Complex regional pain syndrome - Revision history

ClaireLewis at 14:28, 19 October 2019

2019-10-19T14:28:43Z

← Older revision		Revision as of 14:28, 19 October 2019
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	*[[Rheumatoid arthritis]]		*[[Rheumatoid arthritis]]
	*[[Chronic inflammatory autoimmune disease]]		*[[Chronic inflammatory autoimmune disease]]
	*[[~~Raynaud's~~ disease\|Raynaud phenomenon]]		*[[Raynaud’s disease\|Raynaud phenomenon]]
	*[[Erythromelalgia]]		*[[Erythromelalgia]]
	*[[Conversion disorder]]		*[[Conversion disorder]]

ClaireLewis: /* Differential Diagnosis */

2019-10-03T00:38:11Z

Differential Diagnosis

← Older revision		Revision as of 00:38, 3 October 2019
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	*[[Infection]]		*[[Infection]]
	*[[Compartment syndrome]]		*[[Compartment syndrome]]
	*[[Peripheral ~~Vascular Disease~~]]		*[[peripheral arterial disease\|Peripheral vascular disease]]
	*[[Peripheral neuropathy]]		*[[Peripheral neuropathy]]
	*[[Thoracic outlet syndrome]]		*[[Thoracic outlet syndrome]]
	*[[Rheumatoid arthritis]]		*[[Rheumatoid arthritis]]
	*[[Chronic inflammatory autoimmune disease]]		*[[Chronic inflammatory autoimmune disease]]
	*[[Raynaud phenomenon]]		*[[Raynaud's disease\|Raynaud phenomenon]]
	*[[Erythromelalgia]]		*[[Erythromelalgia]]
	*[[Conversion disorder]]		*[[Conversion disorder]]

ClaireLewis: /* No discharge prescription usually required. If needed: */

2019-09-24T03:44:01Z

No discharge prescription usually required. If needed:

← Older revision		Revision as of 03:44, 24 September 2019
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	*[[Amitriptyline]] or [[nortriptyline]] - 10-25 mg at bedtime as initial dose for both<ref name="Birk">Birklein F, O'Neill D, Schlereth T. Complex regional pain syndrome: An optimistic perspective. Neurology 2015; 84:89.</ref>		*[[Amitriptyline]] or [[nortriptyline]] - 10-25 mg at bedtime as initial dose for both<ref name="Birk">Birklein F, O'Neill D, Schlereth T. Complex regional pain syndrome: An optimistic perspective. Neurology 2015; 84:89.</ref>
	*[[Gabapentin]] - 100 mg-300 mg at bed time		*[[Gabapentin]] - 100 mg-300 mg at bed time
	*Topical [[lidocaine]] cream - 2-5% or topical capsaicin cream 0.075%		*Topical [[lidocaine]] cream - 2-5% or topical [[capsaicin]] cream 0.075%

	'''[[Opioids]] should NOT be used for chronic or acute CRPS. Patient education on this is important.'''		'''[[Opioids]] should NOT be used for chronic or acute CRPS. Patient education on this is important.'''

Mholtz: Text replacement - "fx" to "fracture"

2017-08-18T11:26:41Z

Text replacement - "fx" to "fracture"

← Older revision		Revision as of 11:26, 18 August 2017
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	*Generally unknown		*Generally unknown
	*Inciting event		*Inciting event
	**Found in about 90% of cases - usually begin 4-6wks after ~~fxs~~, crush injuries, sprains, and surgery.<ref name="Sand">Sandroni P, Benrud-Larson LM, McClelland RL, Low PA. Complex regional pain syndrome type I: incidence and prevalence in Olmsted county, a population-based study. Pain 2003; 103:199.</ref>		**Found in about 90% of cases - usually begin 4-6wks after fractures, crush injuries, sprains, and surgery.<ref name="Sand">Sandroni P, Benrud-Larson LM, McClelland RL, Low PA. Complex regional pain syndrome type I: incidence and prevalence in Olmsted county, a population-based study. Pain 2003; 103:199.</ref>
	*Proposed mechanisms		*Proposed mechanisms
	**Classic inflammation, neurogenic inflammation, and maladaptive changes in pain perception at the level of the central nervous system		**Classic inflammation, neurogenic inflammation, and maladaptive changes in pain perception at the level of the central nervous system

