Complex Regional Pain Syndrome (Treatment (Medications for neuropathic…
Complex Regional Pain Syndrome
Accompanied by range of symptoms and has variable prognosis
Pain is regional (not restricted to specific dermatome)
Lasts beyond expected timeframe of event
Continuing pain out of proportion to orginal event
Medications for neuropathic pain
Oral prednisolone 30mg
If oral doesn't work, switch to IV Methylprednisolone
If IV doesn't work, 1 week of IV dexamethasone AND Mannitol 10% 250mL IV BD
Low-dose IV Ketamine
Repetitive trancranial magnetic stimulation
Pathophysiology (unknown, but there are a few theories, probably multifactorial)
Neurogenic inflammation may cause some features
Autonomic nerve dysfunction
causes other symptoms e.g. vasomotor, sudomotor
Small fibres in peripheral nerves A-delta and C fibres become dysfunctional
leads to central sensitisation
decreased pain threshold
Budapest clinical diagnostic criteria.
All of the following statements must be met:
The patient has continuing pain which is disproportionate to any inciting event.
The patient has at least one sign in two or more of the categories below.
The patient reports at least one symptom in three or more of the categories below. No other diagnosis can better explain the signs and symptoms.
Temperature asymmetry and/or skin colour changes and/or skin colour asymmetry
Decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes (hair/nail/skin)
Oedema and/or sweating changes and/or sweating asymmetry
Allodynia (pain to light touch and/or temperature sensation and/or deep somatic pressure and/or joint movement) and/or
hyperalgesia (to pinprick)