Complex Regional Pain Syndrome (Treatment (Medications for neuropathic…
Complex Regional Pain Syndrome
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.
Allodynia (pain to light touch and/or temperature sensation and/or deep somatic pressure and/or joint movement) and/or
hyperalgesia (to pinprick)
Oedema and/or sweating changes and/or sweating asymmetry
Decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes (hair/nail/skin)
Temperature asymmetry and/or skin colour changes and/or skin colour asymmetry
Pathophysiology (unknown, but there are a few theories, probably multifactorial)
Small fibres in peripheral nerves A-delta and C fibres become dysfunctional
decreased pain threshold
leads to central sensitisation
Autonomic nerve dysfunction
causes other symptoms e.g. vasomotor, sudomotor
Neurogenic inflammation may cause some features
Repetitive trancranial magnetic stimulation
Low-dose IV Ketamine
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
Medications for neuropathic pain
Continuing pain out of proportion to orginal event
Lasts beyond expected timeframe of event
Pain is regional (not restricted to specific dermatome)
Accompanied by range of symptoms and has variable prognosis