New protocol for treatment of complex regional pain syndrome

Complex regional pain syndrome is a rare condition that causesdebilitating pain and loss of mobility to one or more extremities. While multiple tools have been developed to diagnose this disease, the treatments currently employed are highly variable and the results are unpredictable. In order to address this, we did a review of the literature and created a standardized six week complex regional pain syndrome treatment protocol which included many treatments with proven benefit employed simultaneously. In this article, we present our brief literature review, our standardized protocol, and three case reports of patients who had successful treatment of their disease with our newly established protocol. We also present a discussion detailing why we feel that this protocol has provided benefits in these first three cases.

Introduction

Complex regional pain syndrome (CRPS) is a rare but debilitating disease with an incidence of approximately 26 cases per 100,000 person years in a population study from the Netherlands [1]. Although the underlying pathophysiology remains incompletely understood, the hallmark of the disease is regional pain with multisystem involvement presenting with symptoms of swelling, vasomotor changes, loss of mobility, and trophic changes. While the International Association for the Study of Pain developed the Budapest Criteria in 2003 to further standardize the diagnosis of CRPS, there has been little standardization of treatment of this disease [2]. Physical and occupational therapy (PT/OT) have been shown to provide benefit, but prolonged patient participation can be challenging due to severity of symptoms and lack of motivation [3]. While some medications and procedural interventions have shown promise, literature and randomized trials supporting these measures have remained sparse [3]. To facilitate active participation in occupational therapy (OT), we have created a standardized protocol for the treatment of upper extremity CRPS which includes many treatment modalities with literature proven benefit. In this publication, we will review the literature discussing the individual pieces of our protocol. We will discuss the implementation and the four tenets of our protocol. We will present a case series of the first three cases in which this protocol was implemented. Lastly, we will end with a discussion of why we feel that this approach to the treatment of this disease has been a benefit to our patients at our institution.

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With Regards,

Mary jasmin

Editorial Assistant

Anesthesiology Case Reports