Diagnosis Of Complex Regional Pain Syndrome Research Articles

Electronic Detection and Diagnosis of Complex Regional Pain Syndrome

Complex Regional Pain Syndrome (CRPS) is a chronic disease that is random and abrupt. As a result, an accurate diagnosis and treatment have yet to be identified due to numerous symptoms and causes. Currently, the method of diagnosis of CRPS is the Budapest Criteria. However, this criterion relies on the patient and doctor’s subjective judgments. Therefore, we propose to develop a diagnostic method for CRPS, integrating reliable and objective analysis of common patterns that occur in patients’ genetic and neuronal structures. Utilizing a zinc oxide biosensor, it was shown the patients’ blood samples with high concentrations of MMP-9, and neuroinflammation occurs as the immune system is impaired. By analyzing blood samples, we quantified the number of CD4+ T cells that penetrate nerves, with direct human CD4+ T cell counting. We compared the structure of neuron cells and identified damage in CRPS patients that were located primarily on dendrites. The significance of using DNA detection and neuron biochips will dramatically improve the diagnosis and treatment of CRPS.

Pediatric complex regional pain syndrome following maxillofacial trauma: A case report

Complex regional pain syndrome (CRPS) has been described as a painful disorder with a different type of presentation and evolution months after the noxious event. The affected area shows color and vasomotor changes. Diagnosis of CRPS is hard and usually made by the Budapest criteria, as the pathological basis is still not completely known. We present this rare case that supports the idea of managing signs and symptoms with a multidisciplinary approach and supports the effective presence of a subtype of CRPS in children. This could make any other physician aware of possible diagnosis and, in the future, support the possible integration of this subtype in the Budapest criteria.

Complex regional pain syndrome as acause of acute painful limb swelling – acase report

Complex regional pain syndrome (CRPS) is a complex condition characterised by severe pain and various sensory and motor abnormalities. This case report is of an 18-year-old woman presenting with painful upper limb swelling for a few days, with skin mottling and dysesthesia, with significant disability. With negative investigations, a diagnosis of CRPS was made. The case emphasises the importance of early recognition and appropriate management of CRPS, as delayed diagnosis leads to poor quality of life and functional impairment. Healthcare professionals should maintain a high index of suspicion for CRPS in patients with unexplained limb pain and associated sensory and motor abnormalities, ensuring a comprehensive multidisciplinary approach to optimise patients' quality of life.

Patients With Preexisting Anxiety and Mood Disorders Are More Likely to Develop Complex Regional Pain Syndrome After Fractures.

Complex regional pain syndrome (CRPS) is a multifactorial condition that may affect patients who sustain a fracture in the upper and lower extremities. Prior investigations have formed a foundation for exploring a possible association between psychiatric disorders and the development of CRPS; however, current studies are conflicted regarding the existence and temporality of a relationship between psychiatric disorders and the potential development of CRPS. (1) Are patients with preexisting anxiety and mood disorders (AMDs) at increased risk of receiving a diagnosis of CRPS after upper or lower extremity fractures? (2) Are patients with preexisting AMDs at increased risk of being diagnosed with CRPS after surgical fixation of their fracture? A large, retrospective cohort study was conducted using the TriNetX electronic medical record platform, which contains data from more than 100 million patients. This platform gathers data from healthcare organizations in the United States and Europe and collects comprehensive data over time that includes temporality rather than simply the binary presence or absence of conditions. The cohort included 760,595 patients older than 18 years with upper or lower extremity fractures between 2003 and 2022. Included patients had a minimum 1-year follow-up. We defined AMDs as any diagnosis of anxiety, depressive episode or disorder, a manic episode, or bipolar disorder. Patients with polytrauma or concurrent upper and lower extremity fractures were excluded to reduce confounders. CRPS I diagnosis was identified via International Classification of Diseases, Tenth Edition codes. Propensity score matching was performed to balance cohorts based on age, gender, and race. Hazard ratios and Aalen-Johansen cumulative incidence curves for the diagnosis of CRPS were calculated for patients with and without AMD diagnoses before sustaining a fracture. A subanalysis was performed in which we examined individuals in the upper and lower extremity fracture cohorts who underwent surgical treatment. Patients with preexisting AMDs were at a higher risk of experiencing CRPS I than patients without AMDs were (upper extremity: HR 1.8 [95% CI 1.7 to 1.9]; p < 0.01, lower extremity: HR 2.2 [95% CI 2.0 to 2.3]; p < 0.01). Similarly, patients with preexisting AMDs were at higher risk of experiencing CRPS I after fracture fixation than patients without AMDs were (upper extremity: HR 1.3 [95% CI 1.2 to 1.5]; p < 0.01, lower extremity: HR 2.3 [95% CI 2.1 to 2.5]; p < 0.01). Awareness of the relationship between AMDs and CRPS I will direct future research about the development of this condition and associated neurologic changes. Additionally, surgeons can address AMDs perioperatively and arrange for the treatment of these AMDs with psychiatrists, neurologists, or social work, as appropriate. Accordingly, patients with AMDs should also be made aware of the inherent risk of CRPS I after an upper or lower extremity fracture to comprehensively educate and care for this at-risk patient population. Level III, therapeutic study.

