D138. Surgical Treatment for Patients Diagnosed With Complex Regional Pain Syndrome of the Extremities

PURPOSE: The management of Complex Regional Pain Syndrome (CRPS) is challenging, and the optimal treatment pathway for these patients remains unclear. We aim to describe the treatment trajectory for patients referred with an existing label of CRPS. METHODS: Patients referred with an existing label of CRPS in the extremities to a tertiary care center (2017-2024) were eligible. Three clinicians conducted a retrospective Budapest criteria assessment to classify patients into three categories: (1) Budapest-confirmed CRPS, (2) inconclusive CRPS, or (3) Budapest-confirmed non-CRPS. Patient data (injury and treatment) were obtained through chart review. Outcomes were recorded, defined as reported improvement in pain and/or function at the most recent visit. RESULTS: Of the 52 patients (median treatment duration: 3.9 years (IQR: 2.2-6.6)), common treatment modalities included opioids (77%), neuromodulators (91%), and peripheral nerve surgery in 60%. Reported Improvement rate following surgery was 67%. No statistically significant differences in offered treatments were observed between the three CPRS groups. Reduced opioid use (p=0.024), undergoing nerve surgery after referral (p<0.001), and amputation with Primary TMR (p=0.007) seemed to be related to improvement. CONCLUSION: Over half of the patients referred with a CRPS diagnosis underwent surgical intervention, with 67% reporting post-surgery improvement. With a median treatment duration exceeding three years, our findings highlight the need for an interdisciplinary, personalized approach and the consideration of peripheral nerve surgery for select patients.