Louisiana Administrative Code
Title 40 - LABOR AND EMPLOYMENT
Part I - Workers' Compensation Administration
Subpart 2 - Medical Guidelines
Chapter 21 - Pain Medical Treatment Guidelines
Subchapter B - Complex Regional Pain Syndrome
Section I-2121 - Introduction to Complex Regional Pain Syndrome

Universal Citation: LA Admin Code I-2121

Current through Register Vol. 50, No. 9, September 20, 2024

A. Complex regional pain syndrome (CRPS types I and II) describes painful syndromes, which were formerly referred to as reflex sympathetic dystrophy (RSD) and causalgia. CRPS conditions usually follow injury that appears regionally and have a distal predominance of abnormal findings, exceeding the expected clinical course of the inciting event in both magnitude and duration and often resulting in significant impairment of limb function.

B. CRPS-I (RSD) is a syndrome that usually develops after an initiating noxious event, is not limited to the distribution of a single peripheral nerve, and is apparently disproportionate to the inciting event. It is associated at some point with evidence of edema, changes in skin, blood flow, abnormal sudomotor activity in the region of the pain, allodynia or hyperalgesia. The site is usually in the distal aspect of an affected extremity or with a distal to proximal gradient. The peripheral nervous system and possibly the central nervous system are involved.

C. CRPS-II (causalgia) is the presence of burning pain, allodynia, and hyperpathia usually in the hand or foot after partial injury to a nerve or one of its major branches. Pain is within the distribution of the damaged nerve but not generally confined to a single nerve.

D. Stages seen in CRPS-I are not absolute and in fact, may not all be observed in any single patient. In some patients, stages may be missed or the patient may remain for long periods of time in one stage.

E. Stage 1 - Acute (Hyperemic)

1. Starts at the time of injury or even weeks later. Associated with spontaneous pain, aching, burning. Typically restricted to the distal extremity. Hyperpathia, allodynia, hypoesthesia or hyperesthesia may be present. Initially, hair and nail growth may be increased but later decrease. Skin may be warm or cold.

F. Stage 2 - Dystrophic (Ischemic)

1. Spontaneous burning and/or aching pain, more pronounced hyperpathia and or allodynia. Signs of chronic sympathetic over activity include reduced blood flow; sudomotor changes; increased edema; cyanotic skin; muscle wasting; decreased hair and nail growth; and osteoporosis.

G. Stage 3 - Atrophic

1. Signs and symptoms of this stage include pain may be less prominent; decreased hyperpathia and/or allodynia; reduction in blood flow; skin temperature and sweating may be increased or decreased; irreversible trophic changes in skin and integument; and pronounced muscle atrophy with contractures.

AUTHORITY NOTE: Promulgated in accordance with R.S. 23:1203.1.

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