Complex Regional Pain Syndrome Classification, Damage, Mechanisms, and Treatment: A Narrative Review

Complex regional pain syndrome (CRPS), previously known as reflex sympathetic dystrophy syndrome, is a situation specified by persistent regional pain. The aberrant functioning of the neurological system is believed to be the root cause of an exaggerated reactivity to pain signals that are unable to switch off the sensation of pain. It is characterized by such symptoms as swelling, alterations in the color of the skin and tissues, along with edema. Although it most commonly affects the limbs, such as the arm, leg, hand, or foot, these symptoms can manifest themselves in any part of the body. The existence or nonexistence of nerve injury is used to classify patients into one of two subgroups, I or II, when referring to this illness. Since many medical professionals are unfamiliar with the diagnosis of CRPS and its etiology is not fully elucidated, the condition is frequently incorrectly diagnosed. The treatments available for CRPS focus on alleviating symptoms, regaining organ function, and cosseting a person's quality of life, despite the fact that no cure for the condition has been identified.

Prescription Trends in Complex Regional Pain Syndrome: A Retrospective Case-Control Study.

The objective of this study was to evaluate discrepancies in prescription trends for analgesic medications in complex regional pain syndrome (CRPS) patients based on recommendations in the literature. We conducted a retrospective case-control study. A total of 2510 CRPS patients and 2510 demographic-matched controls participated in this study. The SlicerDicer feature in Epic was used to find patients diagnosed with CRPS I or II between January 2010 and November 2022. An equal number of age-, gender-, and race-matched controls without a CRPS diagnosis were retracted from Epic. General and CRPS-associated prescription frequencies for the following classes were retrieved for both cases and controls: benzodiazepines, bisphosphonates, calcitonin, capsaicin, neuropathic pain medications, NSAIDs, opioids, and steroids. A total of 740 (29%) CRPS patients and 425 (17%) controls were prescribed benzodiazepines (95% CI 0.1-0.15), 154 (6.1%) CRPS patients and 52 (2.1%) controls were prescribed capsaicin (95% CI 0.03-0.05), 1837 (73%) CRPS patients and 927 (37%) controls were prescribed neuropathic pain medications (95% CI 0.05-0.34), 1769 (70%) CRPS patients and 1217 (48%) controls were prescribed opioids (95% CI 0.19-0.25), 1095 (44%) CRPS patients and 1217 (48%) controls were prescribed steroids (95% CI 0.08-0.14), and 1638 (65%) CRPS patients and 1765 (70%) controls were prescribed NSAIDs (95% CI -0.08-0.02), p < 0.001 for all classes. With CRPS-associated prescriptions, (95% CI 0.05-0.16, p < 0.001) more CRPS patients were prescribed opioids (N = 398, 59%) than controls (N = 327, 49%). CRPS is difficult to treat with significant variance in suggested treatment modalities. Based on the results of our study, there is a divergence between some published recommendations and actual practice.

