Background/Purpose:

Complex regional pain syndrome (CRPS) is a form of chronic pain that usually affects an arm or a leg. CRPS typically develops after an injury, a surgery, a stroke or a heart attack. The pain is out of proportion to the severity of the initial injury. CRPS is uncommon, and its cause isn’t clearly understood.

Methods:

To estimate the percentage of patients with CRPS who develop disability and its associated factors. Consecutive patients older than 18 years old whose met Budapest criteria for CRPS type 1 were included. Demographic variables, time of follow-up, main cause of the disease and location, time between trauma and starting treatment were recorded from the electronic clinical history (ECH). Previous immobilization, type were recorded. of treatment, response to it and clinical manifestations. Disability was defined when there was a change in work activity.

Results:

98 patients were included with at least one year of follow up, 65.3% were women. The median age is 54 years (45-61), presented the following clinical patterns: pain 69.7%, inflammation 39.7%, dysautonomic phenomena 33.6% and motor alterations 21.4%. The main cause that triggered the SDRC was fracture in 60.2%, followed by 15.3% in contusion and 14.2% in soft tissue trauma, of which 66% corresponds to upper limb and 37% to lower limb. With respect to the diagnosis, a 3-step scintigraphy compatible with CRPS was obtained in 70.4% of the cases. In the radiographic evaluation, patchy osteopenia was the predominant pattern in 28.5% of the cases. Regarding the treatment, it was distributed: 74.4% received immobilization indication. 56% of patients received oral bisphosphonate and 32% EV. It was also found that 60% of patients used vitamin D and calcium, NSAIDs in 30%, corticosteroids in 23.4% and 29.5% of adjuvant medication during the course of the disease. 66.3% of patients performed rehabilitation as part of their treatment. 67.3% had some response to treatment and 50% had a good response to treatment. The prevalence of disability was 60%. In the univariate analysis, this was associated with: Precise indication of rehabilitation (0.001), Greater use of NSAIDs (p: 0.004) positivity in bone scintigraphy (0.044), dysautonomic phenomena (0.025), and negatively with good response to treatment (p: 0.000). In the logistic regression analysis using disability as a dependent variable, we found a significant and independent association with indication of rehabilitation (OR: 4.3 CI: 1.3-14) and response to treatment (OR: 0.078 CI: 0.023-0, 2).

Conclusion:

60% of the patients developed disability in their follow-up, they were associated independently with the indication of rehabilitation and in a negative way with a good response to treatment.

« Back to 2018 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/factors-associated-with-disability-in-a-prospective-cohort-of-complex-regional-pain-syndrome-type-1/