Complex Regional Pain Syndromes Follow-up

  • Author: Anthony H Wheeler, MD; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
 
Updated: Jul 15, 2016
 

Further Outpatient Care

Patients with CRPS type I should receive care at a pain clinic in which appropriate evaluation and treatment can minimize their discomfort and degree of disability.

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Further Inpatient Care

With CRPS type I, inpatient care is typically reserved for patients with refractory pain or infections of the atrophic limb, patients requiring surgery, and sometimes patients requiring other procedures.

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Transfer

Patients should be referred to a pain clinic as soon as CRPS type I is suspected on clinical grounds.

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Deterrence/Prevention

The early treatment of pain appears to decrease the frequency of chronic disease and later complications.

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Complications

Complications can include the following:

  • Osteoporosis
  • Limitation of active joint movement
  • Infections
  • Nodular fasciitis of the palmar or plantar skin
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Prognosis

Approximately 80% of patients with CRPS type I achieve complete, spontaneous relief of signs and symptoms within 18 months; however, no diagnostic criteria have been shown to predict which patients will fall into this category. Some of the patients whose symptoms do not resolve spontaneously may still be cured by treatment.

Of the patients who develop refractory CRPS type I, 50-80% have disability secondary to pain and/or a limited range of motion. The main disabilities are limitations in their activities of daily living (ADL).

Prolonged symptoms and signs, trophic changes, and primarily cold CRPS type I are all associated with a higher chance of poor outcomes and disability.

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Patient Education

Patients should be informed that, even while wearing a cast, their treatment will include mild, passive range-of-motion exercises. After the cast is removed, physical and occupational therapy should be started immediately, and some ADLs should be resumed as soon as possible in accordance with the recommendations of the physical and occupational therapists.

 

Online Patient Education Resources

There are a number of online resources that patients may find to be helpful. Four sites are listed below. Patients should be mindful of the fact that not all online information is reliable. Disparities can be found between information on different sites or even between information on different parts of the same site. These online resources should be view as a starting point for discussion between the patient and her or his healthcare provider.

American Chronic Pain Association

https://theacpa.org/

American RSDHope

http://www.rsdhope.org/crps.html

International Research Foundation for RSD/CRPS

http://www.rsdfoundation.org/

Reflex Sympathetic Dystrophy Syndrome Association (RSDSA)

http://www.rsds.org

 

Many patients inquire about clinical trials of new treatment methods.

The website www.clinicaltrials.gov  is a good source of information about clinical trials on CRPS (and most other disease). The specific link within this site to CRPS is https://clinicaltrials.gov/ct2/results?term=Complex%20Regional%20Pain%20Syndrome

One can also use the site’s own search function.

 

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Contributor Information and Disclosures
Author

Anthony H Wheeler, MD Pain and Orthopedic Neurology, Charlotte, North Carolina

Anthony H Wheeler, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pain Medicine, North American Spine Society, North Carolina Medical Society

Disclosure: Received salary from Allergan, Inc. for speaking and teaching; Received none from Gralise for consulting.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Glenn Lopate, MD Associate Professor, Department of Neurology, Division of Neuromuscular Diseases, Washington University School of Medicine; Consulting Staff, Department of Neurology, Barnes-Jewish Hospital

Glenn Lopate, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, Phi Beta Kappa

Disclosure: Nothing to disclose.

Chief Editor

Stephen A Berman, MD, PhD, MBA Professor of Neurology, University of Central Florida College of Medicine

Stephen A Berman, MD, PhD, MBA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, Phi Beta Kappa

Disclosure: Nothing to disclose.

Additional Contributors

Jorge E Mendizabal, MD Consulting Staff, Corpus Christi Neurology

Jorge E Mendizabal, MD is a member of the following medical societies: American Academy of Neurology, National Stroke Association, American Headache Society, Stroke Council of the American Heart Association

Disclosure: Nothing to disclose.

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CPRS: complex regional pain syndrome; SMP: sympathetically maintained pain.
 
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