🎙️ 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/