RSD / CRPS

Complex regional pain syndromeDx criteria for RSD / CRPS
Complex regional pain syndrome
Dx criteria for RSD / CRPS
🔲 Disproportionate continuous pain
🔲 1 out of 4
       🟨 Hyperesthesia / Allodynia
       🟨 Vasomotor: Temperature / skin color asymmetric changes  
       🟨 Sudomotor: asymmetric edema/ sweating changes
       🟨 Motor / trophic changes: weakness, dystonia, tremors / skin, hair, nail 
🔲 Involve distal part of limbs but not head / trunk
🔲 Does not involve particular nerve or nerve root
🔲 Triple phase bone scan showing ipsilaterally active bone resorption within 5 months. Compare both sides! increased localized biphosphonate tracer uptake. Diffuse joint involvement r/o inf / arthralgias)
🔲 Xray: severe patchy osteopenia ( rx : Physical therapy), soft tissue swelling, with eventual soft tissue atrophy, subperiosteal bone resorption, preservation of joint space
🔲 MRI: in some  patchy bone marrow edema  signal (particularly subcortical), soft tissue edema / enhancement, skin changes thickening, joint effusion/ synovial hypertrophic changes, localized muscle atrophy
🔲Rx: Multidisciplinary, PT / OT physical therapy / occupational therapy, Meds: neuropathic pain meds, TCAs, SNRIs, Miacalcin , regional meds, Sympathectomy, Dorsal column stimulator, interventional, Nerve blocks, interventional radiology, psychiatrist to see.  See Adjuvant Analgesics list in the comments if needed. 

Type II CRPS: causalgia: high-velocity impact (such as a bullet wound) occurred at the site and is clearly associated with nerve injury. 

Type I CRPS : triggered by some tissue injury where there is no underlying nerve injury, 

RSD Symptoms in summary : chronic, intense pain out of proportion to the injury, get worse overtime, effect extremities, burning pain, increased skin sensitivity to touch with changes in skin temperature: warmer or cooler compared to the opposite extremities, skin color /texture : often blotchy, purple, pale or red, shiny and thin, sometimes excessively sweaty, changes in nail and hair growth patterns with swelling and stiffness in affected joint with trouble moving that part. 

RSD affects the nerves, skin, muscles, blood vessels and bones at the same time.

For educational purposes. Please add your input. This is the shortest note on RSD. Minimum u need to know. Read  UpToDate / Medsscape / Epocrates. 

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2 thoughts on “RSD / CRPS”

  1. ADJUVANT ANALGESICS: Adjuvant analgesics are co-analgesics. They have analgesic properties but developed for something else. They help to alleviate pain either alone or in combination with pain medications. Elavil, Trazodone, Paxil, Prozac , Cymbalta,Tegretol, Neurontin, Lyrica, Calcitonin, Capsaicin , Baclofen, Clonidine, Dextro-methorphan, Neuroleptics, Bisphos-phonates (Fosamax), Miacalcin, Scopolamine, Nonsteroidal Anti-inflammatory (NSAIDS),Local applications (lidoderm patches or 4% local lidocaine),Cox-2: Celebrex,

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