Complex regional pain syndrome – diagnostic, mechanisms, CNS involvement and therapy

Abstract

Complex regional pain syndromes (CRPS, formerly re¯ex sympathetic dystrophy and causalgia) are neuropathic pain conditions of one extremity developing inadequately after a trauma. The initiating trauma aects primarily the extremity, but can also be a central lesion (e.g., spinal cord injury, stroke). CRPS is clinically characterized by sensory, autonomic and motor disturbances. Pathophysiologically there is evidence for functional changes within the central nervous system and for involvement of peripheral in¯ammatory processes. The sympathetic nervous system plays a key role in maintaining pain and autonomic dysfunction in the aected extremity. After a primary central lesion, secondary peripheral changes in the paretic extremity are suggested to be important in initiating a CRPS. Though there is no diagnostic gold standard, careful clinical evaluation and additional test procedures should lead to an adequate diagnosis. An early diagnosis and an interdisciplinary approach are important for optimal and successful treatment.

Wherever is my arm? Impaired upper limb position accuracy in Complex Regional Pain Syndrome

“…Moreover, limb position sense is integral to motor performance yet motor dysfunction is well recognised in CRPS [4,13,14,22,24,38,45,46,47,48]. Brainimaging evidence of altered neural activity in motor cortices has also been found [29].…”

Olecranon Bursitis Causing Reflex Sympathetic Dystrophy Syndrome in a Hemiplegic Extremity

“…A study demonstrated that peripheral traumatic injury of the shoulder joint capsules led to painful extremities after stroke [9]. Some authors claimed that peripheral lesions might initiate a self-perpetuating vicious cycle of pain followed by the full picture of RSDS [10]. We assumed that in stroke patients with extremity OB, like our case, appears to be at a significantly higher risk of developing RSDS.…”

Simultaneous upper and lower extremity complex regional pain syndrome type I in tetraplegia

“…8,9 Gellman et al 10 identified a 10% incidence of CRPS type I in their series of 60 patients with tetraplegia. Cremer et al 2 showed an association between CRPS type I and traumatic myelopathy in five In the literature published so far, CRPS type I in tetraplegic patients has mostly occurred in the upper extremities, with lower extremity involvement mentioned in only one report.…”

“…Treatment of CRPS type I should be immediate and, most importantly, should be directed toward restoration of full function of the extremity. 9 Multiple treatment modalities in CRPS type I have been described. In our patient, we used TENS together with Amitriptyline and Calcitonin in pain control.…”