Related Experiment Video
Updated: Apr 6, 2026
07:12
Chronic Post-Ischemia Pain Model for Complex Regional Pain Syndrome Type-I in Rats
Published on: January 21, 2020
8.5K
Plasma Exchange Therapy in Patients with Complex Regional Pain Syndrome
Enrique Aradillas, Robert J Schwartzman, John R Grothusen
1Drexel University College of Medicine, Philadelphia, PA.
Pain Physician
|July 29, 2015
Summary
Plasma exchange therapy (PE) effectively reduced pain in most complex regional pain syndrome (CRPS) patients with small fiber neuropathy. Pain reduction was maintained with ongoing PE or other immune therapies, suggesting PE as a viable treatment option for severe CRPS.
Area of Science:
- Neurology
- Immunology
- Pain Medicine
Background:
- Complex regional pain syndrome (CRPS) is a severe chronic pain condition often following trauma, potentially linked to small-diameter peripheral axon degeneration.
- Intravenous immunoglobulin (IVIG) shows efficacy in painful polyneuropathies, and some CRPS patients have responded to it.
- A hypothesis of autoimmune etiology in CRPS prompted the investigation of plasma exchange therapy (PE) for patients with small fiber neuropathy.
Purpose of the Study:
- To evaluate the efficacy of plasma exchange therapy (PE) in CRPS patients with small fiber neuropathy.
- To assess PE's effectiveness in patients unresponsive or poorly responsive to existing treatments.
Main Methods:
- A retrospective case series of 33 CRPS patients meeting Budapest criteria who received PE between September 2012 and June 2014.
- Patients underwent comprehensive evaluations including pain assessment, the McGill questionnaire, quantitative sensory testing (QST), and skin punch biopsy.
- The PE protocol involved 5-11 sessions over 2-3 weeks, followed by pain evaluation and consideration of maintenance therapy (weekly PE, oral immune modulators, or IVIG).
Main Results:
- Thirty of 33 patients experienced a significant median pain reduction of 64% after the initial PE series (P < 0.01).
- Twenty-four patients maintained pain reduction with maintenance therapy (weekly PE, oral immune modulators, or IVIG).
- Patients with greater small fiber loss and temperature sensory deficits showed the most benefit from PE.
Conclusions:
- Plasma exchange therapy (PE) is effective for a subset of severe, long-standing CRPS patients with small fiber neuropathy.
- Initial pain reduction from PE can be sustained with maintenance therapy, including weekly PE, IVIG, or other immune-modulating drugs.
- Further large, randomized, placebo-controlled studies are needed to confirm these findings and explore new therapies for CRPS.
Related Concept Videos
01:26Extracorporeal Removal of Drugs: Continuous Renal Replacement Therapy
354
Continuous Renal Replacement Therapy (CRRT) is an essential intervention for patients experiencing severe kidney dysfunction. This therapy offers a continuous mechanism for removing fluids and toxins from the bloodstream, leveraging the patient’s blood pressure to facilitate filtration through a specialized filter. This method contrasts with intermittent dialysis, providing a gentler and more consistent removal of waste products and excess fluid, which is particularly beneficial in...
354
01:30Extracorporeal Removal of Drugs: Peritoneal Dialysis and Hemodialysis
903
Patients with end-stage renal disease (ESRD) or those experiencing drug overdose often require extracorporeal methods to eliminate accumulated drugs and metabolites. Hemoperfusion, hemofiltration, and dialysis are the primary techniques to rapidly remove harmful substances without disrupting the patient's fluid and electrolyte balance. For those with compromised renal function, dosage adjustments of concurrent medications may be necessary during extracorporeal drug removal.Dialysis is a process...
903
01:30Continuous Renal Replacement Therapy
2.0K
Continuous Renal Replacement Therapy, also known as CRRT, is a procedural treatment for acute kidney injury (AKI) that gradually removes uremic toxins and fluids while maintaining acid-base balance and stabilizing electrolytes. It is particularly useful for hemodynamically unstable patients. Unlike intermittent hemodialysis, which is faster, CRRT provides a gentler approach over 24 hours, closely mimicking the function of natural kidneys. However, CRRT is not ideal for patients with...
2.0K
01:27Peripheral Artery Disease III: Interprofessional Care
586
Peripheral Artery Disease (PAD) is characterized by narrowed arteries that diminish blood flow to the extremities. Effective management of PAD requires an interprofessional approach involving various healthcare professionals. The critical aspects of interprofessional care for PAD patients focus on risk factor modification, drug therapy, exercise therapy, nutrition therapy, critical limb ischemia care, and interventional radiology and surgical procedures.The primary treatment goal for PAD...
586
01:25Extracorporeal Removal of Drugs: Hemoperfusion and Hemofiltration
338
Hemoperfusion and hemofiltration are critical techniques in medical treatments to eliminate accumulated drugs, metabolites, and electrolytes from the bloodstream. These methods are particularly vital in cases of accidental poisoning and drug overdose.Hemoperfusion involves passing blood through an adsorbent material to remove unwanted substances. The main adsorbents used in hemoperfusion include activated charcoal and Amberlite resins. Activated charcoal can adsorb both polar and nonpolar...
338
01:16Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia
2.0K
Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...
One of the advantages of...
2.0K