eMedicine Specialties > Physical Medicine and Rehabilitation > Upper Limb Musculoskeletal Conditions

Complex Regional Pain Syndromes: Follow-up

Author: Manish K Singh, MD, Assistant Professor, Department of Neurology, Teaching Faculty for Pain Management and Neurology Residency Program, Hahnemann University Hospital, Drexel College of Medicine; Medical Director, Neurology and Pain Management, Jersey Institute of Neuroscience
Coauthor(s): Jashvant Patel, MD, Medical Director, Department of Pain Medicine and Comprehensive Rehabilitation, Medical College of Pennsylvania Hahnemann University; John Grothusen, PhD, Director of Quantitative Sensory and Autonomic Nervous System Laboratory, Assistant Professor, Department of Neurology, MCP Hahnemann University; Patrick M Foye, MD, FAAPMR, FAAEM, Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine and Dentistry of New Jersey, New Jersey Medical School
Contributor Information and Disclosures

Updated: Sep 22, 2009

Follow-up

Further Inpatient Care

  • Hospitalization usually is not required for patients with RSD, but it depends on how invasive the treatment choice is for pain control and the severity of the case. Sometimes, a short hospitalization is necessary for individuals who need a continuous nerve block. Patients with RSD also may have other associated orthopedic conditions that may be amenable to surgery and that require further inpatient care.

Further Outpatient Care

  • Patients with RSD generally are treated on an outpatient basis and require a variety of health care professionals to optimally manage their condition. Please refer to the Treatment section for a discussion of proper rehabilitation methods and other treatment options.

Deterrence

  • Recognition of RSD at the early stage is very important to achieve the best result and to prevent spread and progression toward the chronic stage (which is usually more difficult to treat).

Complications

  • Chronic edema (occasionally chronic lymphedema)
  • Chronic relapsing infections and ulcers resistant to treatment
  • Brown-gray, scaly pigmentations of the skin
  • Recurrent, unexplained, spontaneous hematomas
  • Dystonia, tremor, and other movement disorders
  • Clubbing of fingers or toes and hourglass nails
  • Depression and other psychiatric disorders

Prognosis

  • Dumitru's report suggests that, in comparison with adults, children are less disabled from and have more favorable prognoses with RSD.31

Patient Education

  • Patient education is very important in the treatment of individuals with RSD. The patient with chronic, debilitating pain usually tries to protect the affected body part and keep it immobile, which leads to further stiffness and a possible frozen joint. The patient's physical and occupational therapists need to educate him/her in the use of the affected extremity through activities of daily living (ADL). Patients with RSD also need to learn about ways to minimize pain. A home exercise program and instruction in the use of a TENS unit may be beneficial. Education and counseling relating to coping with and managing pain are important in patients with RSD, because depression and narcotic dependence can develop.
  • For excellent patient education resources, visit eMedicine's Muscle Disorders Center. Also, see eMedicine's patient education article Chronic Pain.

Miscellaneous

Medicolegal Pitfalls

  • Patients with RSD often are labeled psychogenic or malingering if their pain sources are not recognized, which especially may occur in the early stages.
  • Recognition and treatment of RSD at the early stages are very important in order to maximize outcome.

Special Concerns

  • RSD is rare in childhood, but it has significant morbidity. Therefore, awareness of this disease is important because it allows children with this condition to be recognized earlier and referred for appropriate treatment. As noted by Murray, awareness may avoid unnecessary investigations and treatments that may worsen the condition.
  • According to one report on 70 children (<18 y, predominantly girls [59 of 70 patients]) with RSD (lower extremity [61 of 70 patients]), 38 patients had some degree of residual pain and dysfunction after the usual conservative treatment. As in studies in adults, delay in diagnosis was reported (average time from the initial injury to the diagnosis was 1 y).
 
Acknowledgments

Debra Ibrahim, 4th year medical student, New York College of Osteopathic Medicine, Class of 2008, assisted with a previous revision of this manuscript.



More on Complex Regional Pain Syndromes

Overview: Complex Regional Pain Syndromes
Differential Diagnoses & Workup: Complex Regional Pain Syndromes
Treatment & Medication: Complex Regional Pain Syndromes
Follow-up: Complex Regional Pain Syndromes
Multimedia: Complex Regional Pain Syndromes
References
Further Reading
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Keywords

complex regional pain syndrome, CRPS, RSD, regional pain syndrome, reflex sympathetic dystrophy, reflex sympathetic dystrophy syndrome, RSD symptoms, RSD CRPS, RSD pain, RSD treatment, causalgia, complex regional pain syndrome I, CRPS I, complex regional pain syndrome II, CRPS II, mimo-causalgia, Sudeck atrophy of bone, shoulder-hand syndrome, algoneurodystrophy, reflex dystrophy, reflex neurovascular dystrophy

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Contributor Information and Disclosures

Author

Manish K Singh, MD, Assistant Professor, Department of Neurology, Teaching Faculty for Pain Management and Neurology Residency Program, Hahnemann University Hospital, Drexel College of Medicine; Medical Director, Neurology and Pain Management, Jersey Institute of Neuroscience
Manish K Singh, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pain Medicine, American Association of Physicians of Indian Origin, American Headache Society, American Medical Association, and American Society of Regional Anesthesia and Pain Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Jashvant Patel, MD, Medical Director, Department of Pain Medicine and Comprehensive Rehabilitation, Medical College of Pennsylvania Hahnemann University
Jashvant Patel, MD is a member of the following medical societies: Alberta Medical Association, American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American Medical Association, American Society of Regional Anesthesia and Pain Medicine, and Medical Society of the State of New York
Disclosure: Nothing to disclose.

John Grothusen, PhD, Director of Quantitative Sensory and Autonomic Nervous System Laboratory, Assistant Professor, Department of Neurology, MCP Hahnemann University
Disclosure: Nothing to disclose.

Patrick M Foye, MD, FAAPMR, FAAEM, Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine and Dentistry of New Jersey, New Jersey Medical School
Patrick M Foye, MD, FAAPMR, FAAEM is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, and International Spine Intervention Society
Disclosure: Nothing to disclose.

Medical Editor

Robert J Kaplan, MD, James E Van Zandt VA Medical Center, Staff Physician, Department of Rehabilitation Medicine
Robert J Kaplan, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Patrick M Foye, MD, FAAPMR, FAAEM, Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine and Dentistry of New Jersey, New Jersey Medical School
Patrick M Foye, MD, FAAPMR, FAAEM is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, and International Spine Intervention Society
Disclosure: Nothing to disclose.

CME Editor

Kelly L Allen, MD, Regional Medical Director, IMX-Medical Management Services
Disclosure: Nothing to disclose.

Chief Editor

Rene Cailliet, MD, Professor-Chairman Emeritus, Department of Rehabilitation Medicine, University of Southern California School of Medicine; Former Director, Department of Rehabilitation Medicine, Santa Monica Hospital Medical Center
Rene Cailliet, MD is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American Pain Society, Association of American Medical Colleges, International Association for the Study of Pain, and Pan American Medical Association
Disclosure: Nothing to disclose.

 
 
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