Complex Regional Pain Syndrome

Diagnostic Criteria

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.

  1. Sensory

Allodynia (pain to light touch and/or temperature sensation and/or deep somatic pressure and/or joint movement) and/or
hyperalgesia (to pinprick)

  1. Sudomotor/ Oedema
  1. Motor/ trophic

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)

Pathophysiology (unknown, but there are a few theories, probably multifactorial)

Treatment

Physio/ Rehabilitation

Bisphosphonates

Repetitive trancranial magnetic stimulation

Low-dose IV Ketamine

  1. Vasomotor

Temperature asymmetry and/or skin colour changes and/or skin colour asymmetry

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

TCA's

Anticonvulsants

Definition

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

Small fibres in peripheral nerves A-delta and C fibres become dysfunctional

decreased pain threshold

peripheral sensitisation

leads to central sensitisation

Autonomic nerve dysfunction

causes other symptoms e.g. vasomotor, sudomotor

Neurogenic inflammation may cause some features