Complex Regional Pain Syndrome

 

Definition:

·         A chronic pain syndrome

·         Usually affecting a limb

·         Usually precipitated by injury

·         With complex pathophysiology

·         And variable prognosis

 

Pathophysiology:

·         Somatic nervous system dysfunction

·         Autonomic nervous system dysfunction

·         Inflammation and immune dysfunction

·         Endocrine dysfunction

 

Diagnostic criteria:

Sensory

·      Disproportionate pain

Motor

·      Weakness

·      Atrophy

·      Dystonia

·      Tremor

Other

·      Vasomotor (colour, temp, swelling)

·      Sudomotor (↑ or ↓)

·      Trophic (skin, hair, nails)

 

Types:

CRPS Type I

·      No nerve injury

·      Formerly “Reflex Sympathetic Dystrophy”

CRPS Type II

·      Yes nerve injury (trauma, surgery)

·      Formerly “Causalgia”

 

Phases:

Acute phase – hot

(70%)

Inflammation:

·      Red

·      Hot

·      Swollen

·      Sweaty

Acute phase – cold

(30%)

Ischaemia:

·      Coldwa

·      White, blue

·      Dry

Chronic phase

Central phenomena:

·      Hyperalgaesia

·      Spreading pain

·      Sensory deficit

·      Motor dysfunction

 

Treatment: not one-size-fits-all

Pain

Drugs:

·      Ketamine infusion

·      Lignocaine infusion

·      Gabapentinoids

·      Tricyclic antidepressants

Procedures:

·      Sympathetic nerve block

·      Spinal cord stimulation

·      Dorsal root ganglion stimulation

·      Intramuscular botox

·      Intrathecal baclofen

Inflammation

·      Glucocorticoids 6/52

Osteopaenia

·      Bisphosphonate

Disuse

·      Rehabilitation

·      Physiotherapy

Distorted representation

·      Mirror therapy

·      Graded motor imagery

Psychopathology

·      Cognitive behavioural therapy

 

 

Feedback welcome at ketaminenightmares@gmail.com