Summary
Complex regional pain syndrome (CRPS) is a chronic progressive disease characterised by severe pain, swelling and changes in the skin. Precipitating factors include injury and surgery, and a variety of causes have been described. We present the case of a 68-year-old lady who presented with features indicative of a CRPS following steroid injection for a ‘trigger’ thumb.
--Published in the October 2010 issue of the Journal of Plastic, Reconstructive and Aesthetic Surgery, Volume 63, Issue 10
Something equally innocuous can cause "spread" of CRPS, as well, which is why someone with the disease can be particularly anxious about injections, blood draws -- and, needless to say, things like surgeries.
I have wanted to politely bop a few nurses and lab techs on their pointy little heads for rolling their eyes at my concerns about being stuck in a CRPS-afflicted limb. Even my top-notch, worldclass, wunnerful::wunnerful surgeon doesn't follow all the established precautions for preventing spread... I have shared with him the protocols I find, which include early admission for i.v. infusions and pain meds (yes, ketamine is involved!) and similar infusions afterward -- something that purportedly stops spread and prevents "flare." [These are the recommendations at the Hospital for Special Surgery, an orthopedic Mecca.]
If anyone doubts how far reaching the Dr. Scott Reuben scandal is? One of the often recommended articles on prevention of CRPS spread during/after a surgical procedure is called, nattily enough: Preventing the Development of Complex Regional Pain Syndrome after Surgery
and yes, the author is "Reuben, SS."
He pops up again with Perioperative Pregabalin Reduces Neuropathic Pain at 3 Months after Total Knee Arthroplasty (TKA) and if you are certain that he is not simply a mercenary in his promotion of Pregabalin, then you are a trusting, simple, stupid soul.
On the other hand, the level of my distrust might be excessive.
[It could happen.]
The ideas posited in Surgery on the Affected Upper Extremity of Patients with a History of Complex Regional Pain Syndrome: The Use of Intravenous Regional Anesthesia with Clonidine are considered indisputable, or were, given Reuben's ghoulish signature on the work.
I look forward to the day when baby and bathwater can be carefully and correctly identified, separated -- and the cold, scummy liquid discarded.
In the meantime, take all the precautions that you can when someone approaches your CRPS-afflicted regions. At the very least, say "Stop! Don't touch..." and then take a moment to talk things out with the person in front of you, readying to wield some invasive tool -- because as much as I have maligned nurses and phlebotomists, I have encountered some who were very well informed and who promptly took preventive measures (using the smallest of butterflies, avoiding nerve-rich areas, etc.).
What is immeasurably valuable is the relief that comes from dealing with a health care professional who is familiar with this bug-a-boo syndrome.
The very best advice about surgery in people with CRPS? Avoid it.
Don't get me wrong... You *can* rely on certain truths in this world, in this life.
Scott Reuben is still a dirtbag, and Jose Ochoa remains a big, fat turd.
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