ClaireLewis at 14:33, 22 September 2016

2016-09-22T14:33:20Z

← Older revision		Revision as of 14:33, 22 September 2016
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	==References==		==References==
	<references/>		<references/>

			[[Category:Neurology]]

Neil.m.young: Text replacement - " ==" to "=="

2016-08-04T00:06:26Z

Text replacement - " ==" to "=="

← Older revision		Revision as of 00:06, 4 August 2016
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	*Amplified musculoskeletal pain syndrome (AMPS)		*Amplified musculoskeletal pain syndrome (AMPS)

	===Definition ===		===Definition===
	*Disorder of the extremities characterized by regional pain that is disproportionate in time or degree to the usual course of any known trauma or other lesion		*Disorder of the extremities characterized by regional pain that is disproportionate in time or degree to the usual course of any known trauma or other lesion
	*Pain is not in a specific nerve territory or dermatome		*Pain is not in a specific nerve territory or dermatome
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	*35% of patients report symptoms throughout their whole body.<ref name="Sch">Schwartzman RJ, Erwin KL, Alexander GM (May 2009). "The natural history of complex regional pain syndrome". The Clinical Journal of Pain. 25 (4): 273–80. doi:10.1097/AJP.0b013e31818ecea5. PMID 19590474.</ref>		*35% of patients report symptoms throughout their whole body.<ref name="Sch">Schwartzman RJ, Erwin KL, Alexander GM (May 2009). "The natural history of complex regional pain syndrome". The Clinical Journal of Pain. 25 (4): 273–80. doi:10.1097/AJP.0b013e31818ecea5. PMID 19590474.</ref>

	===Sub-Types ===		===Sub-Types===
	{\| class="wikitable"		{\| class="wikitable"
	\|-		\|-
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	\|}		\|}

	===Causes ===		===Causes===
	*Generally unknown		*Generally unknown
	*Inciting event		*Inciting event
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	;And, there is no other diagnosis that better explains the signs and symptoms		;And, there is no other diagnosis that better explains the signs and symptoms

	===Rule-Out Emergent Etiologies ===		===Rule-Out Emergent Etiologies===
	*XR		*XR
	*CBC		*CBC
	*[[Ultrasound]]		*[[Ultrasound]]

	===Other Imaging ===		===Other Imaging===
	*CT/MRI/XR are all NOT diagnostic for CRPS<ref name="Birk">Birklein F, O'Neill D, Schlereth T. Complex regional pain syndrome: An optimistic perspective. Neurology 2015; 84:89.</ref>		*CT/MRI/XR are all NOT diagnostic for CRPS<ref name="Birk">Birklein F, O'Neill D, Schlereth T. Complex regional pain syndrome: An optimistic perspective. Neurology 2015; 84:89.</ref>

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	*Infusion - 0.2 mg/kg/hr over 4-6hrs.		*Infusion - 0.2 mg/kg/hr over 4-6hrs.

