Background & Aims

Complex regional pain syndrome (CRPS) is a rare complication after limb injuries [1-3]. Population-based studies report variable CRPS incidences 0.07-0.12% [3, 4] mostly after forearm and ankle fractures. The aim of our evaluation is to describe the incidence and treatment of CRPS after different types of surgery using claims data from the BARMER, a German nationwide health care insurance for in- and outpatient treatments.

Methods

A total of N=50,120 BARMER patients with inpatient surgery on the upper or lower limb in 2018 were included. Patients with CRPS were identified by documented ICD-10 diagnosis within 12 months after surgery. For the same period, we assessed medication and non-pharmacological therapies. All these items were also assessed for the patients who did not develop CRPS.

Results

The total incidence of CRPS within 12 months after surgery was 0.47%. With 0.60%, the incidence after surgeries of the upper limb (ULS) was about twice as high as after lower limb surgeries (LLS) (0.27%). Women were more frequently affected (80%), especially with CRPS of the upper limb, with 50 to 70 years of age. Almost all patients with CRPS received physical therapy and non-opioid pain medication within 12 months after surgery. Interdisciplinary pain therapy (15%) and occupational therapy (25%) were claimed less. Antineuropathic and opioid medication were prescribed for a little less than 50%. Cortisone was administered at 20% and no one received the bisphosphonate pamidronate. Non opioid and physiotherapy prescription was equally high in patients without CRPS. One tenth less claimed interdisciplinary pain and occupational therapy. Opioid prescription decreased to 20 (ULS) -30% (LLS). Antineuropathic drugs were prescribed three times less, cortisone a half less.

Conclusions

We found a low incidence of CRPS after various types of surgery. While previous research had focused on distal radius fractures and ankle surgery, our data imply that also after other types of surgery, clinicians should have CRPS in mind, e.g. shoulder and knee surgery. Our data shows a higher therapeutic demand compared to non CRPS patients after ULS and LLS surgeries. Access to adequate treatment, especially occupational therapy and pain therapy, may need to be improved. CRPS patients without surgery are not represented which would increase the numbers.

References

1.Dietz C, Muller M, Reinhold AK, Karch L, Schwab B, Forer L, Vlckova E, Brede EM, Jakubietz R, Uceyler N, Meffert R, Bednarik J, Kress M, Sommer C, Dimova V, Birklein F, Rittner HL. What is normal trauma healing and what is complex regional pain syndrome I? An analysis of clinical and experimental biomarkers. Pain 2019;160(10): 2278-89.
2.de Mos M, de Bruijn AG, Huygen FJ, Dieleman JP, Stricker BH, Sturkenboom MC. The incidence of complex regional pain syndrome: a population-based study. Pain 2007;129(1-2): 12-20.
3.Elsharydah A, Loo NH, Minhajuddin A, Kandil ES. Complex regional pain syndrome type 1 predictors – Epidemiological perspective from a national database analysis. Journal of clinical anesthesia 2017;39: 34-37.
5.Schwarzkopf D. [Long-term outcome of perioperative pain therapy assessed based on routine data (LOPSTER)]. Anaesthesist 2020;69(11): 844-46.

Presenting Author

Gudrun Kindl

Poster Authors

Gudrun Kindl

Dr. med.

Center for Interdisciplinary Pain Medicine, Department of Anesthesiology, Würzbu

Lead Author

E-mail

Topics

  • Specific Pain Conditions/Pain in Specific Populations: Complex Regional Pain Syndrome (CRPS)