Physical Medicine and Rehabilitation for Complex Regional Pain Syndromes Follow-up

Updated: Feb 06, 2019
  • Author: Manish K Singh, MD; Chief Editor: Stephen Kishner, MD, MHA  more...
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Follow-up

Further Outpatient Care

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  • 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.

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Further Inpatient Care

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  • 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.

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Deterrence

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  • 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).

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Complications

Complications include the following:

  • 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 - A retrospective German study found the rate of depression in patients with CRPS to be 15.6%, a higher prevalence than in the general population [39]
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Prognosis

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  • Dumitru's report suggests that, in comparison with adults, children are less disabled from and have more favorable prognoses with RSD. [40]

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Patient Education

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  • 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, see eMedicineHealth's patient education article Chronic Pain.

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