	===No discharge prescription usually required. If needed: ===		===No discharge prescription usually required. If needed:===
	*[[Ibuprofen]] - 400-800 mg TID or [[naproxen]] 250-500 mg BID<ref name="Hard">Harden RN, Oaklander AL, Burton AW, et al. Complex regional pain syndrome: practical diagnostic and treatment guidelines, 4th edition. Pain Med 2013; 14:180.</ref>		*[[Ibuprofen]] - 400-800 mg TID or [[naproxen]] 250-500 mg BID<ref name="Hard">Harden RN, Oaklander AL, Burton AW, et al. Complex regional pain syndrome: practical diagnostic and treatment guidelines, 4th edition. Pain Med 2013; 14:180.</ref>
	*[[Amitriptyline]] or [[nortriptyline]] - 10-25 mg at bedtime as initial dose for both<ref name="Birk">Birklein F, O'Neill D, Schlereth T. Complex regional pain syndrome: An optimistic perspective. Neurology 2015; 84:89.</ref>		*[[Amitriptyline]] or [[nortriptyline]] - 10-25 mg at bedtime as initial dose for both<ref name="Birk">Birklein F, O'Neill D, Schlereth T. Complex regional pain syndrome: An optimistic perspective. Neurology 2015; 84:89.</ref>

Neil.m.young: Text replacement - "== " to "=="

2016-08-03T18:05:53Z

Text replacement - "== " to "=="

← Older revision		Revision as of 18:05, 3 August 2016
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	*Amplified musculoskeletal pain syndrome (AMPS)		*Amplified musculoskeletal pain syndrome (AMPS)

	=== Definition ===		===Definition ===
	*Disorder of the extremities characterized by regional pain that is disproportionate in time or degree to the usual course of any known trauma or other lesion		*Disorder of the extremities characterized by regional pain that is disproportionate in time or degree to the usual course of any known trauma or other lesion
	*Pain is not in a specific nerve territory or dermatome		*Pain is not in a specific nerve territory or dermatome
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	*35% of patients report symptoms throughout their whole body.<ref name="Sch">Schwartzman RJ, Erwin KL, Alexander GM (May 2009). "The natural history of complex regional pain syndrome". The Clinical Journal of Pain. 25 (4): 273–80. doi:10.1097/AJP.0b013e31818ecea5. PMID 19590474.</ref>		*35% of patients report symptoms throughout their whole body.<ref name="Sch">Schwartzman RJ, Erwin KL, Alexander GM (May 2009). "The natural history of complex regional pain syndrome". The Clinical Journal of Pain. 25 (4): 273–80. doi:10.1097/AJP.0b013e31818ecea5. PMID 19590474.</ref>

	=== Sub-Types ===		===Sub-Types ===
	{\| class="wikitable"		{\| class="wikitable"
	\|-		\|-
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	==Evaluation==		==Evaluation==
	=== Clinical: Budapest consensus criteria:===		===Clinical: Budapest consensus criteria:===
	''At least 1 symptom in three of the following four categories:''		''At least 1 symptom in three of the following four categories:''
	{\| class="wikitable"		{\| class="wikitable"
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	;And, there is no other diagnosis that better explains the signs and symptoms		;And, there is no other diagnosis that better explains the signs and symptoms

	=== Rule-Out Emergent Etiologies ===		===Rule-Out Emergent Etiologies ===
	*XR		*XR
	*CBC		*CBC
	*[[Ultrasound]]		*[[Ultrasound]]

	=== Other Imaging ===		===Other Imaging ===
	*CT/MRI/XR are all NOT diagnostic for CRPS<ref name="Birk">Birklein F, O'Neill D, Schlereth T. Complex regional pain syndrome: An optimistic perspective. Neurology 2015; 84:89.</ref>		*CT/MRI/XR are all NOT diagnostic for CRPS<ref name="Birk">Birklein F, O'Neill D, Schlereth T. Complex regional pain syndrome: An optimistic perspective. Neurology 2015; 84:89.</ref>

Neil.m.young: Text replacement - "* " to "*"

2016-08-03T15:53:28Z

Text replacement - "* " to "*"

← Older revision		Revision as of 15:53, 3 August 2016
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	=== Other Imaging ===		=== Other Imaging ===
	* CT/MRI/XR are all NOT diagnostic for CRPS<ref name="Birk">Birklein F, O'Neill D, Schlereth T. Complex regional pain syndrome: An optimistic perspective. Neurology 2015; 84:89.</ref>		*CT/MRI/XR are all NOT diagnostic for CRPS<ref name="Birk">Birklein F, O'Neill D, Schlereth T. Complex regional pain syndrome: An optimistic perspective. Neurology 2015; 84:89.</ref>

