Following trauma or immobilisation , CRPS is not uncommon presentation. As there are various articles with treatment options for this poorly understood phenomenon, how you all proceed to manage these patients in terms of medication or therapy etc.
No idea. But: The search for underlying organic cause should never stop. The “underlying organic cause” may be bad or failed osteosynthesis, badly or incompletely managed some orthopedic or surgical conditions …
My colleagues and I from Johns Hopkins Hospital found that 71% to 80% of patients told they have CRPS really have nerve entrapments. So first establish an accurate diagnosis. Test by peripheral nerve blocks. If 100% relief, decompress the nerve. If the patient has both thermal and mechanical allodynia, and circumferential pain, confirming CRPS, then start with sympathetic blocks. If there is 100% relief for an hour, consider sympathectomy. 27% of patients have both CRPS and nerve entrapments. Both need to be treated in these patients. See attached for details
I have short and not very extensive experience about the condition. However… in one University hospital where I worked for some time (cannot say which), I was asked to try to propose a large project that concerned CRPS condition. I knew almost nothing about the condition, so we examined the cases that were available and I saw some of them on consultation. In almost half of the patient it was obvious that the underlying condition was not completely cured or various complications were locally to identify (too complex fractures, partial healing, deformities, adjacent diseases of the locomotors system, etc). In one case the plate and screw ostheosynthesis was simply failed (and left not diagnosed for moths!).
So I agree with Nelson. I would even add: Diagnostics first, metaphysics later.
Fascinating articles from Dr. Hendler, thank you for sharing! Are you able to add any more specifics regarding the use of IV phentolamine? I am extremely interested in doing this with a current CRPS patient. I use LDN, Vitamin C, palmitoylethanolamide as well as a number of other medications/supplements in CRPS and other pain patients in my practice.
Srinivasa Raja and James Campbell at Johns Hopkins Hospital used phentolamine as a diagnostic test, to see if a patient had CRPS. It is highly unlikely that any long term benefit will accrue. Nelson Hendler, MD, MS, former assistant professor of neurosurgery Johns Hopkins University School of Medicine, past president RSD Association of American past president, American Aademy of Pain Management
Srinivasa Raja and James Campbell at Johns Hopkins Hospital used phentolamine as a diagnostic test, to see if a patient had CRPS. It is highly unlikely that any long term benefit will accrue. Nelson Hendler, MD, MS, former assistant professor of neurosurgery Johns Hopkins University School of Medicine, past president RSD Association of American past president, American Academy of Pain Management
Even for diagnostic purposes, phentolamine sounds like a great idea and I would appreciate some guidance on how it is best administered.
Even if for diagnostic purposes only, phentolamine sounds like a great idea and I would appreciate some guidance on how it is best administered.
Complex regional pain syndrome (CRPS) is a descriptive term for a complex of symptoms and signs typically occurring following trauma of the extremity. Typical symptomatology includes severe pain, swelling, vasomotor instability and functional impairment of the affected limb. At present there is no one, effective method of treatment of the condition. A large number of treatments have been investigated but major multicentre randomized controlled trials are lacking.
A recent study published on May 2018, ( DOI: 10.1016/j.pjnns.2018.03.001) shows the results of a systematic review of the evidence on effectiveness of treatment methods in CRPS. It is a follow-up to earlier reviews of randomized controlled trials on CRPS treatment published between 1966 and 2016.
RESULTS:
The review of randomized controlled trials showed that only bisphosphonates were found to give uniformly positive effects, statistically significantly better than placebo. Improvement has been reported with topical dimethyl sulfoxide, systemic steroids, spinal cord stimulation and graded motor imagery/mirror therapy programmes. The available evidence does not support the use of other treatments in CRPS, however they are frequently used in clinical practice.
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