🎙️ 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

...