CRPS and Pain Pumps for the PM&R Boards!

🎙️ PainExam Podcast Show Notes

CRPS & Intrathecal Pain Pumps — High-Yield ABA Pain Board Review

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🔥 Episode Overview

In this episode of the PainExam Podcast, David Rosenblum reviews two essential ABA Pain Medicine Board topics:

• Complex Regional Pain Syndrome (CRPS)
• Intrathecal Drug Delivery Systems (Pain Pumps)

This episode focuses on:

• High-yield board pearls
• Clinical decision-making
• Interventional treatment strategies
• Common exam pitfalls

Whether you are preparing for the:

• ABA Pain Medicine Boards
• ABPM
• ABIPP
• FIPP

—or looking to sharpen your interventional pain knowledge—this episode delivers practical and testable concepts.

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🧠 Topic 1: Complex Regional Pain Syndrome (CRPS)

🔬 What is CRPS?

CRPS is a chronic neuropathic pain condition characterized by:

• Disproportionate pain
• Autonomic dysfunction
• Sensory abnormalities
• Motor and trophic changes

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📋 CRPS Types

CRPS Type I

• No confirmed nerve injury
• Formerly “Reflex Sympathetic Dystrophy”

CRPS Type II

• Confirmed nerve injury
• Formerly “Causalgia”

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⚠️ Pathophysiology

CRPS involves:

• Peripheral sensitization
• Central sensitization
• Sympathetic dysfunction
• Neurogenic inflammation
• Cortical reorganization

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🩺 High-Yield Clinical Features

• Burning pain
• Allodynia
• Hyperalgesia
• Temperature asymmetry
• Skin color changes
• Edema
• Weakness and trophic changes

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📚 Budapest Criteria (BOARD FAVORITE)

Diagnosis requires:

• Continuing pain disproportionate to injury
• Symptoms in ≥3 categories
• Signs in ≥2 categories

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💊 Treatment

First-Line

• Physical therapy (MOST important)
• Early mobilization

Medications

• Gabapentin
• Pregabalin
• TCAs

Interventional

• Sympathetic blocks
• Spinal cord stimulation

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🚨 Board Pearls

• Early treatment improves outcomes
• CRPS may spread beyond the initial site
• Immobilization worsens symptoms

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💉 Topic 2: Intrathecal Drug Delivery Systems (Pain Pumps)

🔬 What Are Intrathecal Pumps?

Intrathecal pumps deliver medications directly into the CSF, allowing:

• Lower systemic doses
• Better analgesia
• Reduced systemic side effects

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🎯 Indications

• Failed back surgery syndrome
• Cancer pain
• Refractory neuropathic pain
• Severe chronic pain not responsive to conservative therapy

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💊 Common Intrathecal Medications

Opioids

• Morphine
• Hydromorphone

Non-Opioid

• Ziconotide

Other

• Baclofen (spasticity)

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⚠️ Ziconotide — HIGH-YIELD BOARD PEARL

Ziconotide:

• Blocks N-type calcium channels
• Does NOT cause respiratory depression
• Can cause psychiatric side effects

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⚠️ Major Complications

• Infection
• Catheter malfunction
• Pump failure
• Withdrawal syndromes
• Catheter-tip granuloma formation

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🚨 Granuloma Formation

High-dose intrathecal opioids may cause:

• Catheter-tip inflammatory masses
• Cord compression
• Neurologic deficits

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📋 Trialing

Patients typically undergo:

• Bolus trial
• Continuous infusion trial

before permanent implantation.

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🎯 Board Pearls

• Ziconotide = no respiratory depression
• Pump failure can cause life-threatening withdrawal
• Granulomas are associated with opioid concentration

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📝 High-Yield Board Takeaways

CRPS

• Budapest criteria = critical
• Early PT = first-line
• Autonomic dysfunction = hallmark

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Intrathecal Pumps

• Ziconotide is highly testable
• Know granuloma risks
• Understand pump complications and withdrawal

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🎓 Pain Board Prep Resources

Prepare for your ABA Pain Medicine boards with:

👉 https://painexam.com
👉 https://nrappain.org

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🏆 Why Physicians Choose NRAP Academy

• Comprehensive board prep
• High-yield MCQs
• Virtual Pain Fellowship
• Ultrasound-guided pain training
• Interventional pain education

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🎤 Upcoming Training

Join upcoming:

• Ultrasound-guided procedure workshops
• Regenerative medicine courses
• Pain board review sessions

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📢Register today!

If you’re serious about:
✅ Passing your pain boards
✅ Mastering interventional pain
✅ Improving patient outcomes

Subscribe to the PainExam Podcast and join the Virtual Pain Fellowship.

👉 https://nrappain.org
👉 https://painexam.com

Reference 

https://dontforgetthebubbles.com/complex-regional-pain-syndrome/

https://www.ncbi.nlm.nih.gov/books/NBK459151/