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Chapter 27 - Complex Regional Pain Syndrome (CRPS)

from Part VI - Misc

Published online by Cambridge University Press:  01 December 2023

By
Alan D. Kaye  and
Nolan Weinstein
Edited by
Omar Viswanath  and
Ivan Urits
Omar Viswanath
Affiliation:
Creighton University, Omaha
Ivan Urits
Affiliation:
Southcoast Brain & Spine Center, Wareham
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Summary

Complex regional pain syndrome (CRPS) is a long-term pain condition that commonly affects the extremities and is associated with increased sensitivity to pain and touch. CRPS is classified into two types: CRPS-I and CRPS-II. The former occurs when there is no apparent nerve damage, whereas the latter is linked to known nerve damage. Psychological factors may play a role in the development of CRPS, with studies indicating that individuals with a history of depression and PTSD are at a higher risk of developing this condition. There are various treatment options available for CRPS, including physical therapy, medication, and interventional techniques such as nerve blocks and transcranial stimulation. However, larger and more comprehensive studies are needed to assess the effectiveness of these therapies. While NSAIDs have not been found to be effective in treating CRPS, sympathetic nerve blocks are commonly used but have mixed results. Finally, spinal cord stimulation (SCS) is a surgical treatment option that is recommended after conservative treatments have failed to produce significant symptom relief over several months.

Keywords

complex regional pain syndromespinal cord stimulationallodynianerve painnerve injury
Type
Chapter
Information
Cambridge Handbook of Pain Medicine , pp. 220 - 227
Publisher: Cambridge University Press
Print publication year: 2023

