Medical Minute Recap: Complex Regional Pain Syndrome

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November 5, 2015 by dailybolusoflr

By Sharon Bord, MD

What is it?

  • Formerly known as Reflex Sympathetic Dystrophy
  • Common neuropathic pain condition
  • Arises from trauma of any kind
    • Roughly 3% of patients who have Colles fracture develop
    • Minor trauma/blood draw
  • Days to years after trauma

How to diagnose?

  • Sensory and autonomic dysfunction
  • Area red/warm/edematous
    • Misdiagnosed as cellulitis
  • Severe allodynia- pain with light touch
  • Early diagnosis prevents long term complications
    • Muscular atrophy
    • Spread to involve larger body parts
    • Skin changes: shiny, thin, edematous appearance

Treating flare ups?

  • NOT opioids: would require VERY high doses to be effective
  • Treatment directed at stopping NMDA activity
    • Ketamine: 0.2-0.3 mg/kg OVER 10 MINUTES
      • Pain should get better almost immediately after first 10 minutes
    • Then ketamine 0.2 mg/kg/hr for 4-6 hours
Long term treatment?
  • Physiotherapy
  • Gabapentin or tricyclics


References:

Ducharme, J. (2015). Tips for Managing Complex Regional Pain Syndrome. ACEP Now 39(09)

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