Complex regional pain syndrome

Unlabeled Uses Bladder instability complex regional pain syndrome (CRPS), pros-tatic obstruction, Raynaud s disease... 

Pain resulting from non-inflammatory dysfunction of the peripheral or central nervous system without nociceptor stimulation or trauma. Examples include post-herpetic neuralgia, complex regional pain syndromes, phantom pain and trigeminal neuralgia. 

Symptoms consistent with complex regional pain syndrome have been reported after a cervical epidural glucocorticoid injection (SEDA-22, 451 454). 

Siegfried RN. Development of complex regional pain syndrome after a cervical epidural steroid injection. Anesthesiology 1997 86(6) 1394-6. 

Yung Chung O, Bruehl SP. Complex Regional Pain Syndrome. Curr Treat Options Neurol. 2003 5 499-511. 

FIGURE 8.1. Multidisciplinary treatment of complex regional pain syndrome. 

ADRENERGIC NEURONE BLOCKERS-GUANETHIDINE LOCAL ANAESTHETICS l clinical efficacy of guanethidine when used in the treatment of complex regional pain syndrome-type 1 The local anaesthetic i the reuptake of guanethidine Be aware. Consider use of a local anaesthetic that minimally inhibits reuptake, e.g. lidocaine when possible... 

These include postherpetic neuralgia, phantom limb pain, peripheral neuropathies of various causes, central pain, e.g. following a stroke, compression neuropathies, and the complex regional pain syndromes (comprising causalgia, when there is nerve damage, and reflex sympathetic dystrophy, when there is tissue but no nerve injury) they present the most challenging problems. 

Complex regional pain syndrome may occur after ACL reconstruction, albeit rarely, with an incidence of 4-7 % [30, 31]. In these cases, various symptoms manifest after surgery, including disproportionate continuing pain, sensory abnormality, edema, and articular contracture. Plain radiography may show a picture of local osteoporosis. On three-phase bone scintigraphy (Tc-99), uptake is often observed. After onset, remission may take several years. 

Analgesic medication and systematic rehabilitation program are the mainstay for prevention and treatment. Preemptive analgesic technique of initiating continuous NSAlDs treatment from before surgery shows prophylactic effects for both AKP and complex regional pain syndrome [30]. 

Reuben SS (2004) Preventing the development of complex regional pain syndrome after surgery. Anesthesiology 101(5) 1215-1224. Review... 

Schwartzman RJ, Alexander GM, Grothusen JR, Paylor T, Reichenberger E, Perreault M. Outpatient intravenous ketamine for the treatment of complex regional pain syndrome a double-blind placebo controlled study. Pain 2009 147 107-15. 

Goebel A, Baranowski A, Maurer K, Ghiai A, McCabe C, Ambler G. Intravenous immunoglobulin treatment of the complex regional pain syndrome a randomized trial. Ann Intern Med 2010 152 (3) 152-8. 

A comprehensive set of practice parameters on the use of spinal cord stimulation in the treatment of chronic neuropathic pain has been developed [42]. Indications include failed back surgery syndrome, complex regional pain syndrome, peripheral neuropathic pain, phantom limb/post-amputation syndrome, recalcitrant PHN, root injury pain, and spinal cord injury or lesions. It also is being used in the management of pain associated with multiple sclerosis, pain due to ischemic peripheral vascular disease, and interstitial nephritis. 

Kiefer RT, Rohr P, Ploppa A, et al. Efficacy of ketamine in anesthetic dosage for the treatment of refractory complex regional pain syndrome an open-label phase II study. Pain Med 2008 9(8) 1173-1201. 

Sigtermans M, et al. An observational study on the effect of S(-i-)-ketamine on chronic pain versus experimental acute pain in Complex Regional Pain Syndrome type 1 patients. Eur J Pain 2009 ... 

Sinis N, Birbaumer N, Gustin S, et al. Memantine treatment of complex regional pain syndrome a preliminary report of six cases. Clin J Pain 2007 23(3) 237-243. 

Sigtermans MJ, van Hilten JJ, Bauer MC, Arbous MS, Marinus J, Sarton EY, Dahan A. Ketamine produces effective and long-term pain relief in patients with complex regional pain syndrome type 1. Pain 2009 145(3) 304-11. 

In a single-blind, placebo-run-in, dose-escalation study in 36 patients with complex regional pain syndrome, followed for 12 months, there were substantial improvements in patient and assessor-rated dystonia scores, pain, disability, and quality-of-life [36 ]. There were 89 adverse events in 26 patients they were related to baclofen (n = 19) or pump/catheter system defects ( = 52) or could not be specified (n = 18). 

Shibuya N, Humphers JM, Agarwal MR, Jupiter DC. Efficacy and safety of high-dose vitamin C on complex regional pain syndrome in extremity trauma and surgery-systematic review and meta-analysis. J Foot Ankle Surg 2013 Jan-Feb 52(l) 62-6. 

---