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Complex regional pain syndrome

Complex Regional Pain Syndrome (CRPS), formerly Reflex Sympathetic Dystrophy (RSD) or Causalgia, is a chronic systemic disease characterized by severe pain, swelling, and changes in the skin. CRPS is expected to worsen over time. It often initially affects an arm or a leg and often spreads throughout the body; 92% of patients state that they have experienced a spread and 35% of patients report symptoms in their whole body. Recent evidence has led to the conclusion that Complex Regional Pain Syndrome is a multifactorial disorder with clinical features of neurogenic inflammation, nociceptive sensitisation (which causes extreme sensitivity or allodynia), vasomotor dysfunction, and maladaptive neuroplasticity, generated by an aberrant response to tissue injury. Treatment is complicated, involving drugs, physical therapy, psychologic treatments and neuromodulation and usually unsatisfactory, especially if begun late.

Source: Wikipedia

What are the symptoms?

Within all the people who go to their doctor with complex regional pain syndrome, 63% report having loss of sensation, 52% report having leg pain, and 42% report having foot or toe pain. The symptoms that are highly suggestive of complex regional pain syndrome are loss of sensation and paresthesia, although you may still have complex regional pain syndrome without those symptoms.


What might my doctor prescribe?

Common Tests and Procedures

Patients with complex regional pain syndrome often receive magnetic resonance imaging, physical therapy exercises, other diagnostic procedures (interview; evaluation; consultation), lipid panel, hemoglobin a1c measurement, examination of foot, other therapeutic procedures and debridement of wound; infection or burn .

Common Medications

The most commonly prescribed drugs for patients with complex regional pain syndrome include gabapentin, pregabalin (lyrica), amitriptyline, methadone, baclofen, lidocaine-prilocaine topical, buprenorphine (suboxone), milnacipran (savella), midodrine, flunisolide nasal, tenofovir, combivir and sorbitol .

Gabapentin
$25
(28 days)
Pregabalin (Lyrica)
$148
(28 days)
Amitriptyline
$4
(28 days)
Methadone
$20
(28 days)
Baclofen
$18
(28 days)
Lidocaine-Prilocaine Topical

Buprenorphine (Suboxone)
$326
(21 days)
Milnacipran (Savella)
$102
(28 days)
Midodrine
$106
(28 days)
Flunisolide Nasal

Tenofovir

Combivir
$790
(28 days)
Sorbitol

Who is at risk?

Groups of people at highest risk for complex regional pain syndrome include age 75+ years, age 60-74 years and age 45-59 years. On the other hand, age 1-4 years and age < 1 years almost never get complex regional pain syndrome.

Age

< 1 years
0.0x
1-4 years
0.0x
5-14 years
0.1x
15-29 years
0.3x
30-44 years
0.9x
45-59 years
1.8x
60-74 years
1.7x
75+ years
1.6x

Sex

Male
1.0x
Female
1.0x

Race/Ethnicity

Black
0.9x
Hispanic
0.6x
White
1.2x
Other
0.7x
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