Complex regional pain syndrome

Abstract

Complex regional pain syndrome (CRPS) presents with clinical symptoms that can no longer be explained by the initial trauma, including pain, sensory, motor, and trophic symptoms, and impairment of autonomic control of the limb. These symptoms spread distally and go beyond single nerve innervation territories. Typically, the symptoms change through the course of CRPS as a result of the varying pathophysiology. Diagnosis is made clinically after the rigorous elimination of other possible causes, and 3-phase bone scintigraphy can be a useful tool for confirming CRPS. In acute stages, inflammatory symptoms prevail and should be treated with anti-inflammatory agents (steroids), bisphosphonates, or topical application of dimethyl sulfoxide. In chronic stages, many symptoms are related to so-called central neuroplasticity; these include hyperalgesia, sensory loss, motor symptoms, body perception disturbance, autonomic symptoms, and learned incorrect behavior such as nonuse. At this stage, the only medical treatment that is effective against pain without improving the function is ketamine infusions, but this has side effects. Physical therapy, graded motor imagery, and pain exposure/graded exposure in vivo therapy can help to overcome central reorganization. If a relevant mental comorbidity is present, the patient should be referred for psychotherapeutic treatment. Invasive treatment should be restricted to special cases and only offered after psychosomatic assessment. If these recommendations are followed, CRPS prognosis is not as poor as commonly assumed. Whether the patients can return to their previous life depends on particular individual factors.

Complex regional pain syndrome: medical and legal ramifications of clinical variability and experience and perspective of a practicing clinician

“…Birklein et al16 stated, “One avenue for progress will be to abandon categorizations that lump together too many pathophysiologies and introduce too many variations into scientific studies; CRPS research must be more specific.”…”

Can hepatocellular carcinoma cause complex regional pain syndrome?

“…Complex regional pain syndrome (CRPS) is a painful condition associated with motor, sensory, autonomic and bone abnormalities [1]. The most common reasons of CRPS are accepted as tissue trauma, fractures and surgery [2].…”

Algodystrophy in major orthopaedic surgery

“…In some cases pain, along with the typical pattern of CRPS I, is likely to persist even for years, with an incidence ranging from 5.5 (2) to 26.2 (3) per 100,000 persons/ years. The variability of clinical presentation of CRPS comes from the combination of several pathophysiologic mechanisms probably with a predisposing genetic susceptibility (4)(5)(6). It is well known that the main pathogenic mechanism underlying acute phases of CRPS is an abnormal inflammatory responsiveness to injury.…”

“…It was demonstrated a significant increase of proinflammatory cytokines, particularly TNF-α, in patients with acute CRPS. Furthermore, the increased production of Nerve Growth Factor (NGF) and other neuropeptides, such as substance P and Calcitonin-Gene-Related Peptide (CGRP) might play a key role in the pathogenesis of hyperalgesia and allodynia (6). It was also demonstrated an imbalance between the production of Endothelin 1 (ET 1) and Nitric Oxide (NO) in favor of the first one, especially in patients affected by cold CRPS.…”