Complex Regional Pain Syndrome in Emergency Medicine Follow-up

  • Author: Steven J Parrillo, DO, FACOEP, FACEP; Chief Editor: Robert E O'Connor, MD, MPH   more...
 
Updated: Apr 15, 2011
 

Further Inpatient Care

Although not FDA approved in the United States, in some countries, patients with complex regional pain syndrome are hospitalized and placed on continuous intravenous infusions of medications such as lidocaine or ketamine. As a dissociative anesthetic, the latter is intended to "erase" the memory of dysfunctioning neurons. Results have been variable.

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Further Outpatient Care

It is in the best interest of patients with complex regional pain syndrome (CRPS) to have a physician knowledgeable about this entity orchestrate all care. Appropriate referral is important.

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Deterrence/Prevention

It has been well documented that those with complex regional pain syndrome who are diagnosed earliest do the best. Once the disease is well established, it probably cannot be reversed.

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Complications

Once refractory to neural blockade, pain is probably lifelong and may be severe enough to be debilitating.

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Prognosis

Prognosis of complex regional pain syndrome depends largely on timely diagnosis and use of early aggressive therapy.

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Patient Education

Patients should be encouraged to seek out CRPS support groups.

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Contributor Information and Disclosures
Author

Steven J Parrillo, DO, FACOEP, FACEP  Associate Professor, Emergency Medicine, Jefferson Medical College and Philadelphia College of Osteopathic Medicine; Medical Director, Department of Emergency Medicine, Einstein Elkins Park; Chair, Emergency Management Committee, Albert Einstein Healthcare Network; Adjunct Professor, School of Health and Science, Philadelphia University; Medical Director and Faculty, Disaster Medicine and Management Masters Program, Philadelphia University

Steven J Parrillo, DO, FACOEP, FACEP is a member of the following medical societies: American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, American Osteopathic Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Joseph A Salomone III, MD  Associate Professor and Attending Staff, Truman Medical Centers, University of Missouri-Kansas City School of Medicine; EMS Medical Director, Kansas City, Missouri

Joseph A Salomone III, MD is a member of the following medical societies: American Academy of Emergency Medicine, National Association of EMS Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

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

Disclosure: Medscape Salary Employment

J Stephen Huff, MD  Associate Professor of Emergency Medicine and Neurology, Department of Emergency Medicine, University of Virginia School of Medicine

J Stephen Huff, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Neurology, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Robert E O'Connor, MD, MPH  Professor and Chair, Department of Emergency Medicine, University of Virginia Health System

Robert E O'Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Heart Association, American Medical Association, Medical Society of Delaware, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

References

  1. Schwartzman RJ. Reflex sympathetic dystrophy. Curr Opin Neurol Neurosurg. Aug 1993;6(4):531-6. [Medline].

  2. Campbell JN, Meyer RA, Raja SN. Is nociceptor activation by alpha-1 adrenoreceptors the culprit in sympathetically mediated pain?. Am Pain Soc J. 1992;1:3-11.

  3. Sharma A, Agarwal S, Broatch J, Raja SN. A web-based cross-sectional epidemiological survey of complex regional pain syndrome. Reg Anesth Pain Med. Mar-Apr 2009;34(2):110-5. [Medline].

  4. Goebel A, Baranowski A, Maurer K, Ghiai A, McCabe C, Ambler G. Intravenous immunoglobulin treatment of the complex regional pain syndrome: a randomized trial. Ann Intern Med. Feb 2 2010;152(3):152-8. [Medline].

  5. [Guideline] Reflex Sympathetic Dystrophy Syndrome Association (RSDSA). Complex regional pain syndrome: treatment guidelines. Jun 2006;[Full Text].

  6. Maihofner C, Handwerker HO, Neundorfer B, Birklein F. Mechanical hyperalgesia in complex regional pain syndrome: a role for TNF-alpha?. Neurology. Jul 26 2005;65(2):311-3. [Medline].

  7. Blaes F, Schmitz K, Tschernatsch M, et al. Autoimmune etiology of complex regional pain syndrome (M. Sudeck). Neurology. Nov 9 2004;63(9):1734-6. [Medline].

  8. Oaklander AL, Fields HL. Is reflex sympathetic dystrophy/complex regional pain syndrome type I a small-fiber neuropathy?. Ann Neurol. Jun 2009;65(6):629-38. [Medline].

  9. de Mos M, Huygen FJ, Stricker BH, Dieleman JP, Sturkenboom MC. The association between ACE inhibitors and the complex regional pain syndrome: Suggestions for a neuro-inflammatory pathogenesis of CRPS. Pain. Apr 2009;142(3):218-24. [Medline].