Usefulness of thermography in the diagnosis and classification of complex regional pain syndrome

IntroductionWe propose a protocol for study of complex regional pain syndrome (CRPS) based on a battery of quantitative measures (skin thermography, electrochemical skin conductance and sensory thresholds) and apply such protocol to 5 representative cases of CRPS. Patients and methods5 CPRS cases (2 women/3 men) that met the Budapest criteria for the diagnosis of CRPS. ResultsAll patients showed spontaneous pain and allodynia. Two cases correspond to a stage I, in both the resting basal temperature was increased in the affected limb. Three cases reflect more advanced stages with a decrease in resting temperature and a delay in the recovery of the temperature when compared to contralateral limb. DiscussionThese non-invasive quantitative functional tests not only improve the diagnostic accuracy of CRPS but also, they help us to stratify and understand the pathological processes of the disease.

Epidemiology of Upper Limb Complex Regional Pain Syndrome in a Retrospective Cohort of Persons Aged 9-30 Years, 2002-2017.

Introduction This paper describes the epidemiology and clinical presentation of complex regional pain syndrome (CRPS) in a large, integrated health care delivery system; and CRPS incidence rates (IRs) over a time period spanning human papillomavirus (HPV) vaccine licensure and published case reports of CRPS following HPV vaccination. Methods The authors examined CRPS diagnoses in patients aged 9-30 years between January 2002 and December 2017 using electronic medical records, excluding patients with lower limb diagnoses only. Medical record abstraction and adjudication were conducted to verify diagnoses and describe clinical characteristics. CRPS IRs were calculated for 3 periods: Period 1 (2002-2006: before HPV vaccine licensure), Period 2 (2007-2012: after licensure but before published case reports), and Period 3 (2013-2017: after published case reports). Results A total of 231 individuals received an upper limb or unspecified CRPS diagnosis code during the study period; 113 cases were verified through abstraction and adjudication. Most verified cases (73%) were associated with a clear precipitating event (eg, non-vaccine-related injury, surgical procedure). The authors identified only 1 case in which a practitioner attributed CRPS onset to HPV vaccination. Twenty-five incident cases occurred in Period 1 (IR = 4.35/100,000 person-years (PY), 95% confidence interval (CI) = 2.94-6.44), 42 in Period 2 (IR = 5.94/100,000 PY, 95% CI = 4.39-8.04), and 29 in Period 3 (IR = 4.53/100,000 PY, 95% CI = 3.15-6.52); differences between periods were not statistically significant. Conclusion These data provide a comprehensive assessment of the epidemiology and characteristics of CRPS in children and young adults and provide further reassurance about the safety of HPV vaccination.

Signs and symptoms of pediatric complex regional pain syndrome - type 1: A retrospective cohort study

ABSTRACT Background Complex regional pain syndrome (CRPS) presents with an array of symptoms that can vary from child to child, making it difficult to diagnose and differentiate from other pain conditions such as chronic musculoskeletal (MSK) pain. Thirteen symptoms and signs are outlined in the Budapest criteria for CRPS (developed and validated for adults) but have not been well described in pediatrics. Aims The aim of this study was to describe the signs and symptoms of pediatric CRPS type 1 (CRPS 1) and determine whether a cluster of symptoms can differentiate CRPS 1 from chronic MSK pain. Methods A retrospective cohort study of pediatric patients with CRPS 1 and MSK pain in a pediatric pain program was conducted. Descriptive statistics were used to report demographics and pain characteristics. The chi-square test was used to evaluate differences in signs and symptoms between patients with CRPS and MSK pain. A logistic regression model was used to evaluate whether a cluster of symptoms could predict a diagnosis of CRPS 1. Results The sample included 187 patients (99 with CRPS 1 and 88 with MSK pain); 81% were female with a mean age 14.1 years. The most prevalent CRPS symptoms were hyperalgesia (54%) and allodynia (52%). A cluster of symptoms (hyperalgesia, color changes, and range of motion) predicted the probability of a diagnosis of CRPS 1. Conclusions A cluster of symptoms may be critical in differentiating pediatric CRPS 1 and MSK pain. Future research is needed to determine if this model is valid in external populations and to explore whether a similar model can differentiate CRPS 1 from other pain conditions (e.g., neuropathic pain).

