Complex regional pain syndrome: observations on diagnosis, treatment and definition of a new subgroup

Abstract

Several definitions and sets of diagnostic criteria of complex regional pain syndrome have been proposed, but to date none has been accepted completely. This article presents a specific subtype of the disease, called 'chronic, refractory complex regional pain syndrome' which is extremely severe, disabling and resistant to treatment. It also emphasizes difficulties with diagnosing complex regional pain syndrome because of its variable clinical presentation and diagnostic criteria being insufficiently precise. The necessity to distinguish between criteria for clinical use and for scientific purposes is suggested with a proposal of practical guideline for diagnosing acute complex regional pain syndrome. A review of treatments for complex regional pain syndrome is presented, with opinion on their effectiveness: good in an early stage, less well in chronic and generally poor in the chronic, refractory subtype.

Venipuncture Induced Complex Regional Pain Syndrome Presenting as Inflammatory Arthritis

“…As observed in our case, acute CRPS may mimic various inflammatory disorders including arthritis [6]. It is relatively easy to treat when diagnosed early and has a better prognosis as compared to chronic CRPS which is more likely to result in dystonia, atrophy, and dystrophic changes [2, 3]. A fulminant acute form if not treated may progress to the chronic form within two months [2, 6].…”

“…It is relatively easy to treat when diagnosed early and has a better prognosis as compared to chronic CRPS which is more likely to result in dystonia, atrophy, and dystrophic changes [2, 3]. A fulminant acute form if not treated may progress to the chronic form within two months [2, 6]. The disease may involve the other limbs also in due course of time as seen in our patient [1].…”

“…The evolution of CRPS into these three stages has been questioned and now stages have been removed from the taxonomy and two types, acute/warm and chronic/cold, prevail often without temporal change [2, 3, 6]. Patients with warm CRPS tend to have pain of less than six months duration whereas patients with cold presentation usually have pain for more than 20 months [6].…”

“…CRPS was traditionally divided into type 1 and type 2, depending on the absence or presence of a preceding peripheral nerve injury [1]. The necessity of distinguishing these two forms has been questioned, since in most cases nerve involvement cannot be definitively excluded and the forms are clinically identical [2, 3]. …”

Diagnosis of complex regional pain syndrome needs to be tightened

“…Work has shown that different criteria may apply to Japanese patients, 5 and a new diagnostic subset of CRPS has also been proposed. 6 Increased psychiatric involvement in pain services is pertinent. Somatisation disorder is also controversial and badly diagnosed.…”