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COMPLEX REGIONAL PAIN SYNDROME

Rheumatology

COMPLEX REGIONAL PAIN SYNDROME

1. Previously called reflex sympathetic dystrophy (RSD), is a form of chronic pain that usually affects a distal extremity (upper> lower).

2. Two types - CRPS 1 (more common, indirect nerve injury secondary to trauma), CRPS 2 (direct injury to the nerve).

3. Patients have pain, hyperalgesia, edema, temperature asymmetry, muscle atrophy, decreased ROM, or weakness disproportionate to the inciting event.

4. In severe cases, flexion contractures may develop.

5. Profound osteopenia may be seen on x-ray imaging. 3-phase bone scans may be helpful - diffuse increased activity with juxta-articular uptake on the delayed (phase 3) images.

6. Management - NSAIDs; pain modifiers (TCA/gabapentin); physical therapy; short course of glucocorticoids; sympathetic nerve block.


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REFERENCES

1. Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
2. Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
3. Image: no reference available.

Ⓒ A. Manickam 2018

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