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References

Bruehl, S. Complex regional pain syndrome. BMJ. 2016;38:82–86.Google Scholar
Van Velzen, GAJ, Perez, RSGM, Van Gestel, MA et al. Health-related quality of life in 975 patients with complex regional pain syndrome type 1. Pain. 2014;155(3):629–634.CrossRefGoogle ScholarPubMed
Sandroni, P, Benrud-Larson, LM, McClelland, RL, Low, PA. Complex regional pain syndrome type I: Incidence and prevalence in Olmsted county, a population-based study. Pain. 2003;103:199–207.CrossRefGoogle ScholarPubMed
Elsharydah, A, Loo, NH, Minhajuddin, A, Kandil, ES. Complex regional pain syndrome type 1 predictors: Epidemiological perspective from a national database analysis. J Clin Anesth. 2017;39:34–37.CrossRefGoogle ScholarPubMed
de Mos, M, de Bruijn, AGJ, Huygen, FJPM et al. The incidence of complex regional pain syndrome: A population-based study. Pain. 2007;129(1–2):12–20.CrossRefGoogle ScholarPubMed
Rewhorn, MJ, Leung, AH, Gillespie, A, Moir, JS, Miller, R. Incidence of complex regional pain syndrome after foot and ankle surgery. J Foot Ankle Surg. 2014;53(3):256–258.CrossRefGoogle ScholarPubMed
Jellad, A, Salah, S, Ben Salah Frih, Z. Complex regional pain syndrome type I: Incidence and risk factors in patients with fracture of the distal radius. Arch Phys Med Rehabil. 2014;95(3):487–492.CrossRefGoogle ScholarPubMed
Bean, DJ, Johnson, MH, Kydd, RR. Relationships between psychological factors, pain, and disability in complex regional pain syndrome and low back pain. Clin J Pain. 2014;30(8):647–653.CrossRefGoogle ScholarPubMed
Beerthuizen, A, Stronks, DL, Van’T Spijker, A et al. Demographic and medical parameters in the development of complex regional pain syndrome type 1 (CRPS1): Prospective study on 596 patients with a fracture. Pain. 2012;153(6):1187–1192.CrossRefGoogle ScholarPubMed
Birklein, F, Schlereth, T. Complex regional pain syndrome: Significant progress in understanding. Pain. 2015;156:S94–S103.CrossRefGoogle ScholarPubMed
Marinus, J, Moseley, GL, Birklein, F et al. Clinical features and pathophysiology of complex regional pain syndrome. Lancet Neurol. 2011;10(7):637–648.CrossRefGoogle ScholarPubMed
Shi, X, Wang, L, Li, X et al. Neuropeptides contribute to peripheral nociceptive sensitization by regulating interleukin-1β production in keratinocytes. Anesth Analg. 2011;113(1):175–183.CrossRefGoogle ScholarPubMed
Sahbaie, P, Shi, X, Guo, TZ et al. Role of substance P signaling in enhanced nociceptive sensitization and local cytokine production after incision. Pain. 2009;145(3):341–349.CrossRefGoogle ScholarPubMed
Oaklander, AL, Fields, HL. Is reflex sympathetic dystrophy/complex regional pain syndrome type I a small-fiber neuropathy? Ann Neurol. 2009;65(6):629–638.CrossRefGoogle ScholarPubMed
Albrecht, PJ, Hines, S, Eisenberg, E et al. Pathologic alterations of cutaneous innervation and vasculature in affected limbs from patients with complex regional pain syndrome. Pain. 2006;120(3):244–266.CrossRefGoogle ScholarPubMed
van der Laan, L, ter Laak, HJ, Gabreëls-Festen, A, Gabreëls, F, Goris, RJ. Complex regional pain syndrome type I (RSD): Pathology of skeletal muscle and peripheral nerve. Neurology. 1998;51(1):20–25.CrossRefGoogle ScholarPubMed
Reinersmann, A, Maier, C, Schwenkreis, P, Lenz, M. Complex regional pain syndrome: More than a peripheral disease. Pain Manag. 2013;3(6):495–502.CrossRefGoogle ScholarPubMed
Hotta, J, Saari, J, Koskinen, M et al. Abnormal brain responses to action observation in complex regional pain syndrome. J Pain. 2017;18(3):255–265.CrossRefGoogle ScholarPubMed
Goebel, A, Blaes, F. Complex regional pain syndrome, prototype of a novel kind of autoimmune disease. Autoimmun Rev. 2013;12(6):682–686.CrossRefGoogle ScholarPubMed
Guo, T, Shi, X, Li, W et al. Passive transfer autoimmunity in a mouse model of complex regional pain syndrome. Pain. 2017;158(12):2410–2421. doi: 10.1097/j.pain.0000000000001046.CrossRefGoogle Scholar
Merskey, H, Bogduk, N. Classification of chronic pain: IASP pain terminology. 1994. www.iasp-pain.org/publications/free-ebooks/classification-of-chronic-pain-second-edition-revised/.Google Scholar
Harden, NR, Bruehl, S, Perez, RSGM, et al. Validation of proposed diagnostic criteria (the “Budapest Criteria”) for Complex Regional Pain Syndrome. Pain. 2010;150(2):268–274. doi: 10.1016/j.pain.2010.04.030.CrossRefGoogle ScholarPubMed
Harden, RN, Bruehl, S, Perez, RSGM et al. Validation of proposed diagnostic criteria (the “Budapest Criteria”) for complex regional pain syndrome. Pain. 2010;150(2):268–274.CrossRefGoogle ScholarPubMed
Bruehl, S, Harden, RN, Galer, BS et al. External validation of IASP diagnostic criteria for complex regional pain syndrome and proposed research diagnostic criteria. Pain. 1999;81(1–2):147–154.CrossRefGoogle ScholarPubMed
