Different Types of Pain in Complex Regional Pain Syndrome Require a Personalized Treatment Strategy

Abstract

Complex regional pain syndrome (CRPS) is a debilitating painful state of an extremity that can develop after trauma. CRPS is diagnosed by the new International Association for the Study of Pain (IASP) diagnostic criteria for CRPS. The syndrome is characterized by continuing regional pain with abnormal sensory, motor, sudomotor, vasomotor, edema, and/or trophic signs. The clinical presentation of CRPS can be very heterogeneous because CRPS is a multi-mechanism syndrome. Therefore, mechanism-based subgroups have been suggested to personalize treatment for CRPS. Additionally, the presentation of symptom pain may also be able to identify different subgroups of CRPS. In this review, the types of pain recognized by the IASP―nociceptive, neuropathic, and nociplastic pain―will be discussed as possible subgroups for CRPS. Each pain type should be identified in CRPS patients, with a thorough history taking, physical examination, and diagnostic tests or (novel) biomarkers to optimize treatment effectiveness. Over the course of the syndrome, patients with CRPS probably experience more than one distinct pain type. Therefore, pain specialists should be alert to not only adjust their treatment if underlying pathophysiologic mechanisms tend to change but also to personalize the treatment of the associated type of pain in the CRPS patient.

Pain in axial spondyloarthritis: role of the JAK/STAT pathway

“…A recent study undertaken in Hungary is worth mentioning since it also documents the importance of the JAK/STAT pathway in the context of pain. Nociceptive pain in complex regional pain syndrome can be the result of persistent inflammation (103), which shares some similarities and bears relevance to axSpA. Using a complex regional pain syndrome mouse model by transcriptomic analyses, Pohoćzky and colleagues evaluated TNF and JAK/STAT pathways as possible novel targets (104).…”

Complex Regional Pain Syndrome after Distal Radius Fracture—Case Report and Mini Literature Review

“…A separate source on the complex regional pain syndrome suggests that both types can result from trauma, with the distinction hinging on evident nerve injury, observed exclusively in Type II. This differentiation underlies the divergence in chronic pain types, characterized as mainly nociceptive in CRPS I and mainly neuropathic in CRPS II [15]. Some patients may only meet partial criteria for CRPS I or II, leading to the possibility of a third type diagnosis in the absence of a better explanation for the symptoms and signs [12,16].…”