  10. Swart CM, Stins JF, Beek PJ. Cortical changes in complex regional pain syndrome (CRPS). Eur J Pain. Oct 2009;13(9):902-7. [Medline].

  11. Schwartzman RJ, Erwin KL, Alexander GM. The natural history of complex regional pain syndrome. Clin J Pain. May 2009;25(4):273-80.

  12. Stanton-Hicks M. Complex regional pain syndrome. Anesthesiol Clin North America. Dec 2003;21(4):733-44. [Medline].

  13. Tong HC, Nelson VS. Recurrent and migratory reflex sympathetic dystrophy in children. Pediatr Rehabil. Apr-Jun 2000;4(2):87-9. [Medline].

  14. Kachko L, Efrat R, Ben Ami S, Mukamel M, Katz J. Complex regional pain syndromes in children and adolescents. Pediatr Int. Aug 2008;50(4):523-7. [Medline].

  15. de Rooij AM, de Mos M, van Hilten JJ, Sturkenboom MC, Gosso MF, van den Maagdenberg AM, et al. Increased risk of complex regional pain syndrome in siblings of patients?. J Pain. Dec 2009;10(12):1250-5. [Medline].

  16. de Rooij AM, de Mos M, Sturkenboom MC, Marinus J, van den Maagdenberg AM, van Hilten JJ. Familial occurrence of complex regional pain syndrome. Eur J Pain. Feb 2009;13(2):171-7. [Medline].

  17. Merskey H, Bogduk N, eds. International Association for the Study of Pain. Classification of chronic pain: descriptions of chronic pain syndromes and definitions of pain terms. IASP Press; 1996.

  18. Perez RS, Collins S, Marinus J, Zuurmond WW, de Lange JJ. Diagnostic criteria for CRPS I: differences between patient profiles using three different diagnostic sets. Eur J Pain. Nov 2007;11(8):895-902. [Medline].

  19. Veldman PH, Reynen HM, Arntz IE, Goris RJ. Signs and symptoms of reflex sympathetic dysrophy: prospective study of 829 patients. Lancet. 1993;342:1012-1016.

  20. Bruehl S, Harden RN, Galer BS, Saltz S, Bertram M, Backonja M, et al. External validation of IASP diagnostic criteria for Complex Regional Pain Syndrome and proposed research diagnostic criteria. International Association for the Study of Pain. Pain. May 1999;81(1-2):147-54. [Medline].

  21. Brunner F, Lienhardt SB, Kissling RO, Bachmann LM, Weber U. Diagnostic criteria and follow-up parameters in complex regional pain syndrome type I--a Delphi survey. Eur J Pain. Jan 2008;12(1):48-52. [Medline].

  22. Harden RN, Bruehl SP. Diagnosis of complex regional pain syndrome: signs, symptoms, and new empirically derived diagnostic criteria. Clin J Pain. Jun 2006;22(5):415-9. [Medline].

  23. van Hilten JJ, van de Beek WJ, Vein AA, van Dijk JG, Middelkoop HA. Clinical aspects of multifocal or generalized tonic dystonia in reflex sympathetic dystrophy. Neurology. Jun 26 2001;56(12):1762-5. [Medline].

  24. Hulsman NM, Geertzen JH, Dijkstra PU, van den Dungen JJ, den Dunnen WF. Myopathy in CRPS-I: disuse or neurogenic?. Eur J Pain. Aug 2009;13(7):731-6. [Medline].

  25. Schwartzman RJ. New treatments for reflex sympathetic dystrophy. N Engl J Med. Aug 31 2000;343(9):654-6. [Medline].

  26. Beerthuizen A, van 't Spijker A, Huygen FJ, Klein J, de Wit R. Is there an association between psychological factors and the Complex Regional Pain Syndrome type 1 (CRPS1) in adults? A systematic review. Pain. Sep 2009;145(1-2):52-9. [Medline].

  27. Peterlin BL, Rosso AL, Nair S, Young WB, Schwartzman RJ. Migraine may be a risk factor for the development of complex regional pain syndrome. Cephalalgia. Jul 9 2009;[Medline].

  28. Borsook D, Sava S. Pain: Do ACE inhibitors exacerbate complex regional pain syndrome?. Nat Rev Neurol. Jun 2009;5(6):306-8. [Medline].

  29. Maihofner C, Handwerker HO, Birklein F. Functional imaging of allodynia in complex regional pain syndrome. Neurology. Mar 14 2006;66(5):711-7. [Medline].