Impact of Adding Carpal Tunnel Release or Trigger Finger Release to Carpometacarpal Arthroplasty on Postoperative Complications.

This study assessed whether adding trigger finger or carpal tunnel release at the time of thumb carpometacarpal (CMC) arthroplasty would increase postoperative opioid use, readmissions, complications, or development of complex regional pain syndrome (CRPS). Using the IBM MarketScan Research Databases from 2012 through 2016, the authors identified two CMC arthroplasty groups. The CMC-only group only had a CMC arthroplasty on the day of operation; the multiple-procedures group had a CMC arthroplasty and concurrent carpal tunnel or trigger finger release. Between the two groups, the authors compared persistent opioid use, 30-day readmissions, 30-day complications, and diagnosis of CRPS. The CMC-only group consisted of 18,010 patients; the multiple-procedures group consisted of 4064 patients. The patients in the multiple-procedures group received a CMC arthroplasty and a carpal tunnel release (74%), a trigger finger release (20%), or both (6%). CMC-only patients had lower rates of persistent opioid use compared with patients who underwent multiple procedures (16% versus 18%). Readmission rates were also lower for CMC-only patients (3% versus 4%). CMC-only patients had decreased odds of persistent opioid use (OR, 0.85; 95% CI, 0.75 to 0.97; P = 0.013) and readmissions (OR, 0.80; 95% CI, 0.67 to 0.96; P = 0.016). The most common reason for readmission was pain (16%). Adding another procedure to a CMC arthroplasty slightly increases the odds of adverse outcomes such as persistent opioid use and readmission. Patients and providers should weigh the efficiency of performing these procedures concurrently against the risk of performing multiple procedures at once. Therapeutic, III.

Modern Principles of Diagnosis and Treatment in Complex Regional Pain Syndrome.

Complex regional pain syndrome (CRPS) is a relatively common complication, occurring in 5% of cases after injury or surgery, particularly in the limbs. The incidence of CPRS is around 5- 26/100 000. The latest revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11) now categorizes CRPS as a primary pain condition of multifactorial origin, rather than a disease of the skeletal system or the autonomic nervous system. Based on a selective search of the literature, we summarize current principles for the diagnosis and treatment of CRPS. Regional findings in CRPS are accompanied by systemic symptoms, especially by neurocognitive disorders of body perception and of symptom processing. The therapeutic focus is shifting from predominantly passive peripheral measures to early active treatments acting both centrally and peripherally. The treatment is centered on physiotherapy and occupational therapy to improve sensory perception, strength, (fine) motor skills, and sensorimotor integration/ body perception. This is supported by stepped psychological interventions to reduce anxiety and avoidance behavior, medication to decrease inflammation and pain, passive physical measures for reduction of edema and of pain, and medical aids to improve functioning in daily life. Interventional procedures should be limited to exceptional cases and only be performed in specialized centers. Spinal cord and dorsal root ganglion stimulation, respectively, are the interventions with the best evidence. The modern principles for the diagnosis and treatment of CRPS consider both, physiological and psychological mechanisms, with the primary goal of restoring function and participation. More research is needed to strengthen the evidence base in this field.

A Pilot Investigation into Targeted Muscle Reinnervation for Complex Regional Pain Syndrome, Type II.

Herein, we describe a series of 13 patients undergoing TMR for CRPS-II by a single surgeon from 2018 to 2021 in the upper (38%) and lower extremities (62%). All patients had a diagnosis of CRPS-II with either traumatic or postsurgical etiology, each seeking TMR with or without concomitant treatment to control their pain after previous therapies had failed. Three patients had previous lower extremity amputation, whereas three others received lower extremity amputation at the time of TMR, each indicated for control of CRPS pain. Of the patients receiving TMR within 1 year of CRPS diagnosis, all three reported improved function, and two patients were able to tolerate a prosthetic for ambulation after previous pain prevented prosthetic use. Of the entire cohort, all but one patient reported reduced pain interference or improved function. These outcomes suggest that TMR may provide some benefit to reducing pain severity patients with CRPS, even after a more chronic disease course. Further prospective trials are warranted.

