CRPS & Intrathecal Pain Pumps for the Anesthesia Boards

🎙️ PainExam Podcast Show Notes CRPS & Intrathecal Pain Pumps — High-Yield ABA Pain Board Review 🔥 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.

🧠 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

📋 CRPS Types CRPS Type I

• No confirmed nerve injury
• Formerly "Reflex Sympathetic Dystrophy"

CRPS Type II

• Confirmed nerve injury
• Formerly "Causalgia"

⚠️ Pathophysiology

CRPS involves:

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

🩺 High-Yield Clinical Features

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

📚 Budapest Criteria (BOARD FAVORITE)

Diagnosis requires:

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

💊 Treatment First-Line

• Physical therapy (MOST important)
• Early mobilization

Medications

• Gabapentin
• Pregabalin
• TCAs

Interventional

• Sympathetic blocks
• Spinal cord stimulation

🚨 Board Pearls

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

💉 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

🎯 Indications

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

💊 Common Intrathecal Medications Opioids

• Morphine
• Hydromorphone

Non-Opioid

• Ziconotide

Other

• Baclofen (spasticity)

⚠️ Ziconotide — HIGH-YIELD BOARD PEARL

Ziconotide:

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

⚠️ Major Complications

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

🚨 Granuloma Formation

High-dose intrathecal opioids may cause:

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

📋 Trialing

Patients typically undergo:

• Bolus trial
• Continuous infusion trial

before permanent implantation.

🎯 Board Pearls

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

📝 High-Yield Board Takeaways CRPS

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

Intrathecal Pumps

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

🎓 Pain Board Prep Resources

Prepare for your ABA Pain Medicine boards with:

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

🏆 Why Physicians Choose NRAP Academy

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

🎤 Upcoming Training

Join upcoming:

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

📢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/