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Pathophysiology of Complex Regional Pain Syndrome and Treatment: Recent Advancements

  • Pain Management (S Mace, Section Editor)
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Abstract

Purpose of Review

Complex regional pain syndrome (CRPS) is a painful and debilitating disorder involving dysfunction in multiple body systems. This review seeks to evaluate recent data and present treatment options for the practical management of this condition.

Recent Findings

The mechanism by which CRPS develops is multifactorial, affecting both the peripheral and central nervous systems, and nerve changes can be seen at a histologic level. Treatment should be initiated as early as possible, as the chronic disease is less responsive to intervention.

Summary

CRPS is a clinical diagnosis; treatment is symptomatic and aimed at addressing the sensory, vasomotor, sudomotor, and trophic changes which occur in the context of severe pain. Management may include therapy, oral or intravenous medication, procedures, or surgery.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Iolascon G, de Sire A, Moretti A, Gimigliano F. Complex regional pain syndrome (CRPS) type I: historical perspective and critical issues. Clin Cases Miner Bone Metab. 2015;12(Suppl 1):4–10.

    PubMed  Google Scholar 

  2. Merskey H, Bogduk N. Classification of chronic pain: descriptions of chronic pain syndromes and definitions of pain terms. Seattle: IASP Press; 1994.

    Google Scholar 

  3. Harden RN, Bruell S, Perez RS, Birklein F, Marinus J, Maihofner C, et al. Validation of proposed diagnostic criteria (the “Budapest Criteria”) for complex regional pain syndrome. Pain. 2010;150(2):268–74.

    Article  Google Scholar 

  4. Ratti C, Nordio A, Resmini G, Murena L. Post-traumatic complex regional pain syndrome: clinical features and epidemiology. Clin Cases Miner Bone Metab. 2015;12:11–6.

    PubMed  Google Scholar 

  5. de Mos M, de Bruijn AG, Huygen FJ, Dieleman JP, Stricker BH, Sturkenboom MC. The incidence of complex regional pain syndrome: a population-based study. Pain. 2007;129:12–20.

    Article  Google Scholar 

  6. Veldman PH, Reynen HM, Arntz IE, Goris RJ. Signs and symptoms of reflex sympathetic dystrophy: prospective study of 829 patients. Lancet. 1993;342:1012–6.

    Article  CAS  Google Scholar 

  7. Sarangi PP, Ward AJ, Smith EJ, Staddon GE, Atkins RM. Algodystrophy and osteoporosis after tibial fractures. J Bone Joint Surg (Br). 1993;75(3):450–2.

    Article  CAS  Google Scholar 

  8. Satteson ES, Harbour PW, Koman LA, Smith BP, Li Z. The risk of pain syndrome affecting a previously non-painful limb following trauma or surgery in patients with a history of complex regional pain syndrome. Scand J Pain. 2017;14:84–8.

    Article  Google Scholar 

  9. Russo M, Georgius P, Santarelli DM. A new hypothesis for the pathophysiology of complex regional pain syndrome. Med Hypotheses. 2018;119:41–53.

    Article  CAS  Google Scholar 

  10. Groeneweg JG, Huygen FJ, Heijmans-Antonissen C, Niehof S, Zijlstra FJ. Increased endothelin-1 and diminished nitric oxide levels in blister fluids of patients with intermediate cold type complex regional pain syndrome type 1. BMC Musculoskelet Disord. 2006;7:91.

    Article  Google Scholar 

  11. Wasner G, Heckmann K, Maier C, Baron R. Vascular abnormalities in acute reflex sympathetic dystrophy (CRPS I): complete inhibition of sympathetic nerve activity with recovery. Arch Neurol. 1999;56:613–20.

    Article  CAS  Google Scholar 

  12. Clark JD, Tawfik VL, Tajerian M, Kingery WS. Autoinflammatory and autoimmune contributions to complex regional pain syndrome. Mol Pain. 2018;14:1–13.

    Google Scholar 

  13. Yvon A, Faroni A, Reid AJ, Lees VC. Selective fiber degeneration in the peripheral nerve of a patient with severe complex regional pain syndrome. Front Neurosci. 2018;12:207.

    Article  Google Scholar 

  14. Schwartzman RJ, Alexander GM, Grothusen J. Pathophysiology of complex regional pain syndrome. Expert Rev Neurother. 2006;6:669–81.

    Article  CAS  Google Scholar 

  15. Maihöfner C, Handwerker HO, Neundörfer B, Birklein F. Patterns of cortical reorganization in complex regional pain syndrome. Neurology. 2003;61(12):1707–15.