Targeted Muscle Reinnervation for the Treatment of Complex Regional Pain Syndrome in Lower Extremity Amputees: A Case Series

BACKGROUND: Complex regional pain syndrome (CRPS) is characterized by severe pain accompanied by vascular, motor, or trophic changes. Targeted muscle reinnervation (TMR) has been shown to improve phantom limb pain in lower extremity (LE) amputation. The objective of this case series was to characterize TMR as a treatment for CRPS patients with LE amputation. METHODS: A retrospective review was done of CRPS patients receiving LE amputation and TMR with a single surgeon from 2018-2021. Demographics, operative details, and pain outcomes were collected. Variables were analyzed using appropriate statistical tests. RESULTS: There were 6 patients identified, all Caucasian women, with an average age of 32.5±15.4 years and body mass index (BMI) 24.9±5.0 kg/m2. CRPS was the indication for all amputations, done either before or during TMR. All patients were following with Pain Management at the time of TMR. Patients 1 and 2 both carried a CRPS diagnosis due to LE trauma less than 1 year before TMR, for 4 and 11 months respectively. Patient 1 had a simultaneous amputation with TMR, while patient 2 had an amputation 11 months prior. Both patients were otherwise healthy and previously tried ketamine infusions to control their CRPS. They were followed for an average of 11±4.2 months after TMR procedure, and reported no change in their pain based on NRS pain assessments. Patient 1 did not have any previous nerve operations, while Patient 2 had a tibial nerve coaptation and saphenous neurectomy during amputation. At most recent follow up, Patient 1 reported complete resolution of pain and a decreased dose of their neuroleptic medication. Patient 2 continued to endorse generalized pain, but denied any resting leg pain (RLP) or phantom limb pain (PLP). Both Patients 1 and 2 were newly independently ambulatory 90 and 122 days after TMR, respectively, reporting the improvement in pain quality allowed them to tolerate a prosthetic. The remaining four patients all carried a CRPS diagnosis due to trauma or a post-surgical etiology ranging from 3-8 years before TMR. They were all otherwise healthy, with exception of a Sjogren’s (patient 3) and an Ehlers Danlos diagnosis (patient 4). Both of these patients had simultaneous amputation and TMR. Patients 5 and 6 had amputations beforehand, waiting 16 and 93 months, respectively. All had tried either ketamine infusions, spinal cord stimulation, DRG stimulation, or lumbar nerve blocks before TMR. When comparing pre- and post- TMR NRS values, all reported a 2-point increase with exception of patient 5, who maintained a score of 7 both before and after TMR. At most recent follow up, all patients endorsed generalized pain. All but patient 6 continued to endorse PLP after TMR. Of note, patient 6 had multiple neuroma excisions before TMR and reported a decrease in their narcotic dosage by most recent follow up. There were no changes between pre- and post- TMR ambulation status for these patients. CONCLUSION: CRPS is a debilitating condition with a variety of treatment options. Operative results may be improved for patients who have TMR done earlier after CRPS diagnosis.

Clinical practice guidelines for the management of patients with complex regional pain syndrome: a systematic appraisal using the AGREE II instrument.

Aim: Complex regional pain syndrome (CRPS) is a debilitating, painful condition of limbs that often arises after an injury and is associated with significant morbidity. Materials & methods: The Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument, used to assess the quality of clinical practice guidelines (CPGs), was used to evaluate sevenCRPS management guideline. Results: Out of the sevenCPGs evaluated using the AGREE II instrument, only one from Royal College of Physicians was found to have high-quality consensus guidelines for diagnosis and management of CRPS. Conclusion: Future CPGs should be backed by systematic literature searches, focus on guidelines clinical translation into clinical practice and applicability to the desired patient population.

