AN1 Complex regional pain syndrome: An under-recognized cause of complications following minor trauma. (Anesthesiology).

ANI COMPLEX REGIONAL PAIN SYNDROME: AN UNDER-RECOGNIZED CAUSE OF COMPLICATIONS FOLLOWING MINOR TRAUMA. Stephen Bruehl, Ok Chung, Janice Livengood, and Benjamin Johnson. Vanderbilt Pain Control Center, Nashville, Tenn.

Complex regional pain syndrome (CRPS), formerly known as Reflex Sympathetic Dystrophy, is a chronic pain syndrome that can occur following major or minor trauma. Multiple interacting pathophysiological mechanisms appear to underlie the disorder. It usually occurs in one extremity, and is characterized by pain in response to light touch or cold temperature, and exaggerated responses to innocuous stimuli in the affected extremity. Other common features include edema, and unilateral changes in skin temperature, skin color, and sweating. Current research indicates significant confusion regarding proper diagnosis and treatment of this disorder. The purpose of this presentation is to discuss current issues in diagnosis and treatment of CRPS. A key factor in effectively treating CRPS and preventing significant dystrophic changes that can occur is the early recognition and treatment of the disorder. Accurate diagnosis may often be difficult, and optimally, should be made by a physician familiar with the complexities of this disorder. Treatment should be intensive, with the primary goals of decreasing pain and, even more importantly, addressing the intense disuse frequently observed in the affected extremity. This latter goal is often difficult to achieve because of patients' extreme reluctance to use the extremity given the pain processing abnormalities noted above. Temporary pharmacologic blockade of sympathetic ganglia and/or somatic nerves may provide a window of reduced pain in which to make progress in intensive physical therapy. Pharmacologic agents must be targeted toward the specific mechanisms underlying CRPS. Psychological and behavioral factors can also contribute to maintenance of CRPS, and need to be addressed for successful long-term treatment outcomes. Treatment approaches for CRPS are often haphazard, and may not adequately reflect current understanding of its pathophysiology. As a result, outcomes may not be optimal. The Vanderbilt Pain Control Center has developed a time-delimited treatment algorithm ba sed on current research regarding the disorder. The treatment algorithm is multidisciplinary and moves from conservative to more invasive treatment over time, depending upon quantitative treatment outcomes tracked throughout the algorithm. CRPS is a serious but often under-recognized complication of major or minor trauma that requires early, aggressive, and coordinated treatment to resolve successfully.