Oerlemans, HM, Oostendorp, RAB, de Boo, T et al. Adjuvant physical therapy versus occupational therapy in patients with reflex sympathetic dystrophy/complex regional pain syndrome type I. Arch Phys Med Rehabil. 2000;81(1):49–56.CrossRefGoogle ScholarPubMed
Rome, L. The place of occupational therapy in rehabilitation strategies of complex regional pain syndrome: Comparative study of 60 cases. Hand Surg Rehabil. 2016;35(5):355–362.CrossRefGoogle ScholarPubMed
Oerlemans, HM, Oostendorp, RA, de Boo, T, Goris, RJ. Pain and reduced mobility in complex regional pain syndrome I: Outcome of a prospective randomised controlled clinical trial of adjuvant physical therapy versus occupational therapy. Pain. 1999;83(1):77–83.CrossRefGoogle ScholarPubMed
Smart, KM, Wand, BM, O’Connell, NE. Physiotherapy for pain and disability in adults with complex regional pain syndrome (CRPS) types I and II. Cochrane Database Syst Rev. 2016;2(2):CD010853. doi: 10.1002/14651858.CD010853.pub2.Google ScholarPubMed
Kemler, MA, Barendse, GA, van Kleef, M et al. Spinal cord stimulation in patients with chronic reflex sympathetic dystrophy. N Engl J Med. 2000;343(9):618–624.CrossRefGoogle ScholarPubMed
Kumar, K, Rizvi, S, Bnurs, SB. Spinal cord stimulation is effective in management of complex regional pain syndrome I: Fact or fiction. Neurosurgery. 2011;69(3):566–578.CrossRefGoogle ScholarPubMed
Connolly, SB, Prager, JP, Harden, RN. A systematic review of ketamine for complex regional pain syndrome. Pain Med. 2015;16(5):943–969.CrossRefGoogle ScholarPubMed
Penn, R, Kroin, J. Intrathecal baclofen alleviates spinal cord spasticity. Lancet. 1984;323:1078. doi: 10.1016/s0140-6736(84)91487-9.CrossRefGoogle Scholar
Melcangic, M, Bowery, NG. GABA and its receptors in the spinal cord. Trends Pharmacol Sci. 1996;17(12):457–462.CrossRefGoogle Scholar
van Rijn, MA, Munts, AG, Marinus, J et al. Intrathecal baclofen for dystonia of complex regional pain syndrome. Pain. 2009;143(1–2):41–47.CrossRefGoogle ScholarPubMed
Ferraro, MC, Cashin, AG, Wand, BM, et al. Interventions for treating pain and disability in adults with complex regional pain syndrome: An overview of systematic reviews (Review). Cochrane Database Syst Rev. 2013;6(6): CD009416. doi: 10.1002/14651858.CD009416.pub3.Google Scholar
Chevreau, M, Romand, X, Gaudin, P, Juvin, R, Baillet, A. Bisphosphonates for treatment of complex regional pain syndrome type 1: A systematic literature review and meta-analysis of randomized controlled trials versus placebo. Jt Bone Spine. 2017;84(4):393–399.CrossRefGoogle ScholarPubMed
O’Connell, NE, Wand, BM, McAuley, J, Marston, L, Moseley, GL. Interventions for treating pain and disability in adults with complex regional pain syndrome: An overview of systematic reviews. In O’Connell, NE, ed. Cochrane batabase of systematic reviews. John Wiley; 2013.Google Scholar
Goebel, A, Bisla, J, Carganillo, R et al. Low-dose intravenous immunoglobulin treatment for long-standing complex regional pain syndrome: A randomized trial. Ann Intern Med. 2017;167(7):476–483.CrossRefGoogle ScholarPubMed
Goebel, A, Bisla, J, Carganillo, R et al. A randomised placebo-controlled Phase III multicentre trial: Low-dose intravenous immunoglobulin treatment for long-standing complex regional pain syndrome (LIPS trial). NIHR Journals Library. 2017. PMID: 29144634.CrossRefGoogle Scholar
Jaiman, A, Lokesh, M, Neogi, DS. Effect of vitamin C on prevention of complex regional pain syndrome type I in foot and ankle surgery. Foot Ankle Surg. 2011;17:207. doi: 10.1016/j.fas.2010.05.008.CrossRefGoogle ScholarPubMed
Shibuya, N, Humphers, JM, Agarwal, MR, Jupiter, DC. Efficacy and safety of high-dose vitamin C on complex regional pain syndrome in extremity trauma and surgery: Systematic review and meta-analysis. J Foot Ankle Surg. 2013;52(1):62–66.CrossRefGoogle ScholarPubMed
Zollinger, PE, Tuinebreijer, WE, Breederveld, RS, Kreis, RW. Can vitamin C prevent complex regional pain syndrome in patients with wrist fractures? A randomized, controlled, multicenter dose-response study. J Bone Joint Surg Am. 2007;89(7):1424–1431.CrossRefGoogle ScholarPubMed
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):637–641.CrossRefGoogle ScholarPubMed
Malay, S, Chung, KC. Testing the validity of preventing complex regional pain syndrome with vitamin C after distal radius fracture. J Hand Surg Am. 2014;39(11):2251–2257.CrossRefGoogle ScholarPubMed
Kim, JH, Kim, YC, Nahm, FS, Lee, PB. The therapeutic effect of vitamin C in an animal model of complex regional pain syndrome produced by prolonged hindpaw ischemia-reperfusion in rats. Int J Med Sci. 2017;14(1):97–101.CrossRefGoogle Scholar
Midbari, A, Suzan, E, Adler, T et al. Amputation in patients with complex regional pain syndrome: A comparative study between amputees and non-amputees with intractable disease. Bone Joint J. 2016;98-B(4):548–554.CrossRefGoogle ScholarPubMed

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