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Complex regional pain syndrome (CRPS)

Types of CRPS
1. Types I  2. Type 2
  1. CRPS type I is a regional pain syndrome that usually develops after tissue trauma.
    Examples: a. Myocardial infarction, b. minor shoulder or limb injury, c. stroke. 
    1. Allodynia (the perception of a non painful stimulus as painful), hyperpathia (an exaggerated pain response to a painful stimulus), and spontaneous pain occur.
    2. The symptoms are unrelated to the severity of the initial trauma and are not confined to the distribution of a single peripheral nerve.
  2. CRPS type II
    1. It is a regional pain syndrome that develops after injury to a peripheral nerve, usually a major nerve trunk.
    2. Spontaneous pain initially develops within the territory of the affected nerve but eventually may spread outside the nerve distribution.
Clinical Features of CRPS
  1. Pain is the primary clinical feature of CRPS. Vasomotor dysfunction, sudomotor abnormalities, or focal edema may occur alone or in combination but must be present for diagnosis. 
  2. In CRPS, localized sweating (increased resting sweat output) and changes in blood flow may produce temperature differences between affected and unaffected limbs.
CRPS type I (RSD) has classically been divided into three clinical phases.
  1. Phase I consists of pain and swelling in the distal extremity occurring within weeks to 3 months after the precipitating event. The pain is diffuse, spontaneous, and either burning, throbbing, or aching in quality. 
  2. The involved extremity is warm and edematous, and the joints are tender. Increased sweating and hair growth develop. 
  3. In phase II (3–6 months after onset), thin, shiny, cool skin appears. 
  4. Phase III - After an additional 3–6 months, atrophy of the skin and subcutaneous tissue plus flexion contractures complete the clinical picture.
  1. Early mobilization with physical therapy
  2. Brief course of glucocorticoids may be helpful for CRPS type I.
  3. Adrenergic blockers,
  4. NSAID
  5. Calcium channel blockers
  6. Phenytoin
  7. Opioids
  8. Calcitonin
  9. Stellate ganglion blockade is a commonly used.

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