A Clinical Approach to Complex Regional Pain Syndrome

Complex regional pain syndrome

“…The ESR, C-reactive protein, complete blood count, and serum auto-antibodies results are useful in ruling out infections and rheumatologic conditions. [32] Electrodiagnostic studies may be indicated to rule out specific neuropathic conditions, such as peripheral neuropathy, entrapment neuropathies, or nerve injury. Radiographic studies including magnetic resonance imaging are often necessary to rule out bone or soft tissue pathology as the source of pain.…”

“…Periarticular osteopaenia and patchy osteoporosis can be seen in plain radiographs as early as 2 weeks after onset of CRPS. [121932]…”

“…Multiple studies have found that the sensitivity of bone scans decreases and the specificity increases with disease duration. [122632]…”

“…[26] Other drugs for which data from controlled clinical trials have established efficacy in CRPS include gabapentin, Ca-modulating drugs (nifidipine, amlodipine, calcitonin, and bisphosphonates), and free radical scavengers[33] Bisphosphonates (alendronate, pamidronate, and clodronate) are the only class of drugs that have survived placebo controlled trials and shown a statistically significant pain reduction in patients with CRPS. [3234] Randomized controlled trials from the Netherlands have shown promising results with the use of free radical scavengers [topical application of 50% dimethylsulfoxide (DMSO) and oral N -acetylcysteine(NAC)] in the treatment of CRPS. [35] High dose vitamin C (500 mg/day) has been shown to have a prophylactic role in diminishing the incidence of CRPS in patients with distal radius fractures.…”

Complex regional pain syndrome

“…[12,19] A few tests have been described that are complementary to the clinical diagnostic criteria and are useful in demonstrating objective abnormalities characteristic of CRPS. [32] They include:…”