80%
70%
60%
50%
28
40%
174
30%
20%
10%
0%
Neuropathic Somatic
Patients in the neuropathic pain group had significantly higher
chance of getting a TEC infection compared to patients in the
somatic pain group (p=0.029).
Hayek SM et al. 2006, Clin. J. Pain 22(1): 82-89
TEC Infections
There were 24 epidural space infections, 23 of
which were in the neuropathic pain group--22
with CRPS
Staphylococcus was the most common organism
isolated from the epidural space (11/23)
Contrast-enhanced MRI findings
6 frank epidural abscesses
1 phlegmon
2 patients displayed mild epidural enhancement on
MRI suggestive of epidural inflammation
All occurred in CRPS patients
Hayek SM et al., 2006, Clin. J. Pain 22(1): 82-89
Perioperative Prevention
Free radical scavengers used based
on the assumption that CRPS is
induced by the inflammatory response
DMSO
N-acetylcysteine
Mannitol
Carnitine
Vitamin C
Vitamin C for
prevention of CRPS
The only DBRPCT among scavengers
123 adults with 127 wrist fractures
Vit C 500 mg or placebo for 50 days
Conservative management/no surgery
CRPS incidence
Vitamin C 7%
Placebo 22 %