  30. Dadure C, Motais F, Ricard C, Raux O, Troncin R, Capdevila X. Continuous peripheral nerve blocks at home for treatment of recurrent complex regional pain syndrome I in children. Anesthesiology. Feb 2005;102(2):387-91. [Medline].

  31. Markman JD, Philip A. Interventional approaches to pain management. Anesthesiol Clin. Dec 2007;25(4):883-98, viii. [Medline].

  32. Kemler MA, Reulen JP, Barendse GA, van Kleef M, de Vet HC, van den Wildenberg FA. Impact of spinal cord stimulation on sensory characteristics in complex regional pain syndrome type I: a randomized trial. Anesthesiology. Jul 2001;95(1):72-80. [Medline].

  33. Oakley JC, Weiner RL. Spinal cord stimulation in complex regional pain syndrome: a prospective study of 19 patients at 2 centers. Neuromodulation. 1999;2:47-50.

  34. Kemler MA, Rijks CP, de Vet HC. Which patients with chronic reflex sympathetic dystrophy are most likely to benefit from physical therapy?. J Manipulative Physiol Ther. May 2001;24(4):272-8. [Medline].

  35. Cleary AG, Sills JA, Davidson JE, Cohen AM. Reflex sympathetic dystrophy. Rheumatology (Oxford). May 2001;40(5):590-1. [Medline].

  36. Daly AE, Bialocerkowski AE. Does evidence support physiotherapy management of adult Complex Regional Pain Syndrome Type One? A systematic review. Eur J Pain. Apr 2009;13(4):339-53. [Medline].

  37. Kundu A, Berman B. Acupuncture for pediatric pain and symptom management. Pediatr Clin North Am. Dec 2007;54(6):885-9; x. [Medline].

  38. Schwartzman RJ, Patel M, Grothusen JR, Alexander GM. Efficacy of 5-day continuous lidocaine infusion for the treatment of refractory complex regional pain syndrome. Pain Med. Mar 2009;10(2):401-12. [Medline].

  39. Eckmann MS, Ramamurthy S, Griffin JG. Intravenous regional ketorolac and lidocaine in the treatment of complex regional pain syndrome of the lower extremity: a randomized, double-blinded, crossover study. Clin J Pain. Mar-Apr 2011;27(3):203-6. [Medline].

  40. Taskaynatan MA, Ozgul A, Tan AK, Dincer K, Kalyon TA. Bier block with methylprednisolone and lidocaine in CRPS type I: a randomized, double-blinded, placebo-controlled study. Reg Anesth Pain Med. Sep-Oct 2004;29(5):408-12. [Medline].

  41. Everett A, Mclean B, Plunkett A, Buckenmaier C. A unique presentation of complex regional pain syndrome type I treated with a continuous sciatic peripheral nerve block and parenteral ketamine infusion: a case report. Pain Med. Sep 2009;10(6):1136-9. [Medline].

  42. Finch PM, Knudsen L, Drummond PD. Reduction of allodynia in patients with complex regional pain syndrome: A double-blind placebo-controlled trial of topical ketamine. Pain. Nov 2009;146(1-2):18-25. [Medline].

  43. Sigtermans MJ, van Hilten JJ, Bauer MC, Arbous MS, Marinus J, Sarton EY, et al. Ketamine produces effective and long-term pain relief in patients with Complex Regional Pain Syndrome Type 1. Pain. Oct 2009;145(3):304-11. [Medline].

  44. Collins S, Zuurmond WW, de Lange JJ, van Hilten BJ, Perez RS. Intravenous magnesium for complex regional pain syndrome type 1 (CRPS 1) patients: a pilot study. Pain Med. Jul-Aug 2009;10(5):930-40. [Medline].

  45. Brunner F, Schmid A, Kissling R, Held U, Bachmann LM. Biphosphonates for the therapy of complex regional pain syndrome I--systematic review. Eur J Pain. Jan 2009;13(1):17-21. [Medline].

  46. Hsu ES. Practical management of complex regional pain syndrome. Am J Ther. Mar-Apr 2009;16(2):147-54. [Medline].

  47. Bruehl S, Harden RN, Galer BS, Saltz S, Backonja M, Stanton-Hicks M. Complex regional pain syndrome: are there distinct subtypes and sequential stages of the syndrome?. Pain. Jan 2002;95(1-2):119-24. [Medline].

  48. Karmarkar A, Lieberman I. Management of complex regional pain syndrome type II using lidoderm 5% patches. Br J Anaesth. Feb 2007;98(2):261-2. [Medline].

  49. Moseley GL. Graded motor imagery for pathologic pain: a randomized controlled trial. Neurology. Dec 26 2006;67(12):2129-34. [Medline].

 
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