Complex regional pain syndrome: A review of evidence-supported treatment options

Abstract

Complex regional pain syndrome consists of pain and other symptoms that are unexpectedly severe or protracted after an injury. In type II complex regional pain syndrome, major nerve injury, often with motor involvement, is the cause; in complex regional pain syndrome I, the culprit is a more occult lesion, often a lesser injury that predominantly affects unmyelinated axons. In florid form, disturbances of vasoregulation (eg, edema) and abnormalities of other innervated tissues (skin, muscle, bone) can appear. Because of these various symptoms and the difficulty in identifying causative lesions, complex regional pain syndrome is difficult to treat or cure. Complex regional pain syndrome has not been systematically investigated; there are few controlled treatment trials for established complex regional pain syndrome. This article reviews the existing studies (even if preliminary) to direct clinicians toward the best options. Treatments for other neuropathic pain syndromes that may be efficacious for complex regional pain syndrome also are discussed. Some common treatments (eg, local anesthetic blockade of sympathetic ganglia) are not supported by the aggregate of published studies and should be used less frequently. Other treatments with encouraging published results (eg, neural stimulators) are not used often enough. We hope to encourage clinicians to rely more on evidence-supported treatments for complex regional pain syndrome.

Hyperbaric oxygen therapy in chronic pain management

“…The Use of Hyperbaric Oxygen in Complex Regional Pain Syndrome Complex regional pain syndrome (CRPS) is characterized by pain in the extremities, changes in skin color, hypo-or hyperhydrosis, and localized osteoporosis [28]. It is thought that excessive sympathetic nervous system activity plays a major role in its pathology.…”

Physical Therapy Management of Complex Regional Pain Syndrome I in a 14-Year-Old Patient Using Strain Counterstrain: A Case Report

“…If left untreated, these impairments can lead to functional limitations and disability. The lack of understanding of the etiology of this syndrome has led to patient management that tends to be poorly defi ned and symptom- [11][12][13][14] • Sympathetic nerve blocks 13,[15][16][17] • Physical therapy 8,10,13,[17][18][19] • Acupuncture 14,20 • Sympathectomy 13 • Spinal cord stimulation with electrodes implanted in the epidural space 12,14,[21][22][23][24][25] • Transcutaneous electrical nerve stimulation 14,26,27 Interdisciplinary pain management, with an emphasis on functional restoration, is thought to be necessary for an optimal outcome in treatment of individuals with this syndrome 28 . There is widespread agreement that physical therapy is of the utmost importance and an essential part of the treatment approach for CRPS I 3,8,10,13,17,26,29 .…”

Nerve decompression for complex regional pain syndrome type II following upper extremity surgery

“…6 There remains a continued hesitancy to recommend surgical decompression for CRPS. 7 The purpose of this investigation is to illustrate that the development of CRPS after upper-extremity surgery may be due to underlying peripheral nerve compression and to evaluate the subjective and objective results of our patients with postsurgical type 2 CRPS who were treated with nerve decompression.…”