    Article  Google Scholar 

  16. Harden RN, Bruehl S, Stanton-Hicks M, Wilson PR. Proposed new diagnostic criteria for complex regional pain syndrome. Pain Med. 2007;8(4):326–31.

    Article  Google Scholar 

  17. Chung K, Kim KH, Kim ED. Perfusion index as a reliable parameter of vasomotor disturbance in complex regional pain syndrome. Br J Anaesth. 2018;121(5):1133–7.

    Article  CAS  Google Scholar 

  18. Muizelaar JP, Kleyer M, Hertogs IA, DeLange DC. Complex regional pain syndrome (reflex sympathetic dystrophy and causalgia): management with the calcium channel blocker nifedipine and/or the alpha-sympathetic blocker phenoxybenzamine in 59 patients. Clin Neurol Neurosurg. 1997;99:26–30.

    Article  CAS  Google Scholar 

  19. •• Shim H, Rose J, Halle S. Shekane P. Complex regional pain syndrome: a narrative review for the practising clinician. Br J Anaesth. 3302019;123(2) This provides a comprehensive review of our current understanding of the pathophysiology and updated treatments available for CRPS. It provides a comprehensive overview of the condition including diagnostic criteria and management.

  20. Meena S, Sharma P, Gangary SK, Chowdhury B. Role of vitamin C in prevention of complex regional pain syndrome after distal radius fractures: a meta-analysis. Eur J Orthop Surg Traumatol. 2015;25(4):637–41.

    Article  Google Scholar 

  21. Mandyam MC, Ahuja NK. Ketamine-induced mania during treatment for complex regional pain syndrome. Pain Med. 2017;18(10):2040–1.

    Article  Google Scholar 

  22. Goebel A, Baranowski A, Maurer K, Ghiai A, McCabe C, Ambler G. Intravenous immunoglobulin treatment of the complex regional pain syndrome: a randomized trial. Ann Intern Med. 2010;152(3):152–8.

    Article  Google Scholar 

  23. Davis KD, Treede RD, Raja SN, Meyer RA, Campbell JN. Topical application of clonidine relieves hyperalgesia in patients with sympathetically maintained pain. Pain. 1991;47(3):309–17.

    Article  CAS  Google Scholar 

  24. Bickerstaff DR, Kanis JA. The use of nasal calcitonin in the treatment of post-traumatic algodystrophy. Br J Rheumatol. 1991;30(4):291–4.

    Article  CAS  Google Scholar 

  25. Tran DQ, Duong S, Bertini P, Finlayson RJ. Treatment of complex regional pain syndrome: a review of the evidence. Can J Anaesth. 2010;57(2):149–66.

    Article  Google Scholar 

  26. Rowbotham MC, Twilling L, Davies PS, Reisner L, Taylor K, Mohr D. Oral opioid therapy for chronic peripheral and central neuropathic pain. N Engl J Med. 2003;348(13):1223–32.

    Article  CAS  Google Scholar 

  27. Carroll I, Clark JD, Mackey S. Sympathetic block with botulinum toxin to treat complex regional pain syndrome. Ann Neurol. 2009;65:348–51.

    Article  CAS  Google Scholar 

  28. Byrd D, Mackey S. Pulsed radiofrequency for chronic pain. Curr Pain Headache Rep. 2008;12(1):37–41.

    Article  Google Scholar 

  29. Forouzanfar T, van Kleef M, Weber WE. Radiofrequency lesions of the stellate ganglion in chronic pain syndromes: retrospective analysis of clinical efficacy in 86 patients. Clin J Pain. 2000;16:164–8.

    Article  CAS  Google Scholar 

  30. Kemler MA, de Vet HC, Barendse GA, van den Wildenberg FA, van Kleef M. Effect of spinal cord stimulation for chronic complex regional pain syndrome type I: five-year final follow-up of patients in a randomized controlled trial. J Neurosurg. 2008;108(2):292–8.

    Article  Google Scholar 

  31. Geurts JW, Smits H, Kemler MA, Brunner F, Kessels AG, van Kleef M. Spinal cord stimulation for complex regional pain syndrome type I: a prospective cohort study with long-term follow-up. Neuromodulation. 2013;16(6):523–9 discussion 529.

    Article  Google Scholar 

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Correspondence to Sarah Money.

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Money, S. Pathophysiology of Complex Regional Pain Syndrome and Treatment: Recent Advancements. Curr Emerg Hosp Med Rep 7, 203–207 (2019). https://doi.org/10.1007/s40138-019-00198-x

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