May 12, 2026
🎙️ 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/