Complex Regional Pain Syndrome or Limb Pain: A Plea for a Critical Approach.

Most frequently, complex regional pain syndrome (CRPS) develops after a trauma and affects distal parts of the limbs. Early recognition and initiation of adequate treatment is crucial for a favorable outcome. On the other hand, misdiagnosing other disorders as CRPS is detrimental because more appropriate treatment may be withheld from the patients. Despite intensive research, a specific biomarker or paraclinical measure for CRPS diagnosis is still lacking. Instead, clinical criteria approved by the International Association for the Study of Pain (IASP) and latest adapted in 2019 are central for diagnosing CPRS. Thus, the CRPS diagnosis remains challenging with the risk of a “deliberate diagnosis” for unexplained pain, while at the same time a delayed CRPS diagnosis prevents early treatment and full recovery. CRPS is a diagnosis of exclusion. To clinically diagnose CRPS, a vigorous exclusion of “other diseases that would better explain the signs and symptoms” are needed before the patients should be referred to tertiary centers for specific pain treatment. We highlight red flags that suggest “non-CRPS” limb pain despite clinical similarity to CRPS. Clinical and neurological examination and paraclinical evaluation of a probably CRPS patient are summarized. Finally, we pinpoint common differential diagnoses for CRPS. This perspective might help CRPS researchers and caregivers to reach a correct diagnosis and choose the right treatment, regardless whether for CRPS mimics or CRPS itself.

Osteo-Cutaneous Trophic Changes in Complex Regional Pain Syndrome and their Reversal with Steroids.

Complex regional pain syndrome (CRPS) is a chronic pain condition characterized by autonomic and inflammatory features. There is paucity of data regarding sustained benefits of any treatment modality. We aimed to document the effect of steroids in CRPS on long-term basis. We came across five patients of CRPS in Out Patient clinics of super-speciality Institutes in North India. All five cases fulfilled the Budapest criteria for the diagnosis of CRPS. All of them received prednisolone and were prospectively followed up for 2 years. Treatment outcome was carefully recorded in all affected modalities. All five cases were found to have excruciating neuropathic pain in defined regions along with cutaneous manifestations. Osseous changes in the form of surface erosion of underlying bones in four cases and marked marrow edema leading to considerable increase in bone thickness in one case were noted. All these features improved considerably following steroid therapy. Bone marrow edema and bone resorption showed improvement on serial imaging. Apart from pain relief, steroids therapy is capable of reversing the osteo-cutaneous autonomic changes of CRPS type I.

Complex regional pain syndrome following vascular access creation for hemodialysis.

Pain and swelling of a limb following creation of arterio-venous fistula (AVF) are often attributable to vascular disorders like venous hypertension or limb ischaemia. Here we report the case of a 70-years old man who developed pain and swelling of upper limb distal to the AVF during second post-operative week due to a complex regional pain syndrome (CRPS). CRPS is characterized by pain that is disproportionate to the invoking injury, autonomic dysfunction, trophic changes and functional impairment of affected limb. Hyperalgesia and allodynia are pain patterns characteristic of CRPS. CRPS has been reported rarely following AVF creation surgery. Prompt diagnosis of CRPS is important to avoid misdiagnosis of vascular disorders and for implementation of right therapeutic strategy.

Preoperative Predictors of Complex Regional Pain Syndrome Outcomes in the 6 Months Following Total Knee Arthroplasty

