromyalgia)

Question 2

CPRS definition

Answer 2

sympathetically independent pain more refractory to treatment.
Must meet 3 criteria
1. initiating noxious event (ex DRF)
2. continued pain disproportionate to event and beyond single nerve distribution
3. edema, skin blood flow abnormality, or abnormal pseudomotor activity (ex sweating)
4. no other diagnosis
can diagnose with stellate ganglion block or oral sympathetic challange

Question 3

pain fibers

Answer 3

A g and C afferent fibers to dorsal horn of the spinal cord to the spinothalmic tract to brain (cortical modulation)

Question 4

mean duration CPRS

Answer 4

3 years

Question 5

stages CPRS

Answer 5

acute - aching, burning, hyperemia
dystrophic - tissue thickening
atrophic - cool skin, contracture, less pain

Question 6

xray CPRS

Answer 6

peri-articular demineralization

bone scan more sensitive/specific

Question 7

CPRS prevention

Answer 7

Vit C 500 mg for 50 days with DRF

antioxidant affect wall permeability

Question 8

CPRS treatment

Answer 8

• OT/PT
• nerve stimulation
• sympathetic nerve blocks
• antidepressants, anticonvulsants, antiadrenergic, steroids, bisphosphonates
• nerve decompression for type II
• amputation not very effective
• consider stellate ganglion block if need surgery in teh future after CPRS diagnosis