Complex Regional Pain Syndrome

Question 1

What was Complex Regional Pain Syndrome previously called?

Answer 1

Reflex sympathetic Dystrophy (RSD)

Question 2

What does Complex Regional Pain Syndrome affect?

Answer 2

• ** The Extremities ***
• Pain
• Swelling
• Vasomotor dysfunction

Question 3

True or False: Complex Regional Pain Syndrome is a clinical diagnosis.

Answer 3

TRUE

Question 4

What causes Complex Regional Pain Syndrome?

Answer 4

Follows trauma or surgery

Question 5

What is epidemiology of Complex Regional Pain Syndrome?

Answer 5

M=F

30-60 with mean age 49 y/o

Question 6

What is special concering the presentaion of Complex Regional Pain Syndrome?

Answer 6

Usually affects only 1 extremity

Question 7

What are the 3 clinical phases of Complex Regional Pain Syndrome?

Answer 7

1. Acute - 3 months after onset
2. Subacute - 9 months after onset
3. Chonic - 1 year after onset

Question 8

What is involved with ACUTE phase of Complex Regional Pain Syndrome?

Answer 8

3 months after onset

Burning pain
Swelling
Redness
Hyperhidrosis
Coolness to touch
Functional limitations
Bone demineralization

Question 9

What is involved with SUBACUTE phase of Complex Regional Pain Syndrome?

Answer 9

9 months after onset

Several pain
Fixed edema
Pallor and cyanosis
Dry skin
Loss of function
- Joint fibrosis

Question 10

What is involved with CHRONIC phase of Complex Regional Pain Syndrome?

Answer 10

1 year after onet 
Can last for years or be permanent
Variable pain
Decreased edema
Skin- dry, pale, cool and shiny
Osteoporosis
Loss of function
- Joint fibrosis

Question 11

What will a physical exam show of Complex Regional Pain Syndrome?

Answer 11

Edema
- Disproportionate to severity of injury or event

Color changes
- Redness, cyanosis, pale

Stiffness/Decreased ROM

Skin moisture

Joint fibrosis

• Flexion contractures
• Frozen shoulder

Question 12

What is the diagnostic criteria for Complex Regional Pain Syndrome?

Answer 12

Continuing pain disproportionate to inciting event

At least 1 sign in 2 categories

At least 1 symptom in at least 3 categories

Absence of other dx that explains the S/S

Question 13

What labs and imaging are involved with Complex Regional Pain Syndrome?

Answer 13

Labs
- Nothing specific for CRPS

Plain films
- Bone demineralization

Triple phase bone scan

Question 14

What is involved in a Triple Phase Bone Scan?

Answer 14

+ in 50-90% of patients

Increased uptake in articular and periarticular structures

Not specific to RSD, but supportive of clinical diagnosis

Question 15

What is involved in the conservative approach to treatment of Complex Regional Pain Syndrome?

Answer 15

Patient education

Medications

• NSAIDs
• Corticosteroids

Sympathetic nerve block

Physical Therapy/Occupational therapy

Question 16

What is involved in the surgical approach to treatment of Complex Regional Pain Syndrome?

Answer 16

Upper thoracic/lumbar sympathectomy

Chemical sympathectomy

Spinal cord stimulator implantation

Question 17

What is involved with… at least 1 sign in 2 categories

Answer 17

• Sensory: increased pain with pinprick or light touch
• Vasomotor: color or temperature changes
• Sweating or edema
• Motor: decreased ROM, weakness, atrophy of skin or hair loss

Question 18

What is involved with… at least 1 symptom in at least 3 categories

Answer 18

• Sensory
• Vasomotor
• Sweating/edema
• Motor/hair or skin changes