1. Complex Regional Pain Syndrome (CRPS) Sean S. Armin, M.D. Department of Neurosurgery, Loma Linda University Medical Center

2. Introduction to CRPS Confusing terminology: Reflex Sympathetic Dystrophy – CRPS I Causalgia – CRPS II Other previous names: algodystrophy mineures, mimo-causalgia, sympathalgia, post-traumatic spreading neuralgia, Sudek’s atrophy, Shoulder-hand syndrome, Sympathetically-maintained pain (SMP) Long recognized clinical entity: Bernard and Weir Mitchell (1800’s) Still no clearly identified pathophysiology Sympathetic nervous system: etiology vs. epiphenomenon

3. Complex Regional Pain Syndrome I vs. II Harden, et al: Clin J Pain, 22: 415–419, 2006 Sensitivity: 0.98 Specificity: 0.36 Bruehl, et al: Pain, 81: 147–154, 1999

4. Proposed Modified Dx Criteria for CRPS Proposed Modified Clinical Dx Criteria At least one Sx in 3 of 4 categories At least one Sx in 2 of 4 categories Sensitivity: 0.70 Specificity: 0.95 Sensitivity: 0.85 Specificity: 0.69 Harden, et al: Clin J Pain, 22: 415–419, 2006

5. Quisel, et al: J Family Practice, 54: 524–532, 2005

6. Clinical Presentation Wasner, et al: Spinal Cord, 41: 65–71, 2003Simpson: Lancet Neurology, 3: 142, 2004

7. Quisel, et al: J Family Practice, 54: 524–532, 2005

8. Clinical Presentation Vacariu: Disability & Rehab, 24: 435–442, 2002 Harden, et al: Clin J Pain, 22: 415–419, 2006

9. Quisel, et al: J Family Practice, 54: 524–532, 2005

10. Peripheral Response to Injury Teasdall, et al: Clin Sports Med, 23: 145-155, 2004

11. Pathophysiology Wasner, et al: Spinal Cord, 41: 65–71, 2003

12. Pathophysiology Wasner, et al: Spinal Cord, 41: 65–71, 2003

13. Pathophysiology Wasner, et al: Spinal Cord, 41: 65–71, 2003

14. Pathophysiology Teasdall, et al: Clin Sports Med, 23: 145-155, 2004

15. Mechanism-Based Pharmacotherapy Ribbers, et al: Arch Phy Med Rehabil, 84: 141–146, 2003

16. Quisel, et al: J Family Practice, 54: 524– 532, 2005

17. Spinal Cord Stimulation Study Methodologies Grabow, et al: Clinical J. Pain, 19: 371–383, 2003

18. Spinal Cord Stimulation Study Outcomes Grabow, et al: Clinical J. Pain, 19: 371–383, 2003

19. Spinal Cord Stimulation Randomized Trial Kemler, et al: Ann Neurol, 55: 13–18, 2004

20. Complex Psychosical/Behavioral Interaction Deterioration Turner-Stokes: Disability & Rehab, 24: 939–947, 2002 Miller: Orthoped Nursing, 22: 91– 99, 2003