	==Management==		==Management==

Rossdonaldson1: /* Management */

2016-08-03T04:51:25Z

Management

← Older revision		Revision as of 04:51, 3 August 2016
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	==Management==		==Management==
	=====Ketamine for Flare-Ups=====		===[[Ketamine]] for Flare-Ups===
	*~~Ketamine initial~~ bolus - 0.2–0.3 mg/kg of infused over 10mins.<ref name="Duch">Ducharme, Jim, MD. "Tips for Managing Complex Regional Pain Syndrome - ACEP Now." ACEP Now. N.p., 11 Sept. 2015.</ref>		*Initial bolus - 0.2–0.3 mg/kg of infused over 10mins.<ref name="Duch">Ducharme, Jim, MD. "Tips for Managing Complex Regional Pain Syndrome - ACEP Now." ACEP Now. N.p., 11 Sept. 2015.</ref>
	**Avoid IV push - could cause dissociative side effects.		**Avoid IV push - could cause dissociative side effects.
	**Diagnostic- pain should resolve by the end of the 10min bolus and if so, continue ~~ketamine.~~		**Diagnostic- pain should resolve by the end of the 10min bolus and if so, continue
	*~~Ketamine infusion~~ - 0.2 mg/kg/hr over 4-6hrs.		*Infusion - 0.2 mg/kg/hr over 4-6hrs.

	===== No discharge prescription usually required. If needed: =====		===No discharge prescription usually required. If needed: ===
	*Ibuprofen - 400-800 mg TID or naproxen 250-500 mg BID<ref name="Hard">Harden RN, Oaklander AL, Burton AW, et al. Complex regional pain syndrome: practical diagnostic and treatment guidelines, 4th edition. Pain Med 2013; 14:180.</ref>		*[[Ibuprofen]] - 400-800 mg TID or [[naproxen]] 250-500 mg BID<ref name="Hard">Harden RN, Oaklander AL, Burton AW, et al. Complex regional pain syndrome: practical diagnostic and treatment guidelines, 4th edition. Pain Med 2013; 14:180.</ref>
	*Amitriptyline or nortriptyline - 10-25 mg at bedtime as initial dose for both<ref name="Birk">Birklein F, O'Neill D, Schlereth T. Complex regional pain syndrome: An optimistic perspective. Neurology 2015; 84:89.</ref>		*[[Amitriptyline]] or [[nortriptyline]] - 10-25 mg at bedtime as initial dose for both<ref name="Birk">Birklein F, O'Neill D, Schlereth T. Complex regional pain syndrome: An optimistic perspective. Neurology 2015; 84:89.</ref>
	*Gabapentin - 100 mg-300 mg at bed time		*[[Gabapentin]] - 100 mg-300 mg at bed time
	*Topical lidocaine cream - 2-5% or topical capsaicin cream 0.075%		*Topical [[lidocaine]] cream - 2-5% or topical capsaicin cream 0.075%

	'''Opioids should NOT be used for chronic or acute CRPS. Patient education on this is important.'''		'''[[Opioids]] should NOT be used for chronic or acute CRPS. Patient education on this is important.'''

	==Disposition==		==Disposition==

Rossdonaldson1: /* R/o Emergent Etiologies */

2016-08-03T04:49:50Z

R/o Emergent Etiologies

← Older revision		Revision as of 04:49, 3 August 2016
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	;And, there is no other diagnosis that better explains the signs and symptoms		;And, there is no other diagnosis that better explains the signs and symptoms

	=== ~~R/o~~ Emergent Etiologies ===		=== Rule-Out Emergent Etiologies ===
	*XR		*XR
	*CBC		*CBC
	*Ultrasound		*[[Ultrasound]]

	=== Other Imaging ===		=== Other Imaging ===