CRPS

Question 1

Complex regional pain syndrome (CRPS)

Answer 1

neuropathic pain disorder with significant autonomic features that is usually subdivided into two variants:
CRPS 1
reflex sympathetic dystrophy (RSD)

CRPS 2 (documented nerve injury)
causalgia

Question 2

The major difference between CRPS 1 & 2

Answer 2

absence or presence of documented nerve injury

CRPS 1: no nerve injuries or lesions identified

CRPS 2 (causalgia): evidence of nerve damage

Question 3

may occur more commonly in (males/females)

Answer 3

Female

Question 4

Presentation

Answer 4

burning neuropathic pain + hyperalgesia and allodynia

ANS involvement:
* sweating (sudomotor changes)
* color
* skin temperature
* trophic changes in the skin, hair, or nails.

Decreased strength & ROM

Question 5

T/F
the pathophysiology of CRPS 1 and 2 is limited to the sympathetic nervous system.

Answer 5

False
involves both the sympathetic nervous system and the central nervous system

Question 6

Causalgia pain characteristic

Answer 6

burning pain

Question 7

Pain is exacerbated by factors that increase sympathetic tone, such as

Answer 7

fear, anxiety, light, noise, or touch

Question 8

CRPS 2
Causalgia commonly affects which locations?

Answer 8

• brachial plexus (esp median nerve)
• tibial division of the sciatic nerve

Question 8

Patients with CRPS often respond to ____ blocks

Answer 8

sympathetic

Question 9

T/F
Some patients recover spontaneously, but if CRPS is left untreated, other patients can progress to severe and irreversible functional disability.

Answer 9

True

Question 10

T/F
Sympathetic blocks and intravenous regional sympatholytic blockade are equally effective.

Answer 10

True

Question 11

physical therapy
-what should it entail?

Answer 11

active movement without weights and desensitization therapy

Question 12

Which of the alternative modalities can be used for acute phase CRPS?
* TENS
* Spinal cord stimulation
* tunneled epidural for infusion

Answer 12

tunneled epidural cath is used for acute phase

but other 2 are appropriate interventions overall

Question 13

Medication Therapy
For sympathetically maintained pain

Answer 13

PO α-adrenergic blockers
-nonselective phenoxybenzamine
- prazosin (α1-selective)
⚠️ Orthostatic hypoTN (increase dose gradually)

may also be beneficial:
-Anticonvulsant
-antidepressant

Question 14

Surgical sympathectomy
outcomes

Answer 14

(if chronic symptoms)

frequently results in only transient relief and, in some cases, a new, alternate pain syndrome

Question 15

Patients with pain refractory to prior medical or procedural therapies may respond to …

Answer 15

IV ketamine drip
(in a monitored setting)