Complex Regional Pain Syndrome.

Complex regional pain syndrome (CRPS) is a rare, chronic pain disorder. It is challenging for patients and physicians because it leads to significant morbidity due to chronic pain that may last for years. CRPS typically develops four to six weeks after direct trauma, such as an injury or surgery, and causes pain that is out of proportion to the inciting injury. It is associated with multiple physiologic mechanisms, affecting skin texture or localized sensory, motor, sudomotor, and vasomotor pathways. The diagnosis is made clinically using standardized diagnostic criteria. Ancillary testing is not necessary for the diagnosis of CRPS but can be useful to rule out alternative diagnoses. There are two types of CRPS, type 1 and type 2, although treatment is the same for both. There is no single proven treatment modality for CRPS, and there have been no large randomized controlled studies of CRPS treatments. Most treatments are based on studies of their use for other types of neuropathic pain. The mainstay of treatment is to improve function of the affected body part and to decrease pain; therefore, treatment requires multiple modalities, including medications, behavioral health interventions, and referral to a pain specialist.

Outpatient burns: prevention and care.

Most burn injuries can be managed on an outpatient basis by primary care physicians. Prevention efforts can significantly lower the incidence of burns, especially in children. Burns should be managed in the same manner as any other trauma, including a primary and secondary survey. Superficial burns can be treated with topical application of lotions, honey, aloe vera, or antibiotic ointment. Partial-thickness burns should be treated with a topical antimicrobial agent or an absorptive occlusive dressing to help reduce pain, promote healing, and prevent wound desiccation. Topical silver sulfadiazine is the standard treatment; however, newer occlusive dressings can provide faster healing and are often more cost-effective. Physicians must reevaluate patients frequently after a burn injury and be aware of the indications for referral to a burn specialist.