Epidural Infusion of Opiates and Local Anesthetics for Complex Regional Pain Syndrome

Abstract

Complex Regional Pain Syndrome Type-I (CRPS-I) is a neuropathic pain syndrome resulting from complex pain mechanisms that involve several levels and components of the nervous system. CRPS-I consists of multiple signs, including autonomic dysfunction, in the form of edema, vasomotor changes, motor dysfunctions, muscle spasms, tremors and dystonia, as well as burning pain, hypersensitivity and allodynia that could present in any combination. The treatment is progressive physical therapy rehabilitation program. Multiple analgesic modalities have been used to facilitate the rehabilitation program with varying rates of success. The most successful treatment is a multi-disciplinary comprehensive approach, where initial pain control allows for physical and psychological interventions that are believed to be the basis for successful treatment.(1) The pain in CRPS-I may be mediated through the sympathetic nervous system, sympathetic maintained pain (SMP) or sympathetic independent pain (SIP)(2).

CRPS I following artificial disc surgery: case report and review of the literature

“…In the literature, treatment options including spinal cord stimulation (SCS) [16], a guanethidine block [11,12,22], epidurals using morphine [23], ketamine comas and interventional therapies have been reported [24], although these were mostly reported in case reports and these therapies are not standard currently in the treatment of CRPS. Most reports indicate that the early initiation of a specific therapy leads to an earlier improvement of the disease [13,18,24,34].…”

Correction of Severe Foot and Ankle Contracture Due to CRPS Using External Fixation and Pain Management: Report of a Pediatric Case

“…Moreover, acute surgical correction of these deformities can be problematic because of perioperative pain issues that can be very difficult to manage. Gradual correction using an external fixation device, combined with adjunctive procedures such as isolated tendon lengthening and/or botulinum injections, may enable the establishment of a plantigrade foot in a less acutely traumatic fashion and, as such, may be less stressful to the patient and minimize the risk of exacerbation of the pain syndrome (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29).…”

Tunneled Epidural Catheter Infections in Noncancer Pain: Increased Risk in Patients With Neuropathic Pain/Complex Regional Pain Syndrome

“…[1][2][3] Tunneling is undertaken to improve the stability of the catheter for prolonged infusion and to hopefully decrease the risk of infection by allowing early detection. Two tunneled epidural catheter systems exist and include: 1) an externalized catheter system [4][5][6][7] ; and 2) an implanted subcutaneous catheter port system.…”

“…When the pain is not effectively controlled by sympathetic nerve blocks, TECs are placed in proximity to the nerve roots of the involved extremity with the help of fluoroscopic guidance. 2 An automatic infusion delivery system is typically attached to the TEC for prolonged administration of pain controlling medications. Tunneled epidural catheters are also placed in patients with other regional neuropathic entities and in patients with somatic regional pain, such as adhesive capsulitis of the shoulder, or in patients with chronic knee pain and decreased range of motion following multiple knee surgeries.…”