This prospective observational study evaluated preoperative predictors of complex regional pain syndrome (CRPS) outcomes in the 6 months following total knee arthroplasty (TKA). Participants were n = 110 osteoarthritis patients (64.5% female) undergoing unilateral TKA with no prior CRPS history. Domains of negative affect (depression, anxiety, catastrophizing), pain (intensity, widespread pain, temporal summation of pain [TSP]), pain interference, sleep disturbance, and pro-inflammatory status (tumor necrosis factor-alpha [TNF-a]) were assessed preoperatively. CRPS outcomes at 6-week and 6-month follow-up included the continuous CRPS Severity Score (CSS) and dichotomous CRPS diagnoses (2012 IASP criteria). At 6 months, 12.7% of participants met CRPS criteria, exhibiting a “warm CRPS” phenotype. Six-week CSS scores were predicted by greater preoperative depression, anxiety, catastrophizing, TSP, pain intensity, sleep disturbance, and TNF-a (P’s < .05). Provisional CRPS diagnosis at 6 weeks was predicted by higher preoperative TSP, sleep disturbance, and TNF-a (P’s < .05). CSS scores at 6 months were predicted by more widespread and intense preoperative pain, and higher preoperative TSP, pain interference, and TNF-a (P’s < .01). CRPS diagnosis at 6 months was predicted only by more widespread and intense pain preoperatively (P’s < .05). Risk for CRPS following TKA appears to involve preoperative central sensitization and inflammatory mechanisms. Preoperative negative affect is unlikely to directly influence long-term CRPS risk. PerspectiveThis article identifies preoperative predictors of CRPS features at 6 months following total knee arthroplasty, including more widespread pain and higher pain intensity, temporal summation of pain, pain interference, and tumor necrosis factor-alpha levels. Findings suggest the importance of central sensitization and inflammatory mechanisms in CRPS risk following tissue trauma.

Patient Satisfaction with Virtual Evaluation, Diagnosis and Treatment of CRPS

Background The COVID-19 pandemic has led to an increased reliance on virtual care in the rehabilitation setting for patients with conditions such as complex regional pain syndrome (CRPS). Aims To perform a quality improvement initiative to assess patient satisfaction and ensure that outcomes following virtual assessment, diagnosis and treatment of CRPS with prednisone are safe and effective. Methods An online survey was distributed to 18 patients with CRPS who had been seen virtually between March and December 2020 through a rehabilitation clinic and treated with oral prednisone. Thirteen participants completed the survey, which was designed de novo by our team to evaluate participant perceptions and satisfaction regarding the virtual care experience. Also included in the survey was a CRPS-specific validated patient-report questionnaire (Hamilton Inventory for CRPS: PR-HI-CRPS), which allowed participants to describe their specific symptoms and associated functional and psychosocial impacts, both previously (pre-treatment baseline) and at the time of survey (post-treatment). Results CRPS symptoms and related impacts were scored as significantly improved from baseline following treatment with prednisone. Likert scale results from survey responses related to patients’ experiences and satisfaction with the virtual care process were analyzed; the majority of patients reported satisfaction with a virtual appointment for evaluation of CRPS, as well as with subsequent treatment decisions based on virtual assessment. Conclusions This quality improvement study suggests that virtual care is a potential option for a patient-accepted approach to overcoming challenges with in-person care imposed by the COVID-19 pandemic, and could help inform future considerations in addressing geographic and patient-specific disparities in access to specialist care for CRPS.

Post-traumatic and non-traumatic Complex Regional Pain Syndrome type I

Complex regional pain syndrome (CRPS) is an umbrella term covering different clinical scenarios. It is a rare condition characterized by regional persisting pain, disproportionate to its underlying cause, usually coupled with sensorimotor, vasomotor, sudomotor, and trophic abnormalities. Different forms of CRPS have been identified: CRPS type I (algodystrophy); CRPS type II (causalgia); CRPS-NOS (not otherwise specified), and CRPS with remission of some features (CRSF). The pathophysiology of algodystrophy is probably related to multiple mechanisms, such as abnormal inflammation, vasomotor dysfunction, and maladaptive neuroplasticity. In most cases this condition is related to traumatic injuries or fractures, most frequently located at the distal upper limb, although in some patients no related triggering factor can be found. Algodystrophy occurrence after non-orthopedic surgery or procedures, such as percutaneous transluminal coronary angioplasty, cardiac ablation, hemodialysis, or transplantation, is rare and underestimated. Imaging can assist clinicians in the very challenging differential diagnosis of CRPS. To prevent severe and disabling consequences, international guidelines suggest a prompt multimodal approach to algodystrophy, including pharmacological (bisphosphonates, particularly neridronate) and non-pharmacological (i.e., rehabilitation interventions) measures.